alicespringstomind

The evenings in Kampong Cham come alive with young people on motorbikes.  Three riding abreast equals at least six teenagers socialising as they cruise through the streets.  Five is the most bodies I’ve sighted on a single moped to date.  Helmets are an optional rarity.

Another regular sight is these wooden wheelbarrows which have many purposes.  They can carry anything, from human to vegetable, fruit, cardboard, piles of plastic goods or woven cane baskets and anything else that might possibly be sold or exchanged.  They may be drawn by motorbikes, horses or oxes,  pushed or pulled by humans.

Today the Stop TB Partnership made an announcement.  Each year three million people with TB are missed by health systems.  The theme for World TB Day 2014 has been decided – “Reach the three million : A TB test, treatment and cure for all”.  In their announcement they state “To reach the three million and move towards zero TB deaths, infections, suffering and stigma, we must aggressively scale up TB programmes, especially for the most vulnerable groups and in hotspots, while investing in research and development for the new tools that we urgently need“.  World TB Day happens each year on 24 March and aims to build public awareness of the ongoing epidemic which kills almost 1.5 million people every year, or 3 people every minute of every day in the year.  The date commemorates the day in 1882 when Dr Robert Koch astounded the scientific community by announcing that he had discovered the cause of tuberculosis, the TB bacillus. At the time of Koch’s announcement in Berlin, TB was raging through Europe and the Americas, causing the death of one out of every seven people. Koch’s discovery opened the way towards diagnosing and curing TB.  (http://www.stoptb.org/events/world_tb_day/)

Meanwhile today in my little corner of the world I saw two extraordinary chest x-rays.  Both show a whole lung whited out by pleural effusion.  This is a rare sight in the First World and would result in each patient being admitted to a high-technology Intensive Care Unit with supported ventilation.  Here it is a much more common finding with oxygen administered by nasal prongs the only support available.

This x-ray shows the left lung almost completely “whited out”, filled with fluid probably caused by an infection (but possibly another cause, eg cancer).

Similarly, the left lung here is also completely whited out.  The trachea is severely deviated to the right because of the pressure in the left lung and the right lung is much smaller than it should be, as pressure from the left pushes into it, effectively squeezing it.

Both of these men presented today with extreme breathlessness and very poor respiratory clinical findings.  Both are at risk of death if the cause is not diagnosed and treated.

Poverty causes men like these to present very late for medical intervention.  As agricultural workers with families who rely on them for their day-to-day existence, they cannot afford to spend a day traveling to town for such self indulgent reasons.  Lung disease such as this tends to progress in a slow and chronic way so that patients may not notice how unwell they are becoming at first.  But a day off work means the family may not eat and so once the illness is severe, they delay presentation until they are unable to physically work.  Sometimes it is only when someone has collapsed in the field that they are brought to hospital.  By then it may be too late.

When I cycle the dirt lanes of the local villages on my days off, stories like this must surround me as I exchange smiles and chum reap suors with my impoverished neighbours.