The Sunday News
MANAGING tuberculosis (TB) is a challenge for several health institutions in the country and managing Multiple Drug Resistant TB (MDR TB) is even worse but for Tsholotsho district a different story of success is unfolding. It is a story of change and hope for the affected. MDR TB is defined as tuberculosis that is resistant to at least isoniazid (INH) and rifampicin, the two most powerful first-line treatment anti-TB drugs. MDR-TB develops in otherwise treatable TB when the course of antibiotics is interrupted and levels of the drug in the body are insufficient to kill 100 percent of bacteria.
This can happen for a number of reasons. Patients may feel better and stop their antibiotic course, drug supplies may run out or become scarce, patients may forget to take their medication from time to time or patients do not receive effective therapy.
In Tsholotsho the District Medical Officer (DMO), Dr Thandiwe Mushunye, said they had constructed Drug Resistant TB houses where they quarantine patients who have MDR TB due to the complex nature of the treatment.
“We have built these TB houses in various areas of the district so as to accommodate patients that we have that are in the communities who are suffering from MDR TB. This is so because the people live very far from the hospitals,” said Dr Mushunye.
Several communities are far from health institutions such that coming to access treatment everyday is a serious challenge.
Dr Mushunye said patients that suffer from MDR TB need to be injected everyday for a period of eight months so walking a distance of about 10 kilometres everyday might result in some defaulting.
“We treat MDR TB for eight months and getting patients travelling for long distances is a bit difficult so we set up these MDR TB houses where one can be admitted for the period they are under treatment,” she said.
Tsholotsho, having a huge burden of patients with MDR TB, has seen it fit to put effort in their TB programmes so that there are significant changes in the cases of diagnosis and treatment.
One MDR TB house is at Pumula Mission Hospital and another is in Sipepa area. These half way homes have been assisting the community and changing their lives for the better as they are accessing treatment and coming out free of the contagious disease.
Dr David Wachi, a medical team leader with Medicins Sans Frontieres (MSF) said the half way homes were a solution to managing MDR TB and the hospital offered comfort for the patients.
“These (MDR TB houses) help to keep monitoring a patient as the strain of TB that they will have is strong and needs to be monitored well and considering some of our patients are far from the hospitals they are better off within the reach of doctors,” said Dr Wachi.
He said the half way homes offer refreshments to the admitted patients and the hospital occasionally gives food rations to them too.
In an effort to ensure TB is managed well Pumula rural hospital has created an all-encompassing facility that involves a sputum booth.
The DMO said patients who come and test for TB had to produce good quality sputum so that it is tested accurately for any TB bacilli so a sputum booth in a private well ventilated area was erected away from other people accessing the hospital so as to prevent the spread of TB pathogens.
She said according to the Patients Charter, a patient should have their dignity intact when they are receiving treatment.
“The sputum booth offers privacy and dignity of the patient, before some people were shy to cough when other patients were watching and thereby producing a poor quality sputum but with the sputum booth there is privacy,” said Dr Mushunje.
A laboratory at Pumula hospital was renovated by MSF in order to have various tests done at one place for the patients from TB, HIV and other diseases which makes it a one stop for patients as they can be tested and admitted to one institution unlike before where one had to travel to the city to access services.
The rise in HIV infection in the country brought in a lot of strain on hospital infrastructure such that the Government and its partners had to make several developments in order to cope with the changing times.
Mrs Sithabile Moyo, a member of Sibhekimpilo and Pumula support groups, said they formed support groups in the communities so as to help one another in dealing with the various diseases.
“We help others cope with illness, most people who have TB also test positive for HIV so in our groups we encourage each other on how to manage the diseases and asilamahloni lakho khathesi (we are not ashamed anymore),” she said.
Mrs Moyo said in the support groups they also visit the infirm in communities and assist them where they can. She bemoaned the influx of people coming from mainly South Africa who are ill.
“I don’t know why these people come when they are very ill when TB and HIV drugs are available in South Africa. I wonder whether they have the access in the first place,” she added.
The DMO also said a huge number of patients with TB were locals coming from South Africa to seek treatment in their home areas but she said they were managing both HIV and TB well.
Dr Mushunye also said convincing a patient with MDR TB to be admitted in to the half way homes was an uphill task but they were managing to encourage the patients on the benefits of them being treated at the centre.
However, today they have a high success rate of cured MDR TB through the inception of the half way homes.
The Provincial Medical Director for Mat North Dr Nyasha Masuka said the half way homes were a new innovation that came about in 2012.
“This is a new innovation in the district that came about when we were in a position to diagnose MDR TB. They are found only in Tsholotsho and Lupane in the country,” said Dr Masuka.
The table below shows the numbers of patients diagnosed, treated and those who died from MDR TB in Mat North.
The PMD said Mat North was one of the hardest hit in terms of HIV prevalence hence TB and MDR TB cases were also high.
A new drug is also being used to treat patients in this district which is said to prevent HIV positive patients from contracting the deadly TB.
“There is a new drug Isoniazid which prevents HIV patients from getting TB and it is one measure that were are using to ensure cases of TB are reduced,” he said.
