The name of the child in this story has been changed to protect confidentiality.
For two years, Phu’s father was treated for DRTB in a TB specialist hospital. The family had to bear the entire cost of his treatment and hospitalization. Phu’s mother, who looked after her father while he was hospitalized, died suddenly with no known underlying cause, leaving Phu to look after her father.
In early 2009, Phu’s father was discharged from the hospital in good condition, but in June, Phu, 13 years old at the time, developed a persistent cough as well as other worrying respiratory symptoms. She was diagnosed as smear-positive for TB that same month and initiated on first-line TB treatment even though she had a known DR-TB family contact. Phu was supposed to receive DOT, where a health care worker pays daily visits to Phu’s home in order to administer her TB treatment, but this was not the case. Phu’s aunt reported that “the health staff came just once or twice a month, and sometimes prepared some drugs, such as para-aminosalicylic acid [PAS], packed in plastic bags for daily doses making appointments to return.” Poor support and oversight from the DOT health care worker, coupled with financial struggles resulting in nutrition insufficiencies, made it difficult for Phu to tolerate and adhere to her treatment.
Five months later, in November 2009, Phu was still positive for TB. She was regarded as a treatment failure and re-treated with firstline drugs. After an additional five months, Phu was still testing positive for TB. Her doctor sent a culture for DST to a TB center in the north. While waiting for the DST results, Phu and her family relocated to a northern part of the country without informing the township medical officer.
Once Phu settled in the north, the national program reinitiated her on first-line drug therapy. Phu stayed on first-line drugs for another 12 months, but her health began to deteriorate. Phu’s concerned aunt brought her back to her original doctor, who immediately had Phu admitted to the TB specialist hospital where her father had been previously treated. Phu began treatment for MDR-TB in June 2011. While she finally received appropriate treatment for her MDR-TB, she unfortunately developed chronic conditions from her intense MDR-TB treatment regimen, including hypothyroidism and deafness.
Two months into treatment for MDR-TB, Phu’s sputum and culture came back negative, her body weight improved dramatically (from 34 kg to 47 kg, or 75 lbs to 104 lbs), and her respiratory symptoms were relieved. But 14 months later, while her sputum smear was still negative, the culture came back positive for TB, and a month later the sputum, too, tested positive. Phu’s doctor sent a sputum sample to Bangkok, Thailand, where they will perform second-line DST. While they wait for the DST results, Phu is continuing with second-line drugs for MDR-TB.