When I submitted my medical clearance form for SAS awhile ago, I was informed that I needed to provide the results of a recent PPD test. Obviously, on a ship with 600 students, as well as a fair amount of academic personnel and their families, one can’t risk having active TB going around.
A PPD test, or Mantoux test, uses a Purified Protein Derivative of Tuberculosis injected intradermally. An individual who has been exposed to the TB bacillus such that they produced a cellular immune response will experience a delayed hypersensitivity reaction, usually 48 to 72 hours later, in the form of a weal.
Coming from a high TB-area, where I work in a hospital that often has no N95-masks available, this was a little scary. I know that TB is not a death sentence. I know that it is treatable and that I would be an informed, compliant patient. I also knew that a positive result would not necessarily indicate active infection. So the first thing I learned was that, as open-minded as I think I am, I have the same fears as my patients.
My initial response to the request was a curt email saying that I’d rather send a chest radiograph report, as Mantouxs are not commonly done in adults in South Africa. I don’t know where I got this idea – perhaps I was just scared it would come back positive – but it is incorrect. I even remember administering PPD tests to women in antenatal care. So the second lesson I learned was a reminder in humility.
I’ve administered so many of these tests to little children, and they always scream blue murder. It’s so easy to say that it will just be a little bee-sting when you haven’t even experienced it. Guys, it burns when the PPD is injected! It’s not just a little sting. I had to purposefully remind myself not to recoil. This reminded me of the young registrar who tasted a drop of Kaletra after hearing time and time again how mothers can’t get their children to drink it. Kaletra is an essential medicine in the treatment of paediatric HIV. Nobody could have guessed just how revolting this medication tastes! In richer households, children are given nutella to soothe the taste. Apparently, nothing else helps.
So here, even though I thought I was quite gentle and empathetic, I learned to be more so. More considerate. Walk in their shoes, so to speak.
It was difficult to keep the injection area clean and dry. Imagine a mother of a toddler having to do that! I’m quite an allergic person, so the last thing I wanted was for a mosquito to bite me close to the injection site, or for cat hair to cause some irritation. I was paranoid.
Despite my concerns, my Mantoux did not react. Up to ten percent of Mantouxs are false negatives, although a lot of those patients are either severely immuno-suppressed or have severe enough clinical signs to raise such suspicions. I have neither of these. But I know now that I can’t stand back and keep quiet while medical students, who pay a crap-load to work as unpaid labour, work in a high TB-zone with nothing but surgical masks at their disposal. There is an organisation called TB-proof that is doing work in this line, because many young doctors are contracting TB and often the drug-resistant variety. I’ve been meaning to get more involved. This time it’s gonna happen.
P.S: And I think it’s cool that Archbishop Emeritus Desmond Tutu, who will be sailing with us from San Diego to Cape Town with his wife, is the patron of the Desmond Tutu TB Centre at my faculty!