Today is a public holiday in South Africa. I do not get the public holidays off as a holiday but the workload is much less because patients tend not to come in. In addition, most of the buildings are closed and there are no x-rays and even fewer blood tests available.
While working in OPD this afternoon, a very thin forty year old man was wheeled in by his wife. Immediately, I knew he had HIV, TB or both. Such is the prevalence of these disease that I can now be confident before testing simply by the way they look. Sadly, he had both illnesses.
I began to take a history. My interpreter who is a nurse informed me that the reason he came in was because he felt dizzy and his legs had lost strength. Patients here bring a card with them. His was empty except to tell me that he had started TB treatment yesterday. On questioning, he told me he started anti-retrovirals a week and a half ago. No wonder he was weak!
I examined the patient and found some of the biggest lymph nodes I have ever seen in his neck (which will be filled with TB) and a tongue covered in candida (there was no red tongue to be seen). His blood pressure was low and pulse rate was high. I explained that it would be best for him if he was to be admitted onto our TB ward in order to ensure the pills go down and also for the dietician to help him. He weighed 35 kgs.
Medicine is very paternalistic here and patients tend to agree with what you suggest. However this patient was not happy. He explained to me (which the interpreter kindly translated for me) that he was not going to stay in hospital. I was surprised and tried to establish the reason for his resistance.
Our discussion went back and forth with long pauses when suddenly the interpreter asked if it would be OK for the wife to enter the consultation room. In she came and the discussion went on.
Then the brother of the patient arrived and there was further discussion. All in Zulu. Again, long pauses. Suddenly, the brother stated in English that the patient would consent to being admitted. I looked at the patient whose face showed defeat.
I am not confident that he will stay. His prospects are very bleak. We will do what we can.
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