I like to start by sharing a real story which I experienced in one of my visits in the field last year. I’m sure many of you working in the field have similar stories to tell. During a monitoring visit for our PPM program I came across a referral slip made out by a pharmacy staff referring a 36 year old woman to the DOTS health center.

Looking at the symptoms circled on the slip one could tell that this was certainly a pulmonary TB case; weight loss, fatigue, chest pain, fever, and cough with blood. We traced the referral to one of the district health centers where we found out that the woman had indeed gone for further evaluation, she was checked, diagnosed, given medication and sent home. We were told by the health center staff that since the first visit she came back twice, each time sicker than before, and was again send home, no TB. We decided to visit her at home where she lived with her husband, her in-laws, two small children and one baby. We asked the district TB officer to join us so he could be able to follow-up later on.

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