I received a phone call this morning that a patient with pulmonary TB brought her children in to be screened for TB. One of the main objectives of my child contact register project is to get patients to bring their exposed kids in for screening so the fact that someone actually did was great news. However, I encountered a bigger problem when I arrived at the clinic - mom and kids were HIV negative. Why on earth would this possibly be an issue? The original mission of AMPATH was to provide affordable healthcare and support to HIV infected individuals in western Kenya. The organization has succeeded with this and currently manages >160,000 HIV infected individuals and counting. In other words, if you have HIV in Eldoret, your clinic visits, medications, lab studies, and imagining is free. So a child exposed to TB in the home who is HIV infected can see his/her clinician and be sent for a chest x-ray for free (a savings of approx 6 dollars).
What about if your child is HIV negative? Well prepare to wait in a long line at either the sick child Emergency Room or the Pediatric Acute care (only open 2 mornings a week) to have a clinician see the child for a fee. Then the clinician will probably send the child for a chest x-ray so it will be necessary to pay 400KSH for the test. To put things into perspective, a 30 minute bus ride costs 20KSH and a lunch costs 80KSH so these medical costs add up quickly.
Fortunately, this issue is well known, and AMPATH has just started shifting to a primary care model to incorporate HIV negative patients. It will be interesting to see if a test like a chest x-ray will get waived for a HIV negative child who has been exposed to pulmonary TB at home.
In the meantime, I feel a bit torn. Of course I want the clinical officers to encourage pulmonary TB patients to bring their children in for screening if they are symptomatic. Isn't a chest x-ray a small price to pay if your child's life is at risk? Conversely though, if they can't afford the suggested screening, what are the emotional consequences of telling a parent their kid might be very sick but they can't do anything about it due to financial constraints?
I couldn't answer this question today so when the mom told me she could only pay for one x-ray, I contributed the rest to get the second. Luckily, both kids were TB free and mom (and I) are relieved. Here's to hoping that a more sustainable solution is on the horizon!
