Reflecting on Tuberculosis - A Broken Heart to Match Broken Lungs

I have mostly restricted the contents of this blog to the cultural aspects of Moldova, both out of respect for the privacy of the patients I meet as well as due to the ongoing nature of my research and understanding.  But, a short while back I had an experience that I think is a valuable insight for all of us when thinking of disease. 

I was in a rural clinic observing follow-up appointments when two stories unfolded in front of me. 

The first was a father who was coming in to update the doctor on his son.  Apparently two years ago the son had been working in Russia (migrant workers are a very common theme to the story of TB in Moldova.)  While in the "workers' camp" he contracted TB and was sent back to Moldova for treatment.  In the midst of his treatment, his fiancee called him from Russia and told him he needed to come back.  So, this young man put love before health and rushed off to Russia... only to find that the urgent call was made because his fiancee was leaving him.  Soon she was with another suitor... the doctor sadly called it "survival of the fittest."

The next patient to walk through the doors was an older man.  A few years ago, he and his wife and two children were leaving Moldova for the opportunities of Italy, and on the way between borders he was screened and diagnosed with tuberculosis.  He was sent back to Moldova for treatment while his family went on to their destination in Italy.  Apparently he no longer has the opportunity to go back (not necessarily because of TB, it may be that an administrative window closed.)  Regardless, he remains separated from his loved ones three years later... part of the stress that probably led to his reactivation with MDR-TB.

It is often pointed out that social status is closely linked to the epidemiology of tuberculosis.  Indeed, a poor social status leads to an increased risk of tuberculosis.  But the sad reality is that tuberculosis doesn't just take a man's health; it can also deprive him of the only social wealth he has left...