The woman sitting across the desk from me in my clinic examination room looked familiar and I could see from her chart that she had been to the clinic in the past.  I couldn’t remember what I had seen her for without looking at my notes, though, and I saw that her last visit was over a year ago.  “Why didn’t you come back after your last visit?” I asked.  “Here,” she said as she handed me an official looking card.  “I finished my treatment and now I’m back to see you,” she said.  “What treatment,” I thought.  Then, as I looked at the card, I realized that she had been on treatment for tuberculosis.  I quickly scanned through my previous visit notes.  She had seen me three times within about a month, each time stating that she was losing weight, had fevers and large lymph nodes under her left arm.  She had no cough, though, and no pain anywhere.  I did some laboratory tests and found out she was anemic and that her HIV test was negative.  I gave her some antibiotics, but the large lymph nodes persisted.  “You need to get a biopsy,” I had told her at the time.  In the rural area in which we work, that’s like telling someone they need to fly to the moon.  Well, she was very motivated to get to the bottom of her illness, so she went all the way to the town of Cayes, a seven hour drive away.  At the government hospital there, she didn’t get the biopsy, but she did get a TB skin test that was positive and she was put on an intensive course of treatment lasting for 6 months.  She had just completed it and had been officially discharged from the TB program.

“From the time I first started taking the medication, I felt better,” she said.  “I went to every clinic and hospital around Jerémie and they never found out what I had until I came here,” she said.  “I’m going to keep coming here all the time now.”  Positive feedback like that is just what we like to hear!

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