As Durban readied itself to host the International Aids Conference next month, Kamcilla Pillay spoke to a doctor who beat the multidrug-resistant variant of tuberculosis
Durban doctor Uvistra Naidoo says he is living the dream, even though he does not know why he is still around.
“After my diagnosis (with multidrug-resistant tuberculosis), it took three years, one week and one day for me to beat the disease.
“This puts me in a unique position: I have been patient, doctor and now scientist,” he said.
Naidoo is a paediatrician at the Red Cross Children’s Hospital in Cape Town.
“I was very much a brat at the medical school because I never attended all my classes. In fact, I considered myself a sportsman. I was a pro junior tennis player and wanted to go to London to study but, because my father is a professor (and medical doctor) at the university, the free tuition kept me here,” he said.
His attitude changed when in third year he met “an incredible mentor” who inspired him to get into paediatrics.
“I used to join a lot of the Red Cross flying missions, and I think when we had to choose where we wanted to go after our studies, the Red Cross Children’s Hospital appealed to me.”
When Naidoo finished his final year of medical school in 2008, he joined the hospital.
“Because I’d sustained a shoulder injury which prevented me from playing tennis, I took up road running instead. I wanted to do the Comrades and Two Oceans. I was just pushing myself too much – not eating and working long shifts.”
He lost 15kg in six weeks, going from 63kg to 48kg.
When he returned to Durban, his family attributed his weight loss to depression and the change in environment.
“I had the sniffles and a little bit of chest pain. I assumed that it was related to my running. My dad examined me and sent me for a chest X-ray, and we found that the chest was full of fluid.”
A sample was taken and sent to the labs for testing. The test came back positive for TB, and he was started on treatment.
But Naidoo’s condition worsened. Doctors thought he might have a pulmonary embolus.
After doing scans, they found that there was pus in his lungs, leading them to put in a chest drain.
The doctors then harvested samples of his lung tissue, but instead of putting one in a saline solution and another in formalin (as is standard procedure), they put both in formalin, destroying any hope of growing a culture to study the cells.
“It was a two-and-a-half-hour procedure, and they had traumatised the area between my ribs a lot. It really woke my eyes up as to what the patient goes through.”
Soon after the procedure, he began deteriorating throughout the night.
Nursing staff had just managed to persuade Naidoo’s family to go home and get some rest when he took a turn for the worse.
“The nurse ran out and said: ‘Quick – they are resuscitating!’ My family came running through.”
“I don’t remember much. It was weird because when you die they say you have an out-of-body experience. I was out of my body, and it was this very white environment, and I saw my family praying over my bed.
“That’s the only memory I have of that night.”
He remembered offering up a prayer to help his family to find peace if he did not make it.
“‘If I have to come back, just let me do something good with my life.’ The next morning I woke up and the sun’s rays were streaming through.
“I’ll never forget my time in Durban. I got to feel what a typical patient felt – their suffering, their pain.”
He said: “It’s human nature: we only appreciate life when we’re up against it.” A steady stream of people came to see him the next day.
Naidoo’s condition worsened, leading them to believe that he had contracted drug- resistant TB.
“The doctor in charge said he didn’t think so and was going to continue normal treatment. Within six months I would be good to go, so I still thought I was going to run Comrades!”
But, two months later, tests confirmed his worst fears.
“I was resistant to all drugs that they tested until one of the laboratories sent a sample to a professor who said it’s actually what we call pre-XDR TB now, or severe MDR TB.”
Naidoo began having allergic reactions to the drugs.
“I suspected that I maybe had TB in the valves of my heart.”
The other problem was ease of administration of the drugs.
“We opted to put in a catheter. It was a permanent in-dwelling catheter, much the same as what cancer patients get, so within a month or so I started getting a bit of energy.”
Naidoo was desperate to go back to work.
“I pushed myself too hard and the catheter got septic … I then started getting another side effect – severe depression and anxiety.”
He said he contemplated suicide during that time, but immediately sought help from a psychiatrist, who advised him to begin taking antidepressants.
“I was already taking 23 tablets a day.”
He opted not to take the pills, fearing more side effects. To ease his anxiety, he began seeking out other activities such as bonsai and orchid growing.
Naidoo was still not gaining weight. He said doctors were looking after him as best they could, but were relying on experience rather than science. This led to his experimenting with his own drug regimen.
“I looked at the data from the pre-antibiotics. I used a high-dose Vitamin D treatment which was a vitamin used before we had antibiotics in the past.
“I started this in addition to my TB treatment, and I started getting better.”
This, he said, “struck a chord” in him.
“What we are doing is not enough.There is a big divide between scientists in a laboratory and the doctors behind the stethoscopes. There are smart people on both sides of the fence, but not a dialogue created between them.”
He said the experience had changed him.
“I’m coming from a place of pure humility. There isn’t a day I can’t feel for a person suffering from TB.”
Patients coming from a rural background had the utmost respect for the clinician.
“I feel there isn’t enough honesty with the patient.
“There is a lack of empathy. It takes a special person to be a doctor, but younger practitioners are starting to lose that.”
Since his ordeal, Naidoo has been awarded a fellowship to study infectious disease in the US and has been a research associate at the KwaZulu-Natal Research Institute for Tuberculosis and HIV (K-RITH).