Point of no return

 This is the Chest X-Ray of PD.

PD is a 35 year old lady who died 4 weeks back. Mother of 4 children and the only lady in the house. 

PD had been diagnosed to have tuberculosis 3 years back. Unfortunately, we do not have any details of what treatment she took.

We saw her in outpatient about 3 months back. Her lungs were quite a lot damaged. To complicate matters she had severe anemia and we wondered whether she also had Valvular Heart Disease. We wanted an Echo to be done, but the family was too poor to make the trip to Ranchi.

The problem was that she was not too regular with her treatment. In fact, we were surprised she did well with her bronchodilators and anti-failure medicines.

Not when she skipped couple of days of medicines. Her husband had slipped out of the village for about a week to earn some extra money. The review for PD was due and they missed the date. The severe cold weather ensured that the delay was fatal.

She was puffing and putting out bloody froth when she came in. She responded to treatment for the first two days. And then her heart and lungs just could not take the stress.

Quite a lot of diseases bring patients to a point of no return. A patient after a stroke finds it quite difficult to return to normal life. Someone who had a heart attack finds it difficult to do things the way it used to be done. A baby who had birth asphyxia gets so bad brain injury that he/she is never a normal child.

I think, after Hansen's Disease, tuberculosis is the worst infectious disease which can end up with such a point of no return . The damage done on the lungs is so profound that in the absence of an early diagnosis, patients become so much affected that a normal life is hardly possible at all. They are just lucky to cheat death whenever there is an infection, period of malnutrition or extreme climate.

All all this gets very easy in poverty . . . the chances of survival are very slim.

Which of course, brings us back to the reality of socio-economicdeterminants of health . . .