Tag: Global health

TB or not TB? Why tuberculosis remains one of the top 10 causes of death today

Tuberculosis
3D illustration of Mycobacterium tuberculosis bacteria

I was always a sickly child – when I was eleven years old, doctors injected my forearm with tuberculin in order to check whether my immune system raised a response to the bits and bobs of dead tuberculosis (TB) bacteria in it. If it did, it meant my immune system had already been prodded into battling TB, that is, it had previously encountered or was currently encountering an infection with TB bacteria. The injection site swelled like a furious bee sting, the doctors decided TB was the root cause of all my troubles, and I was intensely medicated for the next six months. My symptoms improved, and I have since evolved (visibly even!) towards the hale and hearty end of the healthiness spectrum.

In retrospect, now that I am medically trained and pursuing a PhD in TB immunology, I can appreciate all that my care team must have had to consider before starting an eleven-year-old child on a rigorous anti-TB treatment based on an educated guess. My symptoms were not typical of classical lung TB, the most common and infectious form of TB, they were mostly gastrointestinal, but then TB has also been known to stitch the gut into uncomfortable knots. My mother had recently been diagnosed with a cold abscess, due to TB of the bone, and though this could not possibly be infectious (based on centuries of observation) it still raised flags as it meant I had a history of contact with a TB patient. I showed an immune response to the tuberculin skin test (TST), but then I had received the BCG vaccine, which is a close relative of TB bacteria. This meant I could elicit a cross-reactive immune response and result in a positive TST even in the absence of TB infection due to the similarity of the two bacteria. (more…)

Ten minutes in Beirut: the harsh struggle for health and life facing Middle-Eastern refugees

Beirut, Lebanon
Beirut, Lebanon

20 June is World Refugee Day, and my short morning walk to the American University of Beirut (AUB) provides a daily and grim taste of the global refugee crisis. At 8:50am I take a right out of my Beirut flat onto a bustling and polluted Lebanese street. I live opposite a cheap hotel that hosts medical tourists – Iraqis, mainly – due to crippling of health systems in the region. A quick glance to my left and I’ll see two women outside a supermarket holding babies and pleading with ingoing shoppers for a small bottle of milk. To my right I see a large but flattened cardboard box, knowing this will soon become the cushion for a young mother and her two children. I’ll see them on my way home and I’ll worry about the toddler, who looks thin and tends to wander into the road.

By 8:55am I’m on a steep descend towards the main entrance of AUB. As I pass by a beautifully colourful series of flower shops on my left, I see an elderly man in plain clothes sitting on a white, plastic chair and holding a cup of tea. He has an expressionless face, he has damaged red skin around his ankles, he is obese, and he is silent. We exchange a look and I feel despair; not just for him, but for the nine year old girl who used to be in his place up until April this year. Also silent, she would sit and curiously watch passers go by. She was from Aleppo, a city brought down to its knees in recent years, and she told me her mum wouldn’t let her go to school in Lebanon. I dare not ask the elderly man what happened to her, but let’s not be under illusions – gender-based violence and early marriage are a feature of armed conflicts. (more…)