Crying with stigma
Tuberculosis hit the headlines recently in Mauritius and as I was doing the tuberculosis clinic recently, I was struck by a case. A young immigrant woman of African origin was part of a wider circle of contact tracing. She had a serological diagnosis of latent tuberculosis and we explained the minimal risks of conversion to active disease and those associated with treatment. We explained that she would potentially remain well.
She kept completely quiet during all this, her face a “tabula rasa”. What was I meant to do? Keep talking? Keep probing? Use silence as a communication tool as I had been taught? The specialist nurse who was with me looked at me and I averted my eyes.
Then she broke down loudly into tears and buried her face in her hands. I had no idea why she did that. My colleague was just as perplexed. She told us she was worried she would be an outcast and be left to die. Her beliefs were that tuberculosis was a “dirty disease”. We again explained that she was not ill and that we could offer her prophylaxis and that things would be fine. She eventually calmed down and left with her prescription.
The consultation left me shaken but as I reflected on it, I could not help thinking how lucky we were in this country to have a very accepting and non-judgemental society. In other countries, we hear of albinos being hunted down and killed. We hear of homosexuals being ostracized and persecuted. We hear of racism and very public displays of hatred. We encounter female infanticide in the hundreds so that some governments prevent the prenatal disclosure of the baby’s sex. And people who are afflicted with diseases such as tuberculosis or AIDS are considered “dirty” and prevented from leading a normal life.
How can we change things? Historically, changing mentality and ethos is a hard task. Thinkers and reformers have suffered the same fate as those they were trying to protect or enlighten. Remember when someone suggested the earth was round? He was ridiculed and cast aside. There is hope though with a newer generation of informed patients and members of the public. Widespread education campaigns coupled with ever evolving values and beliefs should make stigmas associated with some medical conditions disappear. AIDS is now a very treatable chronic disease. Tuberculosis is curable.
We have had it really easy here. I will understand my patients a little better now. The university students who got tuberculosis recently have nothing to fear.
Dr Avinash Aujayeb
Respiratory Specialist, UK