Salma Khatoon is a 24 years old lady from a large urban slum called Pilkhana in Howrah, West Bengal. She is unmarried and lives with her parents.In the year 2019, Salma fell sick with tuberculosis (TB) of the spine, involving the upper three vertebrae of dorsal spine. She became paraparetic due to which she could not move or had any sensation in her legs. This happens due to nerve damage in the spinal column housing the nerves from the brain to various body parts and backwards.
If the spine of a human being is damaged due to pressure from the pus and bone chips produced by Tuberculosis, these nerves do not function anymore.
When we learned about Salma in July of 2019, she was bedridden already for one and a half months. This clearly indicated that she was already paraparetic (means, could not move the legs anymore), due to long delay in treatment. This would mean a much lower chance to recover after an operation of the spine and decompression of the nerves in its inner column. As a result, Salma had lost control over passing stool and urine (was incontinent), because the nerves coming down from the brain control the urinary bladder and the gut, too, which were damaged. Salma didn’t have any pain in the spine, that most patients with spine tuberculosis would experience.
In the tuberculosis hospital, she started the TB treatment immediately and had to be kept under the strict bedrest. Without any further delay, she was operated on July 29, 2019 by a surgeon in Ekbalpur Nursing Home, Kolkata. The damaged spine was bridged with a steel implant, that usually stays in the spine for rest of a patient’s life. Salma got all the services free including her operation where GLRA financed her medical treatment and hospital stay, including the salary of nurse who took care for Salma, and a different NGO financed the operation, that usually costs around Rs.80.000.
Salma recovered after the operation and was slowly able to move her legs until she was able to walk again. She was very happy about her recovery. After five months as inpatient treatment at St. Thomas Home, she was discharged but had to continue her anti TB treatment for many more months. Usually, we treat patients with tuberculosis of spine for 18 months, but Government gives free medicine only for six months. Salma was happy to get the medicines from GLRA to complete her treatment after 18 months.
Salma returned to us in August 2020, roughly one years after her first admission to St. Thomas Home. She was tetra paretic again, means, she again couldn’t move legs anymore, but this time, additionally, she couldn’t move her arms anymore, too. She didn’t have any feeling in the lower part of the body. In this episode, she was able to control stool and urine. Reason for her paralysis was a relapse of tuberculosis in the upper dorsal spine, around the steel implant. Patient was terrified about this second episode of paralysis.
Salma was operated once more on September 14, 2020, this time by Dr. K. K. Mukhopadhyay in Genesis nursing home, Kolkata. He removed the bone chips and pus which were sent for microscopic examination and culture of TB germs. This means, the germs in the fluid that has been removed during the operation were tested whether they show a resistance against important anti TB antibiotics. Unfortunately, such resistance of TB germs against important antibiotics is widespread in India and creates much more individual suffering. In Salma`s laboratory test, it was shown that the TB germ that created a problem the second time in her, was resistant against the most important antibiotics for TB germs, namely Isoniazid, Rifampicin and Ethambutol. We did not know whether this resistance against antibiotics had been there already in 2019, or whether resistance was created afterwards. Probably, there were few drug-resistant TB germs already there previously that broke through the immune system and created damage at the same position of Salma`s spine again.
After the operation, Salma recovered again after few weeks, and is now able to walk again. This time Salma gets other combination of antibiotics against TB than before. At present, she gets altogether six antibiotics for nine months. She is one of the few patients who got the new antibiotic drug against TB, Bedaquilin.
Salma is still in our hospital but would be discharged in the near future. She needs to complete her antibiotic treatment and shouldn’t miss even one single dose.
GLRA supported her complete treatment that has continued for many months. Salma has enjoyed all the services free and is now on the recovery path. We wish that TB never returns in her life.