Hospital struggles with deadly S.Africa TB
Pastor Dale Morgan
Hospital struggles with deadly S.Africa TB*
26 Nov 2006 23:04:21 GMT
Source: Reuters
By Sarah McGregor
TUGELA FERRY, South Africa, Nov 27 (Reuters) - In a country where AIDS
kills 900 people each day, full hospitals and beleaguered doctors are
nothing new.
But at one hospital in rural KwaZulu-Natal province, what could be a new
public health nightmare is taking its toll as doctors and nurses grapple
with a new, highly drug-resistant form of tuberculosis.
At least 74 people, including staff, at the Church of Scotland Hospital
in Tugela Ferry have died since January 2005 after catching the
drug-resistant strain. Most were HIV-positive and their immune systems
were already weakened.
The new strain is resistant to most if not all of the lines of defence
against the highly infectious lung disease spread through coughing and
sneezing. Left untreated, TB attacks the lungs and can travel to other
organs, the brain and bones.
Last week, South Africa's health department said 263 cases of extremely
drug-resistant TB, or XDR-TB, had been recorded in KwaZulu-Natal, with
about 30 new cases being reported each month. Another 40 cases have been
recorded in other regions.
XDR-TB is particularly deadly for those whose immune systems have
already been weakened by HIV/AIDS -- terrible news in KwaZulu-Natal
where almost 40 per cent of the adult population is believed to be
infected with the virus.
"Everything changed in 1990 with AIDS. We had TB under control then,
maybe 100 patients. Now we have 800," said the Christian-run hospital's
chief medical officer Theo Van Der Merwe.
"With XDR-TB more people are dying. It's depressing because we can work
longer hours but I don't see it slowing down."
HYGIENE AND HEALTH
The World Health Organisation said last month the new strain could
become a major killer in AIDS-hit parts of Africa where governments have
been slow to roll out TB control programmes.
Experts say the best way to fight AIDS and TB in Africa is to overlap
strategies. But no new antibiotics have been developed for TB in 40
years and it will be at least 2020 before new treatments are widely
available.
Poverty and lack of resources complicate the problem.
In KwaZulu-Natal, the well-kept modern Church of Scotland hospital is a
stone's throw from dilapidated shacks where running water and reliable
electricity are luxuries and bucket toilets are standard.
The poor residents settled in the lush hills nearby are a target for
acute diseases. About 1.3 million of KwaZulu-Natal's 9.2 million people
are HIV-positive.
The hospital waiting-room is packed with patients who eke out a living
as subsistence farmers or sell small items like single cigarettes or
fresh produce at roadside stalls.
Inside the TB ward, the windows are wide open -- fresh air makes it hard
for TB germs to stay alive -- but the breeze offers little comfort to
the bedridden and fatigued.
Dozens are kept in crowded rooms. There are no vacancies and a waiting
list of around 50. Staff strap on surgical masks and patients cough into
cloths to prevent spreading the illness.
Doctors and nurses are on call day and night, stretched to
breaking-point because the hospital is short 20 medical staff and
efforts to recruit are hampered by a lack of specialists.
"My neighbour stopped coming over to visit. Finally she yelled (across
the yard) that she no longer wanted to sit with me because I work with
XDRs," said Thobeka Majola, 24, a nurse at the hospital. "I'm scared too."
UNCERTAIN THREAT
In many ways, life has changed remarkably little on the streets of
Tugela Ferry despite the arrival of the deadly TB strain. Friends greet
each other with outstretched hands, huddle to chat and stroll arm-in-arm
on the town's rutted roads.
But there are fears the disease might not be fully understood in an area
which has lost many of its educated residents to urban centres.
"I am not 100 percent sure but I've heard that you can die from it,"
said Jaheni Majolo, 36, who tested positive for the deadly strain and is
being treated.
The mother-of-five, a widow, said she expects to survive.
Elena Jordaan, the hospital's chief nurse, said she cranks up the volume
in the TB ward when Zulu-language television programmes talk about
XDR-TB in an attempt to teach sufferers.
"In some ways I don't think patients understand the graveness, in other
ways it could be denial," she said.
Doctors researching the outbreak theorise that the tuberculosis bug may
have become virulent after TB patients skipped treatment -- a relatively
common occurrence.
Medical experts say XDR-TB is present in other communities but the
strain in KwaZulu-Natal is alarming because of the high number of deaths
in an isolated region.
Critics say the government dragged its heels while the death toll
mounted, but the hospital's chief medical officer Van Der Merwe said
authorities have now pledged 53 million rand ($7 million) in funds to
fight the disease.
"We had hoped it would be something that we would get past but we
didn't," said Van Der Merwe. "The fact is we don't know what caused it
but we hope there is an answer."