PCL 12!

Patient History
Female
Vietnamese
23 years old
Paddy field worker
Married, has a 2 year old daughter
Progressive cough for a month, with bloody sputum.
Wakes up at night drenched in sweat
Complaints of fatigue and fever
Previously diagnosed with HIV and not on antiretrovirals
Previously worked as a sex worker
Child showing similar symptoms

Differential Diagnosis
• TB
• Cancer
• Smoking
• Emphysema
• Flu
• Bronchitis
• Influenza/ URTI
• Pneumonia

What is URTI?
What is lower respiratory tract?
Why no previous AIDS treatment?
• Financial difficulty
• Distance. Access to healthcare
• Lack of symptoms
• Education- lack of awareness and her personal education
• Doubts on existence of disease
• Taking time off work??
• Alternative medicine. Cultural beliefs
Doc’s responsibility
• If tests during window period, AIDS not diagnosed.
• Failure to reach her

Vietnamese Healthcare compared with Malaysian healthcare
• Viet Gov subsidizes 20%, high ratio of patients to doc, 14.8 beds/ 10000 people
• Viet spends 0.9 % of GDP for healthcare
• Insurance and clinics exist, but patients left for dead due to failure to pay
• Acupuncture
• Anti malaria drugs reduced morbidity
• Victims of HIV in Viet most discriminated
• Upgading in water, sewage, sanitation prob, cholera, dengue, malaria.
• 8 nurses per 10000 people, 20 per 10000 in Malaysia
• Life expectancy 75.
• Healthier people, cycling, no McD lol.
• Infectious diseases?
• Malaysia has more chronic diseases.


Learning issues
• TB normal stuff ( 3 people- amlah, teh, gurki)
• ALL somehow related to management of infectious diseases, what is BIG Pharma? TRIPS? The Doha and August Declaration? What is Track 2? Why hasn’t there been a new TB drug in over 30 yrs? ( jonathan, rezza, jin li, Nicole)
• Charlene, revathy,deena, sharvin – What is WHO? How does it relate to UN? Limitations these orgs face in bringing abt positive chgs in global health? Millenium goals?
• Val, Lincoln, dev – Intro to orgs, what is their goals?activities? how do they differ to WHO?why do they need support? Advertise for own orgs. Oxfam- val, Docs witout borders-dev, SAP-VN-linc