We are used to have be people with the conditions such as congestive cardiac failures, hyper tension and liver failures but now we usually nurse people with epigastric diseases such as diarrhea aseptic meningitis usually streptococcus mostly HIV related more than anything else now. KwazZulu-Natal is one of the nine provinces in South Africa and it really is the epicenter of the co-epidemics in the country. the rates of TB infection here and the rates of HIV are unprecedented throughout
the country. We know here at Edendale 60% of women, pregnant women test HIV positive so id we extrapolate that from that we’re looking at mid to high 40% so just under half of the population is HIV infected. TB a couple decades ago
was on the down swing, it was being controlled fairly
well globally, but with HIV coming on the scene you see TB rising exponentially because patients who are
HIV infected of course is much greater risk of tuberculosis so that’s why TB is on the upswing in the inner cities in the US and definitely in developing countries where there’s a high burden of HIV. It’s the number one killer far and away of patients who are HIV positive. people typically wait a very long time before they seek medical attention so they present very where they are very very ill and I think we see a lot more people honestly die here than we do in the US just because people are so diseased and it presents so late it receives so little treatment on the outside.
And I think one of the biggest differences is we see HIV probably as HIV looked in the US the late ’80’s early ’90’s before there were treatments and you see all of the the infections and ravages of the disease that we’re not really accustomed to seeing anymore
since therapy in countries that can afford it is so good. The main thing that I’ve gained is just a true personal experience and understanding of it you know, being here, during the epidemic getting a sense of how things really are you hear about it in the United States but it’s difficult to really get a sense of it until you come here and you see
the burden that there is in the hospitals I mean 80-90% of patients here in the hospital
are HIV positive and an incredible number of those have TB as well. unfortunately it took XDR to generate so much international interest in the problems now we have a lot of of people thinking about what better infection control measures, better treatment mention measures, integrating
HIV and TB care, so these things are all essential to relook at our protocols to find out why are we failing the standard TB treatment
in the first place that are leading to both the MDR and XDR epidemics.