‘You know the drill. Ordinary TB is horrible enough. It kills one point four million people every year with another nine million suffering from the disease, mainly in developing countries like Narumba. Along with malaria and HIV it’s one of the three main killer infectious diseases. Drug resistance and multi-drug-resistant TB numbers are increasing all the time. Because it’s spread through the air when people cough and sneeze, it’s virtually impossible to stop the spread. One third of the world’s population is infected with mycobacterium tuberculosis but it’s dormant in their bodies. Ten per cent of these people will develop active TB at some point in their life.’
There was passion and enthusiasm in her voice. There was also a hint of anger. She was angry at what this disease was being allowed to do to people all around the world. He liked that about her.
‘We’ve been using the same archaic test for the last one hundred and twenty years and the test is only accurate half of the time—even less so if the patient has HIV. I hope you’re comfortable with kids. We have a new test for TB but it’s not suitable for kids. They need the traditional test and we have the facility for chest X-rays if necessary. Mainly, we go on clinical presentation and history.’
He nodded. He’d read more notes after Gabrielle had gone to bed. He was happy to do something to pass yet another long night when he couldn’t sleep.
She kept talking, her voice going at a hundred miles an hour. ‘You know the clinical presentation, don’t you? A persistent cough, fever, weight loss, chest pain and breathlessness. The nurses will bring through anyone who has tested positive and is showing resistance to rifampicin. You’ll need to check them over clinically before starting their prescription.’ She pointed to a printed algorithm. ‘We have a chart for adults and a chart for paeds. The new test also doesn’t show anyone who has non-pulmonary TB. The nurses will bring through anyone with a history who gives concern.’
He blinked as he looked at the clinic list. ‘You see this many patients every day?’
She nodded, her brown hair bouncing. It was tied up on her head again. She was wearing a high-necked, long-sleeved shirt and long trousers, even though the temperature was soaring. He was lucky. He had on shorts and a T-shirt, but even so the heat was causing trickles of sweat to run down between his shoulder blades.
She gave a little tug at her neck. ‘Okay?’ he queried.
She gave a nod. ‘Let’s just get started. We need to see as many patients as we can.’
She wasn’t joking. It was only seven a.m., but news of their clinic must have spread because there was already a queue forming outside.
Four hours later he’d seen more kids in this TB clinic than he’d ever want to. Doctors Without Borders might be there to try and tackle the TB epidemic, but to the people of Narumba he was just a doctor. His surgical highlight of his day so far had been grabbing some equipment and a scalpel to drain a few abscesses. He’d also seen a huge variety of skin conditions, variations of asthma, diabetes, polio and sleeping sickness. He’d seen multiple patients with HIV—mixed with TB it would be deadly for many of the people he’d seen today. He could barely keep track of how many patients he’d actually seen. And the queue outside? It just kept getting longer and longer.
Long queues were good. He had never been work shy. Long days were much more preferable to long nights. If he exhausted himself with work, he might actually get a few hours’ sleep tonight.
He kept a smile on his face as another mother came in, clutching her child to her chest.
He nodded towards her, speaking in Narumbi. ‘I’m Dr Darcy, one of the team. What’s your name, and your son’s name?’
She gave an anxious smile at his good grasp of the language. ‘I’m Chiari. This is Alum, he’s sick.’
Sullivan nodded and held out his hands to take the little boy. ‘How old is he?’
‘Four,’ she answered quickly.
He blinked. The little boy resembled a two-year-old. The weight loss of TB had clearly affected him. He took out his stethoscope and gently sounded the boy’s chest. The rattle was clear and he had the swollen and tender lymph nodes around his neck. He asked a few more questions. ‘Does anyone else in the family have symptoms?’
The woman’s face tightened. ‘My husband died last month.’
He nodded in sympathy. There was a little pang in his chest. He recognised the expression in her eyes. He’d seen that loss reflected in his own eyes often enough when he looked in the mirror. But there was no time for that here. He had a job to do.
‘What about you? Have you been tested?’
She shook her head and looked anxiously at her son. ‘I don’t have time to be tested. I need to take care of Alum.’
Sullivan reached over and put his hand on her arm.
‘I understand. I do. I’m sorry for your loss. We need to make sure that you are well enough to take care of Alum. We can treat you both at the same time.’ He glanced outside the tent. ‘I can get one of the nurses to do the test. It’s a new kind. Your results will be available in a few hours. We can start you both on treatment immediately.’
He sent a silent prayer upwards, hoping that her test didn’t show multi-resistant TB. Chances were if she had it, her son had it too. Normal TB took a minimum of six months to treat. But if Chiari showed signs of resistance to rifampicin and isoniazid she’d be considered to have MDR-TB. The MDR-TB drug regime was an arduous eight months of painful injections and more than ten thousand pills, taking two years to complete. The side effects could be severe—permanent hearing loss, psychosis, nausea, skin rashes and renal failure had all been reported. But the worse news was there was only a forty-eight per cent cure rate.
He pressed again. ‘What about Alum? Has he been eating? Has he had night sweats or lost weight?’
Chiari nodded slowly. He could see the weariness in her eyes that was obviously felt in her heart. She’d likely just nursed her husband through this disease. Now there was a chance she could have it herself, and have to nurse her son through it too.
He stood up, holding Alum in his arms. ‘Let’s go and see one of our nurses. I’d like to try and give Alum some medicine to help with his weight loss, and start some medicine for TB. Our pharmacist, Gretchen, will give you the medicines and teach you how to give them to Alum. Then we can arrange to get your test done.’
After a few moments of contemplation Chiari stood up and nodded. Sullivan carried the little boy into the next tent. The nurses Lucy and Estelle nodded towards a few chairs in the corner. This was the fiftieth child he’d taken through to them this morning. They knew exactly what to do.
He filled out the electronic prescription for Gretchen and left her to explain to Chiari how to dispense the medicines for Alum. The reality was that children had to take adult pills, split or crushed. There were no TB medicines ready for kids in the field.
Gabrielle appeared at his side. ‘Everything okay?’ Her hand touched his shoulder.
He reached up automatically and his hand covered hers. He appreciated the thought. She was looking out for him. He met her dark brown eyes. ‘It’s a steep learning curve.’
She looked a little surprised. ‘I thought it would only take someone like you an hour to ace.’
Was she joking with him again? He shook his head. ‘Maybe after the two weeks. But not on the first day.’
She tilted her head to the side. ‘I heard you talking there. You really do have a good grasp of the language. How do you do that?’
‘It’s similar to Farsi. It was a necessary skill when I was in the army. We treated a lot of civilians as well as servicemen. It doesn’t matter where you are in life—or what you do—communication is always the key.’
She gave a careful nod. He folded his arms across his chest. ‘There are a few cases we might need to chat about later. Adults. They’re