Twenty-three years ago, we launched the Sudan Tuberculosis Project. Since our patients stay for 6 to 12 months of directly observed therapy, TB remains our largest program. It is a bit scary to have so many TB patients crowded into our increasingly crowded town. But now we have a TB center where sputum positive patients can isolate for at least their first 2 weeks of therapy. That decreases transmission.
165 TB patients were admitted in 2022.
40% male, 60% female
79 patients are under 16.
15% of patients had spinal TB, which causes a “broken back”.
54% of adults have pulmonary TB – they spread TB by coughing.
We test sputum by microscopy, and also use algorithms to diagnose TB. The PPD skin tests can be helpful for young kids. Older people, even those who are not ill, will uniformly test positive, since they have all been previously exposed to TB.
This year, MSF helped us with the TB LAM test. This is a urine test designed for diagnosing TB in those severely immune compromised by HIV. Sputum testing is less reliable for diagnosing TB when HIV is far advanced. In these patients, disease spreads through the body instead of confining itself to the lungs. TB LAM testing is not sensitive enough to pick up all TB cases. But if you test positive, you know you have TB. We have broadened its use to test severely malnourished kids. Malnutrition lowers immunity. Kids are also hard to diagnose as their TB spreads throughout the body. And they can die so quickly.
In another advance for TB diagnosis, the South Sudan Ministry of Health and the World Health Organization have donated an Xpert MTB/RIF sputum assay machine. Here is what CDC says about this test: The Xpert MTB/RIF assay is a new test that is revolutionizing tuberculosis (TB) control by contributing to the rapid diagnosis of TB disease and drug resistance. The test simultaneously detects… TB.. and resistance to rifampin in less than 2 hours. In comparison, standard cultures can take 2 to 6 weeks… In South Sudan there is no sputum culture testing, so we have relied on sputum smears. This can take us five days, and the results are only approximately 40% sensitive.
WOW, revolutionizing tuberculosis control right here in Old Fangak!
Revolutionary upgrades require dedicated national staff.
Kuon Deng first came to us from a far away state south of us, a precocious youngster suffering spinal TB and speaking English. With treatment, the disease progression stopped, but the damage was done. His spinal bones were no longer strong, and he became paraplegic. We provided one of the lovely fat tire carts so he could use his arms to peddle around town.
Then, just when we were inundated with kala azar, he showed up at clinic. Speaking English and carrying the rapid diagnositic malaria kits on his cart, he became a perfect translator for Jill. Rather than taking a salary, he asked that we help him with school. South Sudan had no handicapped accessible schools. We sent him out to Kenya in 2011. He later admitted being shocked on the plane for that first time, when flying through clouds he had thought were solid!
After secondary school, his three year lab tech course stretched to five years, thanks to COVID. Now he is back in Old Fangak, operating our fancy new TB assay machine. He and his wife live on the hospital compound with handicapped accommodations!