On Weather and TB

I'm starting out by showing you several pictures of the same view...the view out my bedroom window. All these pictures were taken this month....summer in Mbabane. I have never lived in a place with so much extreme variability; right now I am wearing a sweatshirt yet just this past weekend I was sweating in shortsleeves. I'm also showing you some of the beautiful wildflowers that now cover a lot of the fields and mountainsides this time of year here in southern Africa.

Let me throw in a clinical story for those of you curious about my work. The other day four of my doctors friends and I were sitting at lunch discussing a patient two of us had just seen this week. This was school aged girl with sputum positive TB. Most children we just treat for TB based on symptoms; but this child actually was growing TB in her sputum. In the US we admit children to the hospital to obtain gastric aspirates for culture while here the hospital had no idea what to do with the kid we admitted for that very reason several weeks ago. So, anyways, my one doctor friend said, "I told the family she couldn't go to school and they were really sad". To which us newer doctors said, "Wow, we never thought of telling the child not to go to school". To which an another more experienced doctor said, "I would at least wait until her sputum was 1+ not 3+" (translation, less TB in the sample). To which one other doctor looked at all of us and said, "I can't believe this is even a conversation. Do you know how rediculous you would sound to any doctor in the US, even allowing any child to go to school with any sort of untreated TB." Yes, but this is Africa. Our infection control is opening the windows in the exam room.