In DWF’s HEALTH IN EVERY HUT PROGRAMME, Community Health Outreach Workers (CHOWs) visit homes screening for TB, hypertension, diabetes, HIV and monitor maternal and child health. They record the location of homesteads using GPS coordinates. DWF CHOW,  Noalon Rolinyathi chats to Siyolo Mayeza during a homestead screening. Photo – Susan Winters Cook

Earlier this year, Foundation staff working in the Health in Every Hut programme met with the head of the TB unit at Madwaleni Hospital in an effort to forge stronger links and map out ways of assisting the unit with case identification and fostering treatment adherence for patients discharged from hospital.

Head of Paediatrics and the MDR-TB Unit, Dr John D. Lotz introduced the 180-bed hospital’s TB programme to both screening and embedded CHOWs. Madwaleni Hospital  serves the Mbashe health sub-district and has an estimated population of around 265 000. Some health researchers have rated the Mbashe area the eighth most deprived sub-district in the country.

Rural areas also have a high TB and MDR-TB burden with former migrant labourers (miners) and children under five years being particularly at risk. In remote rural areas, GeneXpert tests are sent to regional areas such as Mthatha, which then alert district hospitals and clinics of identified TB cases.

“Sometimes we have addresses or approximate locations but clinics often do not have the resources to follow-up these cases. We struggle to get to the homesteads of these patients. This is where DWF can really helps us by being our hand and feet on the ground,” Dr Lotz added.

He explained to health outreach workers what MDR-TB was and how they could both protect themselves from infection and counsel patients on infection control together with outlining treatment and drug regimens.

The treatment regimens for both MDR and XDR-TB are notoriously onerous for patients usually lasting up to 24 months with the possibility of severe side effects such as deafness from Kanamycin injections; nausea, vomiting and diarrhoea; renal failure and jaundice. This is one of the reasons that patients give up on their treatment, particularly in rural areas where bad roads and poverty make it nigh impossible for patients to access district hospitals and local clinics.

“Madwaleni has four outreach sites – Madwaleni, Xhora Community Health Centre (CHC), Willowvale and Dutywa – where we see our patients once a month on a Wednesday. We split the patients so that we see them at the closest outreach site to where they live,” he explained.

Ways in which DWF can assist

• By finding patients who have defaulted and somehow getting them to come back to Madwaleni to continue treatment;
• To caution and counsel close contacts/community leaders at homes of patients who have defaulted;
• By finding new patients and persuading them to come to Madwaleni for admission and treatment;
• With contact tracing and home visits of known DR-TB patients including contact tracing at homes and referrals to clinics for sputum testing; identifing contacts under 5 years and referring them to Madwaleni OPD; educating families (with their consent) on MDR-TB safety, risk and infection control, side effects and appropriate support; by discussing ways of making separate rooms available for infected patients to sleep; and
• By helping with adherence problems for problematic patients by possibly assisting with daily Kanamycin injections for patients who cannot travel to clinics and daily DOTS for tablets or frequent adherence counselling.

DWF is already integrating ongoing TB screening in huts and homes, supporting good adherence in TB patients to prevent treatment failure, holding MDR-TB patient support and education groups and community leader education sessions as part of the Health in Every Hut programme.

DWF Embedded CHOW team leader, Nomonono Maphoselo, is co-ordinating the linkages with Madwaleni Hospital.

For more on the Foundation’s urban aspect of the MDR-TB programme click here