Cecilia is 30 years old but moves with the hesitant gait of an old woman. She was admitted to the Thyolo hospital a week ago and is still too weak to walk unaided. She has active TB for the second time in two years. The first time she was diagnosed and treated as an outpatient at the Queen Elisabeth hospital in Blantyre, her home town. She got a little better with treatment, but then her condition worsened again: although she was not in pain, she completely lost her appetite and became emaciated and very weak. This time she sought help from the Thyolo district hospital, arriving there in an ambulance.
Cecilia’s sputum test was negative. Unlike the first time she was diagnosed with TB in 2002, the bacilli aren’t lodged in her lungs. Instead, she has been diagnosed with miliary TB – an acute, generalised form of the disease characterized by lesions in affected organs. The standard TB re-treatment regimen requires that she will have to stay at the hospital during a three-month intensive phase, and then continue taking TB drugs for another five months afterwards.
After a week at the hospital, Cecilia says she is feeling much better already, although she still has to pause between sentences to steady her breath. She frowns as she talks about her two-year-old daughter who is staying with Cecilia’s sister as Cecilia’s husband works. “I am happy with the care offered at the hospital, but Thyolo is over half an hour’s drive away from Blantyre so it is expensive for my family to come and see me,” she says. She is asking to be transferred to a hospital in Blantyre instead but this will depend on availability of beds there, among other things.
Cecilia complains about pain and swelling in her legs, which she thinks could be a side effect of the TB drugs she is taking. But her medical assistant thinks the symptoms might be linked to the fact that she is also HIV-positive, like 80% of all the TB patients at the Thyolo district hospital. Cecilia would qualify for antiretroviral treatment. But she has not been able to begin her ARVs yet because she is still too weak to tolerate the potentially life-threatening drug-related side-effects. Paradoxically, ARVs might also contribute to her TB disease worsening as a consequence of her immune system getting stronger.
For Cecilia, the future holds a dependency on medicines: first to cure her of TB; and second, to take ARVs for the rest of her life.