Excerpt from New Issue of Streamline: What to do when a patient with active TB leaves the country and stops treatment?
[Editor's Note: Picture this: A woman arrives in South America from the US, and heads to the doctor. She's midway through her treatment for active tuberculosis -- until the doctor tells her she's fine and can stop treatment early.
If you're a Health Network Associate, this situation would make you very, very concerned. This scenario happened recently to Rob Corona. Here is his story, and how he managed to get the patient back into treatment despite being thousands of miles away. Our Health Network Associates are public health champions!
This week, we celebrate the release of the new issue of Streamline, our quarterly clinical publication! In addition to the following article, the new issue is chock full of useful resources, engaging stories from the field, and profiles of clinicians hard at work. Read the issue online at: http://www.migrantclinician.org/news/streamline/2017/jun/springsummer-2017.html . Interested in subscribing to Streamline, free of charge? Email firstname.lastname@example.org with your address.]
Out of the dozens of Tuberculosis (TB) cases that I managed in 2016, one stands out in my mind. Felicia Diego,* a woman in her 90s from South America, was diagnosed as being positive for active M. Tuberculosis by a health department in the eastern United States. Ms. Diego started treatment in November of 2015 and was enrolled in Health Network because she would be moving back to South America the following week. The enrolling clinic wanted to ensure that the patient would continue with her treatment and expressed a strong concern for this patient given her advanced age.
When I first tried to contact the patient, she was already in South America. I never spoke with Ms. Diego directly. I instead received all information regarding the patient from her daughter, Roma. When I first spoke with Roma, she informed me that upon return to South America, her mother was seen by a doctor at a local hospital who did some follow-up exams and determined that her mother no longer had TB. The doctor told the family that Ms. Diego did not need to continue with the treatment so the patient stopped taking the medication immediately thereafter.
Hearing this was very disconcerting for me. From what I had read on her medical records, Ms. Diego had positive Sputum and Culture results, which classified her as a very active case. I consulted our Chief Medical Officer, who affirmed that she definitely needed to continue with her treatment for the full six-month period prescribed by the health department in the US. The anxiety I felt knowing that this patient with active TB was at risk and that her daughter was under the impression that her mother was fine made a lasting impression on me. I called the patient’s residence no less than 10 times, repeatedly recommending that they see another doctor to get a second opinion. Roma seemed insistent in believing that the family doctor’s negative diagnosis of her mother was correct, despite my relating to her the findings of the US-based health department.
What happened next? Such a cliffhanger! Read the rest of "Different Countries, Different Diagnoses" and puruse the rest of the new issue of Streamline here: http://www.migrantclinician.org/news/streamline/2017/jun/springsummer-2017.html.