THE BABY WITH THE BROKEN BACK
Pediatric tuberculosis clinic in Port-au-Prince is a draining experience. All day long you see tired moms with tired, malnourished babies who won’t eat, have fevers, and “used to be big”. The mothers are exasperated that their children won’t grow. They always have colds and coughs. Because the kids don’t get enough to eat, their immune systems don’t function well, and it predisposes them up to all sorts of infections. Close to 100% of poor Haitian children have worms at one time or another in their young lives.
When one mother brings three children to be checked, it is colloquially referred to as a “3-for-1”. That can break the spirit of the physician at the end of the day when he is tired and emotionally beat up by witnessing the results of poverty all day long.
My last “case” the other day was a “3-for- 1”. The mother looked like she was barely alive as she struggled into the office with her 3 children. The oldest was a 5 year old girl, the second oldest was a 4 year old boy, and the baby she was carrying was 18 months.
Mom weighed about 80 lbs and her cheek bones stuck out prominently. She had a blue scarf on her head and rested her head on the desk as she spoke and held the baby on her lap. She was just diagnosed with tuberculosis in her lungs. Her CXR revealed a cavity that had formed in her right upper lung where the tuberculosis was actually eating a hole in her lung tissue. She had a folded stapled piece of paper that said TB Sanitarium on it where she was being referred for the treatment of her tuberculosis. She obviously had no money and could barely even stand. She needed inpatient therapy in the antiquated sanitarium that is known in PAP as a place you go to die. She would need at least 8 months of therapy. If her HIV test came back positive, her therapy would be longer if she lived long enough to receive it.
The baby lay in a prone position on her lap and was dozing. He would stir now and then during the exam. At one point he urinated all over his mother’s lap as she lay with her head on my desk. Urine dripped down her legs onto the floor. The mother didn’t notice. My finger ran down the baby’s spine to find a fairly large lump in the middle of the thoracic spine area. This could only be one thing….Potts disease. Potts disease was named after Sir Percival Potts who described this malady too many embarrassing years ago. When TB gets in the blood and seeds the spine, the bone can become infected and break leaving the patient with a broken vertebrae and frequently an abscess that runs down the side of the spine. In Haiti with a mother who is coughing up TB germs (“red snappers”), her baby is at high risk for developing some form of TB. This pathetic poor baby had Potts disease in my opinion.
The other two kids were terribly dirty and malnourished but seemed to be like normal kids. I screened them for TB as well due to the fact they were exposed to their mother as well and had immune systems that were less than ideal.
The baby’s CXR and thoracic spine showed TB in both locations—the lung and the spine. A vertebral body in the middle of the back was squished due to bony destruction caused by the TB germ that hunts babies like this.
Several days later, they returned with the mother’s sister who looked poor, but not on the verge of death like the children’s mom. I explained to the aunt that she needed to bring the baby back in 2 days and we would admit the baby to the inpatient ward at the pediatric TB hospital. This seemed to cheer the aunt up because now she would only be responsible for the older brother and sister while the mother with the blue scarf languished in the sanitarium where most go to die.