Menkhu – Nepal
The name of the child in this story has been changed to protect confidentiality.
Menkhu was living in Nepal with her sisters in impoverished conditions when she first began coughing and experiencing chest pain. One sister took her to a hospital, but the doctor did not diagnose or treat Menkhu’s symptoms. That hospital was the first of many that Menkhu would visit while seeking a diagnosis for her respiratory symptoms.
Finally, in July 2011, a community health worker sent Menkhu’s sputum sample to the national TB center lab. When the results came in, Menkhu was diagnosed with TB and told to go to the nearest treatment center. When Menkhu reported to the treatment center, they again tested her sputum and, when it came back positive, initiated a full course of first-line drugs. Menkhu took her oral medications and received injections for nine months. Menkhu started to feel better and stopped taking her medications.
Two months later, in March 2012, her symptoms returned. When Menkhu returned to the clinic, they tested her sputum and performed DST. DST found Menkhu’s strain of TB was resistant to isoniazid, rifampicin, and ethambutol. Menkhu was diagnosed with MDR-TB, but she was not started on second-line treatment for three months. Second-line drugs are not available at all hospitals in Nepal, and as a result patients travel from all different districts to the same treatment clinics. Because patients are not provided with housing and travel support, they all prefer to stay at the hospital, leaving little room for new patients and causing delays in treatment initiation.
Eventually, in June 2012, Menkhu was started on second-line drugs. Eight months into her treatment for MDR-TB, Menkhu’s condition is deteriorating. She was admitted to the hospital because she is unable to keep her TB medicines down: “If I take any medicine, I immediately start vomiting and the medicine comes out. Again, I have to take another one.” Menkhu is taking 13 pills each day and has lost her ability to hear, a side effect of one of her medications. She is also losing weight. While her sisters still take care of Menkhu, ever since her MDR-TB diagnosis, they treat her differently: “I have separate dishes, utensils, and clothes now,” which makes Menkhu sad.