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What Do You Make of This?

Together with her first-year resident, Theoneste, and fourth-year medical student, Felix, Geisel School of Medicine Professor Lisa Adams, MD, works up a newly arrived patient on the infectious disease ward at the University Teaching Hospital (CHUK) in Kigali, Rwanda.

Recently diagnosed HIV positive, the patient has come by way of the emergency room with a bad cough, abdominal pain, anemia and a fever. It's not immediately clear what's wrong with him. It could be TB—he's already been started on treatment—but there are lots of other unknowns at this point. Like his CD4 count, for example.

Often, the team at the tertiary hospitals in Rwanda will see symptoms that have progressed well beyond what doctors would encounter in the United States, and textbook cases of conditions like miliary TB are not unusual.