[procaare] SA faces worst TB epidemic in the world.

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SA faces worst TB epidemic in the world.
- Mail & Guardian (03.27.03), Johannesburg.
********************

South Africa is said to be facing one of the worst tuberculosis (TB) epidemics in the
world, with disease rates up to 60 times higher than those currently experienced in the
United States. The HIV/AIDS epidemic has compounded the problem. It is now estimated that
out of the 13 of every 1 000 South Africans who will be actively suffering from TB by
2004, nine will also be HIV-positive. But patients at Tshepanong TB hospital are not
interested in the statistics. For many of them TB is an illness -- like HIV/AIDS -- which
they would prefer to keep quiet about. The hospital is situated on the outskirts of
Pretoria, near the township of Atteridgeville, and is home to about 120 chronically ill TB
patients.

Tucked away behind Kalafong hospital, the buildings are protected by a razor wire fence
and a stern security guard. "There are sick people here, you cannot just walk in," said
the guard.

The flowerbeds and lawns dotted with colourful benches are deceptively cheerful. But a
closer look reveals tired-looking patients who are anything but jolly. Taking advantage of
the midday sun, they quietly chat among themselves, and look warily at passing visitors.

The stigma and rejection they have encountered in their communities has made them
reluctant to talk about an illness, which is so closely linked to poverty and HIV/AIDS.

"This place is now seen as a hospice, people don't want to come near it and of course it
doesn't help that most of the TB patients are [HIV] positive," said Matron Sibongile
Mokwena.

Mokwena warned that TB education campaigns need to address the cultural nuances of the
disease. "There are still a lot of people who think that you have been bewitched or your
badimo [ancestors] are unhappy with you.

"We are still struggling to make people understand what TB is. Even after they are
admitted here, they are still influenced by relatives from outside," said Mokwena.

TB treatment, however, is "freely available" at all state health facilities, said Phumlani
Xhimiya, Acting Director of the Health Department's TB directorate. Xhimiya admits that
there are "pockets" of people in the country who might not be aware that TB can be easily
treated. Consequently, the government is embarking on a "huge advocacy campaign" to ensure
that everyone receives TB treatment.

Their first port of call will be traditional healers. "It is estimated that about 70% of
South Africans go to alternative healers when they are ill. So it is very important that
we strengthen our partnerships with traditional healers," Xhimiya noted.

The South African Red Cross Society (SARCS) has also been active. It has implemented a
community home based care project to provide care and support to around 5 000 people
living with HIV/Aids (PLHA?s) and other chronic diseases, such as TB.

Once SARCS volunteers suspect that their clients might have indications of TB they refer
them to the health service. If they are diagnosed with TB they monitor adherence to the
prescribed drugs and keep the health workers informed of the progress of the disease.

Despite these initiatives, however, TB treatment interruption remains a major problem.
After the initial intensive phase, "a person feels so well and so much stronger" that
continuing the treatment for four months seems unnecessary, Xhimiya said. But the tragedy
is that three or four months later, TB infection sets in, and this time more resistant to
the treatment.

Multidrug resistance TB is more expensive to treat. The first time around, treating one
patient with TB can cost up to R400 ($49), the second time around, it could cost up to R1
000 ($125). "The cost may escalate to R28 000 ($3 500), which includes hospitalisation for
up to 18 months," Xhimiya noted. Health care workers "may not convey appropriately enough
the importance of continuing with treatment," Xhimiya acknowledged. But Matron Mokwena and
her staff feel they are sometimes powerless to prevent treatment interruptions.

?When someone feels strongly that they do not belong here and don't need any more
medicine, they become violent and start attacking us. So what else can we do?"

She related how "on very rare occasions" patients have resorted to cutting the razor wire
fence to escape from the hospital. Clad in the regulation striped green and white hospital
clothes, one TB patient who asked not be named shrugged his shoulders in resignation when
asked about his condition. "Its better that I'm here. Matron and the sisters are good to
us, and at least I get good food here," he said.

According to a Stop TB fact sheet, poor nutrition can weaken the immune system and
increase the chances of infection and the development of TB. "Poverty is inevitably an
ever present phenomenon in TB -- this is both a disease of poverty and lifestyle," Xhimiya
noted.

To make matters worse, the impact of the HIV/AIDS epidemic is now being acutely felt at
the hospital. "Our budget is exhausted from the extra antibiotics, food, and napkins that
we have to provide to patient who are positive," Mokwena said.

The staff are overworked and need additional support. Two of the hospital's nurses
recently left to work overseas. "I don't blame them, you can't work in such a place -
after a while it depresses you," she added.

The death rate has now increased to about two or three patient a day, she noted.

But the bright colours of a window decoration, and the wildlife paintings laid to dry on
the trestle tables in the therapy centre are a sign that all is not lost.

"They need to be motivated and given hope, this [TB] is something that can be cured,"
Mokwena said. Community involvement and support was crucial to keep places like Tshepanong
going, she added. --

Source: Mail & Guardian (03.27.03), Johannesburg.

Cross posted from Aids-Africa TB&HIV/AIDS in South Africa
Aids-Africa is a forum for communication and information on AIDS related issues in Africa.
The views are that of the authors.
Web:  http://www.yahoogroups.com/group/aids-africa



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