Hlabisa Cover 2.Cdr

Hlabisa Case Book Supportingorganisations in TB&HIV Medicine TomHellerMD(Ed.) HlabisaCaseBookinTBandHIVmedicine Editor: TomHeller MD,SpecialistinInternalMedicineandInfectiousDiseases(Germany) HlabisaHospital Authors: CatherineHoulihan MBChB,MRCP (UK),DTM&H ART Programme AfricaCentreforHealthandPopulationStudies AmberSeigel MBBS,PhD,BPharm HlabisaHospital MahalaBuckley MBBS,DTM&H HlabisaHospital JulieCopelyn MBBS HlabisaHospital RichardLessells BSc,MBChB,MRCP (UK),DTM&H,DipHIVMed AfricaCentreforHealthandPopulationStudies HlabisaCaseBookinTBandHIVmedicine i Disclaimer Dedication Although every attempt has been made to ensure that the information in this casebook is ToClaudia, accurate and correct, the authors, editor and publishers accept no responsibility for any loss or damage that may arise out of the reliance of any person upon any of the information «nomequitesturisa», provided in the book; nor is responsibility accepted for any loss or damage sustained as a result of the use of the information contained herein. (T.H.) When in doubt, seek assistance of a more senior colleague, or, when further information is required concerning drug indications or dosage, consult the South African Medical Formulary, the current pharmaceutical package inserts or the relevant pharmaceutical and company. tothepeopleofHlabisasubdistrict, whocontinuelaughing,despiteallthis. (T.H.,C.H., A.S.,M.B.,J.C.,R.L.) HlabisaCaseBookinTBandHIVmedicine HlabisaCaseBookinTBandHIVmedicine ii iii Disclaimer Dedication Although every attempt has been made to ensure that the information in this casebook is ToClaudia, accurate and correct, the authors, editor and publishers accept no responsibility for any loss or damage that may arise out of the reliance of any person upon any of the information «nomequitesturisa», provided in the book; nor is responsibility accepted for any loss or damage sustained as a result of the use of the information contained herein. (T.H.) When in doubt, seek assistance of a more senior colleague, or, when further information is required concerning drug indications or dosage, consult the South African Medical Formulary, the current pharmaceutical package inserts or the relevant pharmaceutical and company. tothepeopleofHlabisasubdistrict, whocontinuelaughing,despiteallthis. (T.H.,C.H., A.S.,M.B.,J.C.,R.L.) HlabisaCaseBookinTBandHIVmedicine HlabisaCaseBookinTBandHIVmedicine ii iii Tableofcontent Foreword.............................................................................................................................vi Acknowledgments..............................................................................................................vii Outlineofhealthanddiseaseandthehealthservicesinthe HlabisaSubdistrict,KwaZuluNatal ......................................................................................1 Cases ..................................................................................................................................8 Epilogue(fortheoverwhelmeddoctor) ...........................................................................138 Abbreviations...................................................................................................................140 Index................................................................................................................................142 HlabisaCaseBookinTBandHIVmedicine HlabisaCaseBookinTBandHIVmedicine iv v Tableofcontent Foreword.............................................................................................................................vi Acknowledgments..............................................................................................................vii Outlineofhealthanddiseaseandthehealthservicesinthe HlabisaSubdistrict,KwaZuluNatal ......................................................................................1 Cases ..................................................................................................................................8 Epilogue(fortheoverwhelmeddoctor) ...........................................................................138 Abbreviations...................................................................................................................140 Index................................................................................................................................142 HlabisaCaseBookinTBandHIVmedicine HlabisaCaseBookinTBandHIVmedicine iv v Foreword Acknowledgments Due to a variety of reasons there is a chronic shortage of health care professionals in rural To come to a new place and deal with new conditions is always challenging for a doctor. The African hospitals. Despite South Africa being a relatively well resourced country in health system in Hlabisa subdistrict, as the health system in most rural parts of South Africa, comparison to its neighbours it is not immune to this shortage. Often rural hospitals operate rely heavily on physicians “who come new to the area”. Many hospitals are staffed with with less than 50% of the medical officers they are supposed to have. community service doctors, who are at an early stage in their clinical career, and by short-to- Overseas trained doctors from more developed settings who act as a lifeline to rural hospitals medium term physicians, who come from abroad. For many the exposure to the combined often arrive with little or no preparation for the kind of cases they will meet, this is not the fault epidemic of TB and HIV is new and one can only be vaguely prepared for the number and the of the individual but often of the health system where due to shortage of personal it is not severity of the cases. possible to fully induct a new doctor into their new environment. The idea to write a case collection was born out of our own experience of facing new I know from personal experience that arriving in a hospital such as Hlabisa from the UK conditions with different pathologies, but also with different diagnostic and therapeutic despite having read numerous books and gone on tropical medicine courses I was really at possibilities. These cases should give an idea which diseases can be expected but also sea for a few months. which steps can be taken with the limited resources at our disposal. The following series of cases prepared by doctors at Hlabisa hospital based on real patients Medical books are never written only by the authors and being in a district hospital we that presented and were managed at Hlabisa using the resources available provide an frequently liaise with other departments for advice and help. We would like to thank Dr. Martin invaluable educational tool. The cases include common and less usual presentations but Dedicoat, Infectious Diseases specialist in Ngwelazane Hospital for his frequent help and the probably all the conditions covered would be seen by a medical officer spending a year at possibility of “un-beurocratic” patient transfers, Dr. Swan, chief radiologist in Ngwelezane Hlabisa. Hospital for the help and great support with CT and MRI studies. Dr. Ramjee and the MDR- TB team in King George V Hospital as well as the Cardiothoracic Surgery team at Inkosi The cases cover presentation, management outcome and give further reading. All are Albert Luthuli hospital need to be thanked for the help with our TB problem cases. accompanied by useful images. Learning points are emphasized. These cases can be read as an educational series and then used as a resource. We would like to thank Tracey Hudson from African Health Placements for helping our hospital and programme with recruitment and placement of physicians (if someone needs The authors should be commended for compiling such a comprehensive and well help to come to South Africa, contact her at [email protected]) as well as helping us to researched set of presentations as well as managing to investigate and follow up their publish and print this book. patients so well with the limited resources available. Additionally we would like to thank the colleagues we work with on a daily basis. L. Mhlongo, Dr.MartinDedicoat M. Ndlovu and the rest of the TB team helped to set up the chronic cough clinic, where many Headofdepartmentofinternalmedicine of the TB patients were seen. S. Hlabisa and the staff of the ART team in all our clinics are NgwelazaneHospital supporting us on a daily basis and I would like to thank the KwaMsane team in particular for finding patients, translating histories and asking permission to take the pictures. Finally we want to thank the patients whose cases are shown in this book. They understood the need to train other doctors and health care workers. We hope that this book will be of help to all who come to ruralAfrica to practice medicine. FortheHlabisateam TomHeller HlabisaCaseBookinTBandHIVmedicine HlabisaCaseBookinTBandHIVmedicine vi vii Foreword Acknowledgments Due to a variety of reasons there is a chronic shortage of health care professionals in rural To come to a new place and deal with new conditions is always challenging for a doctor. The African hospitals. Despite South Africa being a relatively well resourced country in health system in Hlabisa subdistrict, as the health system in most rural parts of South Africa, comparison to its neighbours it is not immune to this shortage. Often rural hospitals operate rely heavily on physicians “who come new to the area”. Many hospitals are staffed with with less than 50% of the medical officers they are supposed to have. community service doctors, who are at an early

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