A convenient untruth: The TB-proof healthcare worker

“For your first patient, please examine this man with pulmonary tuberculosis [TB]. He has excellent lung signs.”

I was a second-year medical student and this was our group’s first “real life” clinical examination. We were learning about the respiratory system and everybody knew that few diseases could rival TB in terms of the cavitating (ie, causing gaping holes) pathology it wreaked. Yet, a gaping hole of a different kind went entirely unnoticed during our fledgling training – our own vulnerability to TB. Our revered teachers would say, with trademark confidence, “Sure, you will all be infected, but you won’t become sick. So don’t worry about it.” 

To quote a comforting medical adage, “the patient is the one with the disease”. This helped us cope with so-called “second-year syndrome”, where students commonly associate any new personal symptoms or signs with a rare and terrible malady they had recently learned about. Hence, the rapid assurances by our seniors that TB disease, despite being the leading cause of death in South Africa, was one less thing to worry about. 

A year later the first stirring of doubt cast a fleeting shadow. A classmate became ill with TB. “What was wrong with him/her?” Because we were taught to believe something had to be wrong, right? Another in fourth year, and in fifth year, two in the final year – anomalies, rumours, myths. We shrugged off these troublesome aberrations, because we would be real doctors soon. Those who care for others, not themselves. 

A decade later three precocious third-year medical students came to my office in the Division of Haematological Pathology at Tygerberg Hospital. Not because they were interested in the arcane art of examining blood, but because they could not believe that they had been told they were “TB-proof”. Google was quite the thing by now, and it clearly found that they, and all other health workers, were at a three times increased risk of becoming sick with the disease they were supposedly impervious to. Even worse, the risk for drug-resistant TB was up to six-fold higher. Heresy! Except my wife, who worked in the same teaching hospital, was sick with MDR-TB (multidrug-resistant TB) at the time. (Barely) living proof that they were right. The evidence was right. What the fact? 

Hiding in plain sight 

Two years earlier, my cousin, who was also my flatmate and fellow junior doctor at the time, had become ill with TB. Three years later my brother was diagnosed with isoniazid-resistant TB while working at a private hospital. After further inquiry so too had my GP (general practitioner) uncle a decade ago. And he. And she. And yet another one – after every educational talk at least one colleague would come forward. If you tell me your dirty little work secret, so will I.

We were overwhelmed by the magnitude of our ignorance. The magnitude of the most common occupational disease among health workers in South Africa. Hiding in plain sight, yet driven underground by stigma and brinkmanship and fixed false beliefs. Why were patients “no longer” the only ones with the disease? 

There are at least three reasons, as it turns out:

1. Places where health workers work attract sick people, who then continue to be sick when they arrive.


2. These places of work do not take TB prevention seriously, in defiance of multiple WHO guidelines dating back decades.


3. Everybody keeps on breathing.