Saturday, March 28, 2015

It is here . . .

The rest of the world has had drug resistant TB for years.  I am sure Papua New Guinea has also had it for years, but we were never able to really prove it . . . until now.  Since I have been here, I have suspected that people had resistant TB if they didn't improve on their TB medicines, and so I would give them an injectable medicine for 2 months and hoped that would be enough.   Sometimes it was and sometimes it wasn't.  But without any other option, we did the best we could.

That all changed about 5 months ago when we got a new machine called the Gene Xpert machine.  This is a machine that can determine if someone's TB is resistant to the standard drugs that we use to treat TB.  We have been testing patients we thought might have resistant TB, but hadn't gotten any positives so far (which was great for our patients).  That changed last week.

I saw a kid who had finished his TB treatment in December, but was having more weight loss and coughing.  Just looking at him I was worried he had TB, and his Chest Xray confirmed TB, but then the question was does he have resistant TB.  So we sent him to get the Gene Xpert test and the next day, he comes back to see me with the words MDR-TB written in his book.

MultiDrugResistant TB is what MDR-TB stands for.  It is bad.  It means that most likely his strain of TB is resistant to two of the medicines we use to typically treat TB.  MDR isn't as bad as XDR-TB - Extensively Resistant TB (which is resistant to the meds in MDR, but also 2 others medicines also).  MDR is bad enough, XDR would be really bad.  MDR requires at least 8 months of a daily injectable medicine and oral pills and then 12+ more months of taking oral pills - that is about 2 years of your life spent trying to get rid of TB.  2 years seems like a long time, but in the long run, it is sure worth it, as the alternative is likely death.

So once I found out we had this patient, we then had to figure out how to take care of him, where we get the meds, etc.  Thankfully, we have a National TB program, so our provincial TB guy gave me the number of the doctor in Port Moresby who is coordinating the countries treating of the MDR cases.  We have had multiple conversations and are now in the process of completing a MDR-TB ward to separate our patient from our other TB pts.

We are in unchartered territory here at Kudjip, but it isn't stopping us.  We are building a wall, we are reading about the new medicines we will be administering and their side effects, we are learning more about MDR and XDR TB so we can better diagnose it in our patients and then help facilitate their treatment.

One of the reasons why I love practicing medicine here is that I get to do something new all the time.  I had never cared for anyone with HIV or with TB prior to coming to PNG.  Now I am one of our main doctors who looks after both of those populations of patients.  I am not an infectious disease doctor, but I am willing to read and learn and care for the patients the best we can with what we have.

Pray that as we enter into this new phase with our TB patients, that we will continue to grow in our knowledge to better care for them, but that through their time with us, they might also understand more of God's love and grace and the gift He gave us in Jesus.