Chapter 15: Nomsa confirmed to have XDR-TB

 

This blog has two stories.  One is about Nomsa’s health status at the TB Hospital.  The other is about a pregnant woman, also at the TB Hospital.  I will give more detail about the pregnant woman in this blog and then give a detailed report about Nomsa on my Wednesday blog (wednesdayswithnomsa.blogspot.com).

Thursday night Nomsa sent me a text message telling me that she had run away from the hospital after a nurse (who should be fired) left her a note on her bed giving her the “heads up” that her most recent SMEAR test had come back positive and she would be moved in to isolation the next day.  Nomsa ran and then asked me to forgive her.  It was a long complicated night, but with help from friends who shall remain anonymous we were able to find her in Manzini, get her back to the TB Hospital and sneak her back in to the ward with the promise that I would come in the morning and discuss it all with her.

Doctors making rounds at TB Hospital

 The morning came and Chloe and I headed to the hospital.  When we arrived we learned that the Doctors were going to meet with Nomsa and tell her that she was no longer responding to the Multi-Drug Resistant Tuberculosis (MDR-TB) and that they now wanted to start treating her for Extremely Drug Resistant Tuberculosis (XDR-TB) and they would immediately move her into an isolation room with one other patient so that she did not infect any of the MDR-TB patients with XDR-TB.  There is a documentary being filmed about MDR-TB and so the filmmakers were there to capture this awful moment (their intention is to bring awareness to the issue and hopefully drug companies can help with better treatments in third world countries).  The message of XDR-TB is equal to being given a death sentence, and Nomsa knew it. She is a smart girl and asks questions so she knows that no one has recovered from XDR-TB in Swaziland, ever.  The news was devastating, the silence was earth shaking and her tears were heart wrenching.

Nomsa is being told she has XDR-TB.  BBC/PBS filming.

On the other side of the half wall lay another MDR-TB patient who was pregnant.  She is bone thin with a small baby bump showing the world that she was carrying a child.  She is also HIV positive and very very weak.  Her CD4 count (for those who know that is) is between 129-230.  After delivering Nomsa’s news the Doctor moved on to finish her rounds in the ward.  She found the woman in distress and suspected that she was in full labor. The baby was only 34 weeks old, but an emergency C-Section would need to be done to save both mother and child.  There is no labor and delivery facility at that hospital so other plans had to be made and made quickly.

Thankfully the woman was in false labor just one week ago and that prompted me to try to help find a hospital that would admit and care for an MDR-TB patient.  The disease is highly infectious so it would require full isolation as well as total fumigation of the Operating Room with no use of it for 24-hours.  The C-Section would have to be perfectly timed on a Friday afternoon after all other C-Sections are completed and the room can rest for the weekend.  I am thankful to say that the private Women and Children’s Hospital (WCH), where Benjamin was treated for his burn and where Helen Muli had her baby last Friday, said “yes” and agreed to help us.

Unfortunately the OBGYN at the WCH died suddenly and unexpectedly a few short weeks ago and the Doctor who was filling in for her lost her brother suddenly last Friday so there was a “hole” in the communication process when we tried to contact WCH.  I will say that Sister Patience (who likely will never read this blog) was amazing and stepped right in to help bring order to confusion and prepare for this special patient.  Then there was the transportation problem.

The TB Hospital did not have a way to transport the woman in labor to WCH.  WCH had an ambulance, but it was heading to Mbabane (the opposite direction).  The labor pains were intensifying and the woman was 4cm dilated.  Sister Patience asked if I had a car and could just bring her.  Well, yes, I guess, but she is in labor and has MDR-TB … but what was the alternative?  Chloe and I went back to the hospital and helped her out of bed.  Took her hospital gown off and put clothes on her rake thin body.  Helped her down the stairs. Put a mask on her (we already had masks on) went back and got a blanket for her along with her cell phone and the nurses handed me her MDR-TB medications (syringes for her daily injections and 22 pills per day) along with her HIV Anti-Retroviral tablets.  Surreal.

MDR-TB patient in labor in our car.

As I was driving away with windows open for natural ventilation and CDC masks on I suddenly wondered about liability?  Patient confidentiality?  Family input and a thousand other things.  Last week when we formulated the plan for us to take her to a private hospital I did speak with the woman’s brother to get his consent.  He was so happy that we wanted to help and asked if we could also take the baby when it was born as he was already caring for three of her children?  I said we would discuss that after the baby arrived with Social Welfare involved.  So as Chloe and I drove the woman and her labor pains were intensifying I thought it best to call her brother again.  Thankfully he was still happy that we were helping and gave his consent.  In fact, only an hour later he also gave the nurses consent to do a tubal ligation during surgery to prevent any further pregnancies for this woman.

MDR-TB patient in isolation at private hospital.

At  4:55PM a beautiful little baby girl was born.  I was thankful to be in the Operating Room for the surgery, but it was eerie to see a beautiful life come out of something that looked like a corpse.  I don’t mean to be unkind or critical, but that is what it looked like. Even Sister Patience commented on how such a perfect new life could come from “that shell”.  The baby was 2KG (4.8 lbs), breathing on her own and looks perfect. 

Welcome baby girl (unnamed).  2KG and healthy.

I requested that the baby not be taken to the mother for two reasons. First, the baby must not be exposed to MDR-TB if possible. Second, the mother is HIV positive so if we can avoid breastfeeding that would be best.  But the real question is if the mother will take the baby home or if she will come to us. If the baby goes home with her (well, with the family because the mother will go back to the TB Hospital) then they can decide how the baby is fed.  If she comes to the El Roi Baby Home then she will enjoy a formula diet.

As Chloe and I drove home at 6PM I received a call from an unknown number.  It was the Grandmother to the new baby girl.  I had texted the good news to the brother and he had called her. She was so happy to hear that both mother and baby were well (technically we aren’t sure about mother yet, but the surgery went well).  She requested a meeting with me today at noon at the hospital.  I am hoping that we will meet and that she will take the baby girl home to be raised within the family, but I suspect that will not be the case.  I will post an update on this blog after the meeting.

God’s timing is always perfect. If Nomsa had not run away on Thursday night I would not have been at the hospital to hear the news with her about her XDR-TB status. If I had not been there I may not have been notified that the woman was in labor.  The Lord had Nomsa there for a specific purpose in that woman and baby’s lives and HE kept her there until His work was complete.  I stand in awe of an awesome God who sees everything and wastes nothing.

Janine

Update:  On Saturday I went to the hospital and met with the woman who I was told was the Gogo (Grandmother). In fact, she wasn't the Gogo, she was the wife of the oldest brother of the mother of the baby.  Why wasn't the Gogo there?  Because she was drunk.  According to the family this happens by 9AM each morning so by the time we met at noon there was no speaking to her.   The mother of the baby named the baby "Surprise" because she said she didn't know she was pregnant until 6 weeks ago in the hospital.  Well, "Surprise" is now at the El Roi Baby home and while we will always have her given name as a part of her life, we will nickname her Abigail.   We are thankful.