The Sunday News
Robin Muchetu, Senior Reporter
A CLOUD of dust hangs in the smelly hot air, all one can see are mounds of dirt strewn all over the place, young children can be heard chuckling in a nearby corner while flies buzz like bees all over. This is Ngozi Mine compound in the outskirts of Bulawayo.
The mine is a Bulawayo City Council dumpsite and home to a number of homeless people who survive on scavenging.
Mr Gideon Tshuma (50) is the chairman of the area and a successfully treated tuberculosis patient.
According to him when he fell ill he did not know he had TB.
“I fell ill and initially did not know that I had TB. I had been coughing for a long time, during the day I was much better but at night the coughing was extreme such that I would wake up with pain in my chest and lower stomach,” he said.
Mr Tshuma said he would then feel unbearable pain and he remembers getting an attack when he had visited the rural areas.
“I went to my rural area Bhazha in Matopo in Matabeleland South and while I was there I had an attack and I decided to go to the clinic to understand what it was. I was told that they wanted to screen me for TB and HIV and I agreed,” he said.
Mr Tshuma explained that he was given a container that he used to collect sputum that was then tested for TB bacteria at Maphisa District Hospital. The results came back five days later and it was positive for TB while his HIV test came out negative. After the test I was then counselled by the nurses at the institution.
“I was told and given a lot of information by the nurses on TB and HIV too. They told me that TB was curable and that people who get TB are not necessarily HIV positive,” he said.
He said he was encouraged to take his tablets religiously until the course was over to be completely cured of the infection.
Treatment was then initiated and he collected tablets every week which he would drink from his home.
“I would drink them every day at 8pm and I pushed three months and my sputum was tested again and I still continued treatment. In the fourth month of treatment the hospital suggested that I collect my treatment from Bulawayo since that was where I was based and I was also physically fit to go back to the city,” said Mr Tshuma.
He was told that if they supplied him with tablets enough for a month then if he ran out maybe he would not have any busfare to travel back to Maphisa hence they transferred him to the nearest clinic which is Cowdray Park Clinic.
Each Thursday he said he would go to Cowdray Park Clinic to collect his weekly medication until the treatment period of six months was over. He got screened for TB again and this time he came back with negative results. He had been successfully treated of TB which is still a challenge in the country despite it being treatable.
He said he had no challenges in collecting medication as he would walk to Cowdray Park Clinic each week.
He said people who develop drug fatigue compromise treatment.
“The moment you stop taking your TB treatment it affects how you heal and at times you end up having resistance to the TB drugs and your healing is affected,” said Mr Tshuma.
Asked how he was infected with TB he said it was not his first time being affected.
“My mother told me that I once suffered from TB and I was admitted at Thorngrove Infectious Hospital, I was about 5 years old. I was cured but then I got infected again. I think now the reason is because of the living and working conditions that we have here at the dumpsite. The air is very dirty and our homes are not well ventilated so I’m sure the bacteria was somewhere in the air and I was infected,” he said.
He also said there are a lot of dirty gases in the atmosphere coming from the dumpsite that could have also contributed to his infection. Furthermore he said their working space, the dumpsite, is a haven for bacteria to spread and said ventilation masks could assist while they scavenge. He said this will ensure that they do not spread the bacteria among each other as they work on a day-to-day basis.
Mr Tshuma, who stays with his wife and son, said his family accepted his condition and did not discriminate him, neither did they move out or think he was going to infect them. He said the family ensured that he was observing good practices such as coughing into his elbow and not spitting everywhere around their home as it could infect other people who come in to contact with it.
He encouraged his fellow scavengers that if they have a persistent cough and general unwellness they should visit the nearest clinic and get screened for TB so that they start treatment. Mr Tshuma said those that are found to have TB should adhere to treatment in order for them be successfully treated.
However, Mr Tshuma also mentioned that he has been on PreExposure Prophylaxis (PreP) for the past 40 weeks and is still going on. Asked on why he is on treatment he said prevention was better than cure. He said he wants to ensure that he protects himself also from HIV infection.
The success in treatment of Mr Tshuma is chiefly because the Bulawayo City Council Health department has the best model for integrated Tuberculosis (TB) and HIV care in the country. This was said by the country director of the International Union against Tuberculosis and Lung Disease (The Union) Dr Christopher Zishiri. Dr Zishiri said TB has been prioritised in the country as there is a record high of co-infection of TB with HIV.
“With more than two thirds of TB patients co-infected with HIV, we have to prioritise integrated TB-HIV care under one roof.
We take pride that Bulawayo city has one of the best models for integrated TB-HIV care,” he said.
Dr Zishiri said The Union acknowledges that provision of TB medicines alone is not enough to end the epidemic.
“As a social disease, TB is largely stigmatised mainly due to limited understanding and knowledge of the disease in the communities. There is need for our leadership to take bold steps in so far as possible health seeking behaviour is concerned,” he said.
The Barcelona and the Bulawayo TB-HIV Declarations, which were signed by the First Lady Amai Auxilia Mnangagwa in April, echo well with the global drive to galvanise political commitment as they look forward to concrete commitments from Heads of States to end TB at the upcoming United Nations High Level meeting on TB in Moscow.
Dr Zishiri said for close to a decade The Union has collaborated with the National TB programme with funding mainly from USAid and the Global Fund to improve access to TB services across the country. The First Lady said the signing of the TB and HIV declarations is critical in light of the planned UN General Assembly High Level meeting on TB to be held this September.
“This meeting seeks to raise political priority for TB and secure commitment from Heads of States and Government for a co-ordinated global response against TB,” she said.
The National Aids Council donated TV sets to the BCC health department to promote access and utilisation of HIV prevention and general health education including TB and non-communicable diseases at city clinics. Health education is one of the strategies which can promote utilisation of HIV prevention together with other conditions such as cancer, TB, diabetes, blood pressure and family planning. The health departments can take advantage of the presence of people at clinics to promote the services and educate people about general hygiene through the use of televisions.
