Malick – Senegal

The name of the child in this story has been changed to protect confidentiality.

Malick, 17 years old at the time, was first diagnosed with TB in February 2010. He was treated as an outpatient at a health center 30 kilometers (19 miles) from his home for two months with rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by four months of treatment with rifampicin and isoniazid. After completing six months of treatment with first-line drugs, Malick was declared cured of TB.

Unfortunately, Malick’s symptoms returned four months later, in early December 2010. This time Malick was evaluated at a health facility closer to his home, where they performed microscopy and sent a culture to the national reference laboratory for DST. Malick was re-treated, but this time his regimen consisted of two months of streptomycin, rifampicin, isoniazid, pyrazinamide, and ethambutol, followed by six months of rifampicin, isoniazid, pyrazinamide, and ethambutol.

Two months into treatment, microscopy done at the local health facility came back negative. At the same time, however, the results from the national reference laboratory came back positive and showed that Malick’s strain of TB was resistant to rifampicin, isoniazid, streptomycin, and ethambutol. According to the national reference laboratory results, Malick had MDR-TB. Malick and his parents disagreed with this diagnosis; Malick’s physical condition had improved, and the recently performed microscopy from the local health facility was negative. Malick and his parents stopped his treatment.

Three months later, Malick returned to the local health facility where they again performed microscopy and sent a culture to the national reference laboratory. Both came back positive. Malick then refused to be treated at the local health facility; he preferred to travel the 30 kilometers each day to the health center at which he was initially treated. Malick did not reinitiate treatment with second-line drugs until September 2011, eight months after he was diagnosed with MDR-TB by the national reference laboratory.

Once Malick was back on track with his second-line therapy, his health began to show signs of improvement; however, one unfortunate effect of his treatment was that Malick experienced memory loss. His doctors monitored him closely for other signs of cardiac, neuropsychiatric, and biochemical trouble. Malick’s refusal to receive treatment at the local health facility placed a significant financial burden on his family, who now had to cover the costs of his daily trips to the health center.

Throughout the duration of his lengthy treatment, Malick desperately wanted to return to his studies in transportation logistics, however Malick’s father was opposed: they did not have the financial means, and he did not want Malick to risk spreading MDR-TB to others.

Malick, now 19 years old, with the financial support of his brothers, is currently enrolled in his first year of college and is studying transportation logistics.

Story Collected by: Ramatoulaye Sall Touré, MD, National TB Control Program (NTP), Senegal; Momar Talla Mbodji, MD, Plan International, Senegal