2 December 2015

The benefits of health education programmes for the youth, peer education in overcrowded prisons and the fact that access to available treatment was not always easy for the poor in remote areas were some of the messages received during a tour of DWF multi-drug resistant TB (MDR-TB) programme sites in the greater Buffalo City.

The tour group, hosted by the DWF MDR-TB programme, visited a varied group of intervention sites in the metropole which included Masakhe Primary School in Duncan Village, the maximum security wing of Fort Glamorgan Prison, the Dimbaza Community Health Centre and the recently upgraded Nkqubela Hospital in Mdantsane.

The tour party consisted of Dr Diana Wangari (Kenya), medical doctor and health journalist for www.citizen-news.org; Dr Karin Rønning, medical doctor with National Institute of Public Health, Norway; Kevin Carney from the US-based NGO, The United Way; Catherine Kolozsvari, Lilly, Geneva Switzerland; Nomampondo Barnabus, a community and HIV activist with The International Union against Tuberculosis and Lung Disease, SA; and Miriam Talia, Ethics and Compliance Director, Lilly SA.

The South African project officer for the Lilly-SA MDR-TB programme, Thandekile Essien also accompanied the tour.

Many schools, such as Masakhe – a large primary school in Duncan Village – have incorporated HIV and TB education programmes into school activities. Both the school management and SGB together with parents have actively embraced such programmes with parents granting consent for the screening of their children for TB.

Screening for infectious diseases is crucial in prisons as prison conditions are highly conducive to the spread of infectious diseases. The city’s Fort Glamorgan Prison is no exception. It’s an older prison where communal cells are overcrowded, conditions are not conducive to good hygiene and many areas are not well ventilated.

This makes the work of DWF’s MDR-TB peer education programme in prisons absolutely essential in addressing the spread of TB. Some 23 very proud prisoners were handed peer educator certificates during a morning of events held for World AIDS Day (1 December annually).

Peer educators and health promoters with the DWF also work within the larger urban and peri-urban areas such as Mdantsane and Dimbaza, where the tour party heard how valued these educators are. Senior management at the Dimbaza Community Health Centre told delegates that DWF peer educators played a vital role in assisting them in tracking patients – a vital service to the over-burdened clinic staff.

The staff highlighted one of the biggest complicating factors in treating TB was the mobility of people – as people moved around looking for work opportunities and livelihoods, this made it very difficult for busy clinic staff to keep accurate track of them.

Another issue was the heartbreaking situation where patients who had not responded to MDR or XDR-TB treatment were discharged and basically sent home to die. In preparing for their homecoming and the subsequent journey, the family needed a lot of education and social support. Here peer educators played a crucial role.

Last stop was the recently refurbished 150-bed Nkqubela Hospital, situated next to Cecilia Makiwane Hospital in Mdantsane. The group met with senior nursing and clinical staff from both Nkqubela and Fort Grey Hospital near East London airport.

The executive manager of Fort Grey Hospital, Mrs N. Nqini explained that the two hospitals were the main referral hospitals for the eastern region of the province, covering a very large area. The Eastern Cape is roughly the size of Uruguay at 168 966 square kilometres.

While Fort Grey is still the biggest MDR-TB treatment facility in the region, more and more patients will be referred to Nkqubela now that it has been upgraded. The plan is to double capacity over the next few years.

A big part of their work is outreach where they do a lot of capacity building in all 6 provincial districts. Here they relied heavily on DWF peer educators, Mrs Nqini said, adding that the educators tracked and traced patients who had stopped their treatment.

They painted a profile of TB in the province, saying most patients were young and that they needed a lot of psycho-social support as the treatment regime was very hard and onerous. Stigma was also a big issue in South Africa.

They pointed to an often-overlooked issue with TB treatment – the fact that while it is freely available it was not necessarily easy to access for poor patients, particularly from remote rural areas.

Mrs Nqini elaborated: “Patients have to take a taxi (and pay out of their own pockets) to a regional hospital in the rural areas. From there they will have to wait for patient transport or an ambulance for the journey to a treatment hospital in the cities and towns, a journey which could take 3 days in some cases, depending on where the patient is from.”

The group heard the heartbreaking testimony of DWF peer educator Xolelwa Joni who not only survived XDR-TB but also had to cope with the double tragedy of losing a twin sister to the disease and her mother passing away from cancer during Xolelwa’s treatment.

The recall was not easy for Xolelwa who asked the group to imagine taking 27 tablets daily and to enduring six months of daily injections. Patients also had to undergo constant drawing of blood samples as the drugs used to treat XDR-TB are toxic to the liver and some can cause terrible side effects such as hearing loss.

“People don’t know about XDR-TB, it’s everywhere and we still need help to spread the word and educate people,” Xolelwa said.

Xolelwa thanked and paid tribute to both the nursing and clinical staff during her treatment, adding that they were the reason she was still alive today and that she would not have coped without them.

Thandekile Essien of the Lilly-SA MDR-TB paid tribute to the work conducted by the DWF in Buffalo City as a good example of public/private partnerships, one that provided a crucial service which was much needed by an already struggling public health system.

Some of the delegates were on their way to attending the 46^th Annual World Lung Conference in Cape Town from 2-6 December 2015. See www.worldlunghealth.org

The Donald Woods Foundation is Lilly’s Eastern Cape partner in tackling MDR-TB and other diseases such as diabetes, hypertension and HIV both in the greater Buffalo City area and the deeply rural Mbashe district in former Transkei.