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  • South Africa: Clinic Offers Hope to TB Sufferers

    Source: http://allafrica.com/stories/200903240369.html

    South Africa: Clinic Offers Hope to TB Sufferers

    Anso Thom
    24 March 200

    Khayelitsha ? The tall woman walks from window to window, undoes the latches and flings them open. Next she negotiates her away through the throngs of people sitting on benches against the walls, some collapsed in the laps of their minders, others coughing behind thin, white, paper masks. Children squeal and run around, bored from waiting in the stuffy clinic. A stray dog is shooed away by a security guard.

    Site C Clinic in Cape Town's Khayelitsha township is organised chaos as hundreds throng to the health centre every day for various reasons, some to collect their anti-Aids medication, others to confirm their TB tests or simply for check-ups.

    For one group of people, the trip to clinic is a daily ritual. They have drug-resistant TB and are part of a groundbreaking pilot project that is treating patients in the community, under strict infection control measures, rather than hospitalising them for six months as is the traditional approach.

    The project is based on the premise that more patients will be diagnosed and successfully treated if they are supported to follow treatment in their homes and communities, than isolated in hospitals.


    After opening at least 10 windows, Busi Beko walks into a small examination room and removes a mask from a container against the wall, pulls it over her head and slides it over her mouth. Once a drug-resistant TB patient herself and HIV positive, Beko has an intimate understanding of what her patients are going through.

    Without missing a beat she turns to a male nurse injecting a patient and has a discussion with him before walking to the clinic's exit again, into the Cape Town sunshine where she pulls her mask down.

    She walks to a group of women and one or two men who are sitting on plastic chairs against a wall. The group, members of a support group for drug-resistant TB patients, meets every week at Site C under Beko's guidance, to share their challenges, fears and victories.

    While in the open air, where the risk of transmission is almost zero, the group all have their masks hanging around their necks, but once they board the taxis to go home or are at home, they have to wear the masks,. But this is not an easy choice when stigma is still deeply entrenched and people equate masks, with TB and TB with death.

    "I had terrible problems at home. My family were afraid of me. They wouldn't let me come near the children. I was at the point of moving out, but I was able to discuss it in the support group and Busi was able to speak to my brother, so now everything is okay," says Noxolo Mrwetyana (29), who arrived in Site C a year ago.

    "The neighbours would tell other people that they shouldn't come to my house. They would say: 'That lady has big TB'. I mean I was thin and I was wearing the mask at home, but I just told them that my teeth were sore or I was trying to keep the dust out, but still it wasn't easy," adds Mrwetyana.

    However, despite the obvious hurdles of stigma the City of Cape Town and Medecins Sans Frontieres (MSF) have made great strides in establishing a community-based drug-resistant TB programme in the Khayelitsha, home to more than 500 000 people, over half of whom are unemployed.

    The community-based programme emerged as an urgent necessity as Cape Town's drug-resistant TB hospital, Brooklyn Hospital, is unable to cope with the numbers. Patients sent to Brooklyn for six months witness many deaths and are cut off from their families as it is far away from Khayelitsha and not easy to reach via public transport.


    Beko was herself hospitalised at Brooklyn in 2006 after being diagnosed with drug-resistant TB. "The support group members tell me that this community treatment programme is helping a lot. How can they go to Brooklyn if they have kids and they are the breadwinner? They tell me that if they were told to go to Brooklyn they would abscond or default," explains Beko.

    A large number of South Africans are believed to die of TB without ever being diagnosed, compelling those working in the field to come up with new ways to encourage patients to be tested.

    According to the National Institute for Communicable Diseases there were more than 24 000 documented cases of multi-drug resistant TB (MDR TB) diagnosed over the five year period from 2004 to 2008 in South Africa. Of these 7% were found to be infected with extensively drug resistant (XDR) TB strains. Although high, these numbers are thought to be a fraction of the estimated drug resistant TB burden in the country.

    Of the nearly 6 000 people diagnosed with TB in Khayelitsha in 2008, 196 have been diagnosed with drug-resistant TB to date, a substantial increase from previous years. Experts believe the rise if mainly ascribed to better case detection.

    Dr Cheryl McDermid, who runs the MSF HIV/TB programme in Khayelitsha and oversees this pilot project, says it is tough to strike a balanced message, conveying on the one hand the seriousness and complexity of the treatment and the disease and on the other, the positive message that it can be cured.

    "Treatment for drug-resistant TB is nasty and it comes with a tremendous amount of stigma. People are very aware of XDR TB and believe they are going to die when diagnosed with a drug resistant strain. We need to break through that barrier," says McDermid.

    She admits that educating the community is tough, but that they are determined through their support groups and various education drives "to make it okay for people to wear masks, to catch a taxi wearing a mask". For now the project has make inroads in encouraging taxis to keep windows open and to encourage cough hygiene among users.

    Executive Director for Cape Town Health Dr Ivan Bromfield said the current way of treating patients in hospital had become unsustainable.

    Bromfield said the city was looking at rolling out part of the pilot programme to other districts. "The stark reality is that patients, if managed in the community, are more likely to stick to their treatment." However, he pointed out that it was important that the project continued to work in close consultation with the hospital, which was the best option for some patients.


    "Personally, I can understand that being hospitalised could be a disincentive for many people. I ask myself, would I be willing to give everything up and go to hospital for six months?"
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