Another of our correspondents in Swaziland, Charlie, writes about an unusual case he recently encountered on the same day Emma was delivering her condom promotion classes …
During a day spent in the rural community, during a teaching session on condom promotion. I was approached by an elderly lady and asked if she could speak to me regarding her son. I agreed and she began to relay the story of her son’s problems dating from about three years ago…
Her son, Sibelo, had been diagnosed with HIV at the age of 26 (he may have been infected with it quite a while earlier), not unusual by any means in the Swaziland population. What was unusual was how his condition had deteriorated since then. He is now 29 and his mother explained that he had started experiencing seizures about two and a half years ago; he was subsequently diagnosed with epilepsy and given anti-epileptic medication that controlled these seizures.
Since then, about a year ago, he has become exceedingly weak in his right arm and leg, had developed problems with walking and with his speech and was experiencing tremors every 3-4 minutes down the right side of his body. These were obviously causing increasing concern to his mother. She took him back to the doctor who concluded that he needed a CT scan of his brain, in order to better see what was going on up there. After several weeks of saving money in order to afford this scan (equivalent of £10), which in rural Swaziland is a serious expense, they travelled to the capital, Mbabane, to have the scan.
On returning to the clinic with the scan in hand to see the doctor who had originally requested it, in order to have it interpreted, they found that the doctor had changed jobs. His replacement was unable to interpret the scan, as had never received formal training in CT scans, and they were therefore sent home without any resolution to his problems. This is why she came and spoke to me, to try and receive some help in helping her son. I agreed to look at the scan (with which I am only vaguely familiar) but had to make clear that I wasn’t qualified to interpret them sufficiently.
Looking at the scan it was immediately obvious, even to my inexperienced eye, that something was grossly wrong with this man’s scan. There was a seriously large brain abscess that had shifted a lot of his brain across to the other side under significant pressure. The only possible explanation for him still being able to walk, and to still be fully conscious, was that this had developed over a long time and he had compensated bit-by-bit for the effects that this huge mass was having on his brain. Based on this scan and his progressive worsening of his symptoms, his 2-year outcome does not look in any way promising.
I asked to take the scan and medical notes from them, with the promise to get them back to the family, and have since shown the scan to a group of doctors here that have helped to formulate a plan of action for this man. At the time of writing, one of the doctors (a specialist in HIV medicine) is urgently trying to get in contact with a neurosurgeon, and Sibelo is hopefully to be brought in and formally assessed by this same doctor. I only hope that it is not already too late to help this gentleman, the outcome of this story will be told in a later blog.