St Luke's Medical Exam- Question on standard operating procedure

[chrismanilyn 4]

My fiancée went for her Day 1 at St Luke's in Manila for her medical exam. Her (my K1) and her daughter (K2) got through the day in a very short time (5am arrival, 10:30AM departure).

Because of our visa interview scheduled at the Embassy for April 16th, her "monthly visitor" (SHE WOULD KILL ME IF SHE KNEW I POSTED THAT!!) and then due to Holy Week resulting in St Luke's closing, we had a narrow window to get her medical exam before the interview.

Monday, April 2nd, she arrived, and followed the process for her and her daughter. As far as I can tell, she got her pregnancy test & chest x-ray, both got their blood drawn as well as physical exam and general interview. Then they said that she would have to come back the following week for the TB skin test, since the TB test staff was out on the next day April 3rd. I'm assuming they didn't do the TB skin test on her day 1, because that staff was out the rest of the week (presumably off on 3rd, 4th and the 5th and 6th they are closed). At first she requested to come back on April 11th, but then changed to April 10th so that she could have a chance to get the results prior to her interview on the 16th...they are telling her that the medical results should be ready to pick up on the 13th. I hope that's realistic.

AT ANY RATE, they told her that they both are required to take the TB skin test. I thought that it was only mandatory that the children take the TB skin test (??), so I was surprised to hear that they want her to take the test as well.

Is it standard procedure for both the child and parent to take the TB skin test? Am I reading too much into this, fearing that her X-ray was a cause for concern with the physician? OR, is the standard procedure for X-ray concerns to require the Sputum test immediately after?

Oh I'm on pins and needles for this one...I'm not worried about the interview but the bureaucracy and ineptness of the RP medical system (even if US approved) concerns the hell out of me!!!

But, live positive :-)

[JimVaPhuong 4,863]

In a normal course of diagnosis, a TB skin test would be performed before an x-ray. I've heard that St. Luke's usually skips the skin test for adults and goes straight to the x-ray, but they give a skin test to children. It would seem counter productive to do the skin test on an adult who has already had a chest x-ray. If they find a problem on the x-ray then they go to the next level of diagnosis, which is a sputum culture, and don't go backwards to the previous level of diagnosis.

I suspect that whoever said they both needed a skin test was in error. However, if they do give her a skin test and it turns out negative then it won't delay you at all since you have to wait for her daughter's skin test to be checked anyway.

The ineptness comes from people with different levels of training trying to perform as experts in multiple disciplines, including the legal requirements of immigration law, the technical requirements of the CDC, and the professional requirements of a medical examiner. It's a rare person who thoroughly understands all of them.

[Zharren Young 32]

in PI they normally request tb skin when if they find something on her xray. still that can possibly be negative or positive. keep your fingers cross

[sjr09 155]

They don’t skip adults for the skin test, or if they find something on x-ray it’s just not part of the requirements, or procedure. CXR is require for all adults age 15 and above, or children who had exposure to TB or history of TB disease.TB skin test is a requirement for applicants 2-14 years of age.

Better to post the right links for rhe 'medical exam for US visa applicants' then speculate http://www.slec.ph/us-visa-applicants.shtml#required-exams

[chrismanilyn 4]

JimVaPhuong probably hit the nail on the head, she was told she was taking the TBT in error, when in actuality it's her daughter taking it (as normal SOP...in accordance with the other posts here and info on SLE's website). Another possibility is my fiancee is confused!

IF she does have to take the TBT, will hope and pray that the nasty "false negative" doesn't pop it's head...if she truly had TB, of course I would want them to catch it and treat her, even though I understand the delays and complications associated with that. As I understand for TBT positive test results, they then go to the Sputum test...which will mean delays, up to 2 months. And then if the cultures still show positive indications of TB, then full blown treatment is required for 6 months.

Hope and pray!!!

Another note, from her account it does not appear they did the immunization interview...although if they do that at the same time as they would have done the TBT for her daughter then it doesn't surprise me. The TBT staff was not available.

[chrism07023 4]

I don't recall if my wife had to have the TB skin test or not, but I don't believe so. And i should add that she ended up testing positive for TB and successfully completing the 6 month DOT treatment...

From what I remember, the two tests performed are the sputum (the same test done 3 times) and the TB culture (the "gold standard"). These two tests were done due to her x-ray showing a shadow.

In this light, the skin test would essentially be a waste of time because even if it showed negative, they would still do the sputum and the culture (per the US government requirement). The skin test is an interpretive test and is not always accurate, especially since it will show positive for many people who were given vaccinated against TB as children.