A deadly but beat­able foe

Lesotho Times - - Feature - Pas­cali­nah Kabi

WHEN Tha­bang Tšoeu (name changed to con­ceal his iden­tity) was handed a one-year jail sen­tence for armed rob­bery early last year, he had no idea this would be a life-chang­ing ex­pe­ri­ence in more ways than one.

A few days into his prison stint at Berea Cor­rec­tional Ser­vice in Tey­ateya­neng, Tsoeu’s health be­gan to de­te­ri­o­rate.

“I was sen­tenced to one year in prison af­ter be­ing con­victed of rob­bery. I was de­ter­mined to make my prison life as nor­mal as pos­si­ble but in less than a week, things took a turn for the worse,” Mr Tsoeu told the Le­sotho Times.

Mr Tsoeu nar­rated how he soon dis­cov­ered what he had thought to be a com­mon cold was, in fact, the be­gin­ning of the deadly tu­ber­cu­lo­sis (TB) in­fec­tion.

“I thought I was catch­ing a com­mon cold be­cause of the change of en­vi­ron­ment but I coughed con­tin­u­ously for days with­out get­ting bet­ter. My chest was painful and I felt weak dur­ing the day and sweated at night,” he said.

Mr Tsoeu was even­tu­ally taken to hos­pi­tal where he was in­formed he had TB.

“I was im­me­di­ately put on med­i­ca­tion, which I had to take ev­ery day for six months,” Mr Tsoeu re­counted.

“I was also told I had high chances of re­laps­ing if I stopped tak­ing my med­i­ca­tion within the six months pe­riod of treat­ment. I was warned of the pos­si­bil­ity of suf­fer­ing from a more deadly multi-drug re­sis­tant (MDR) strain of the disease in the event of de­fault­ing on treat­ment.”

With the warn­ing ring­ing in his head, Mr Tsoeu said he re­li­giously took his med­i­ca­tion, although there were times he felt like giv­ing up due to the se­vere side-ef­fects.

“I would vomit and dur­ing the first month, my feet were swollen, mak­ing it hard for me to walk. With the help of the prison of­fi­cers and my wife who fre­quently re­minded me to do it for the sake of our chil­dren, I per­se­vered with the med­i­ca­tion,” he said.

Mr Tsoeu has since been re­leased from jail and is now a healthy ven­dor mak­ing a liv­ing out of sell­ing fruits and veg­eta­bles on the streets of Maseru.

“I am for­ever thank­ful for the strong sup­port I re­ceived from fel­low pris­on­ers, warders and my fam­ily. I urge con­victs and every­one else to ad­here to the TB treat­ment no mat­ter the side-ef­fects,” he said of his ex­pe­ri­ence.

Mr Tsoeu spoke to the Le­sotho Times shortly af­ter the coun­try be­lat­edly com­mem­o­rated World Tu­ber­cu­lo­sis Day on 30 March at the Maseru Cen­tral Cor­rec­tional In­sti­tute. The day is ob­served an­nu­ally on 24 March and was held un­der the theme, ‘Unite to end TB’, this year.

World TB Day is one of eight of­fi­cial global pub­lic health cam­paigns marked by the World Health Or­gan­i­sa­tion (WHO), along­side World Health Day, World Blood Donor Day, World Im­mu­ni­sa­tion Week, World Malaria Day, World No To­bacco Day, World Hepati­tis Day and World AIDS Day.

This year, Le­sotho com­mem­o­rated World TB Day un­der a dark cloud af­ter WHO an­nounced it was now ranked first in TB in­fec­tions glob­ally. Ac­cord­ing to the World Health Or­gan­i­sa­tion’s 2015 Global TB Re­port, 852 in ev­ery 100 000 Ba­sotho suf­fer from the highly in­fec­tious disease.

Neigh­bour­ing South Africa is sec­ond with 834 peo­ple in ev­ery 100 000 be­ing in­fected.

The highly con­ta­gious disease is caused by var­i­ous strains of my­cobac­te­ria and is trans­mit­ted through the air when peo­ple who have an ac­tive TB in­fec­tion cough, sneeze, or trans­mit res­pi­ra­tory flu­ids. This makes it a highly un­pre­dictable and dan­ger­ous disease mainly at­tack­ing the lungs, although it can also af­fect other parts of the body.

WHO says the prob­a­bil­ity of de­vel­op­ing TB is much higher among peo­ple in­fected with HIV, leav­ing Le­sotho ex­tremely vul­ner­a­ble due to its high Hiv-preva­lence rate. At 23 per­cent, Le­sotho’s HIV preva­lence is the sec­ond high­est in the world be­hind Swazi­land’s 26 per­cent.

“TB now ranks along­side HIV as the lead­ing cause of death world­wide. HIV’S death toll in 2014 was es­ti­mated at 1.2 mil­lion, which in­cluded the 0.4 mil­lion TB deaths among Hiv-pos­i­tive peo­ple,” reads part of the WHO re­port.

For­tu­nately, TB can be treated if de­tected early. This is the one sil­ver lin­ing in what is an oth­er­wise dark and per­ilous world where the pa­tient who is not treated grad­u­ally wastes away and ends up as another sad statis­tic.

In her ad­dress dur­ing last Wed­nes­day’s com­mem­o­ra­tion, Le­sotho Cor­rec­tional Ser­vice (LCS) Com­mis­sioner, ‘ Matefo Makhalemele, re­vealed that 714 in­mates and 107 mem­bers of staff and their fam­i­lies had been screened that week for TB.

“Of the 821 peo­ple screened, 74 were sus­pected to have TB and more tests are be­ing run. I think we are do­ing rel­a­tively well as an in­sti­tu­tion given these fig­ures,” she said.

Ms Makhalemele, how­ever, con­ceded “74 is still a huge num­ber given the ca­pac­ity of this place and the fact that this disease mul­ti­plies faster where there are many peo­ple con­gested in one place”.

Ac­cord­ing to Ms Makhalemele, LCS was work­ing on boost­ing its health de­part­ment to en­sure the disease is con­trolled. New in­mates are screened for TB on ar­rival to min­imise chances of in­fec­tion, she added.

“How­ever, we have one nurse per cor­rec­tional in­sti­tute through­out the coun­try and this poses a chal­lenge for us given the num­ber of peo­ple these fa­cil­i­ties are serv­ing,” she said.

“We have a lim­ited bud­get for our health de­part­ment but I must stress that we have a good work­ing re­la­tion­ship with the Min­istry of Health who al­ways come to our res­cue ev­ery time we ask for a doc­tor.”

Ms Makhalemele thanked cab­i­net for the de­ci­sion to build new houses at Maseru Cen­tral Cor­rec­tional In­sti­tu­tion, adding this would “make a huge dif­fer­ence to the lives of these in­mates and peo­ple around them es­pe­cially in terms of disease con­trol”.

In her speech, WHO Rep­re­sen­ta­tive to Le­sotho, Dr Cor­nelia At­syo, praised the coun­try for com­mem­o­rat­ing World TB Day with spe­cial em­pha­sis on the lives of pris­on­ers.

“Al­low me to com­mend the Min­istry of Health for fo­cus­ing on pris­on­ers, among other groups, dur­ing their pre-tb World Day cam­paigns. Pris­on­ers are one of the vul­ner­a­ble groups that are usu­ally for­got­ten in many coun­tries,” Dr At­syo said.

“TB con­tin­ues to be a pub­lic health con­cern. There is an es­ti­mated nine-mil­lion new TB cases world­wide ev­ery year de­spite the huge in­vest­ment in health ser­vices in coun­tries in­clud­ing Le­sotho. Out of these, three mil­lion are still to be di­ag­nosed and treated, or have been di­ag­nosed but not yet reg­is­tered by the na­tional TB con­trol pro­grammes.”

Africa, she said, had the high­est TB and HIV co-in­fec­tion rates in the world and that MDR con­tin­ued to pose a se­ri­ous chal­lenge due to the pro­hib­i­tive costs of treat­ment and lack of lab­o­ra­tory ca­pac­ity to de­tect the disease.

“Although it is ev­i­dent that the pre­vi­ously in­creas­ing trend of TB cases had been halted and the re­gion is ob­serv­ing a de­clin­ing trend, it is im­por­tant to reach, treat and cure all pa­tients, es­pe­cially the vul­ner­a­ble peo­ple. These in­clude chil­dren, women, peo­ple liv­ing with HIV, di­a­bet­ics, refugees, min­ers, ex-min­ers, pris­on­ers and drug users whose ac­cess to ba­sic health­care ser­vices may be lim­ited,” Dr At­syo said.

“A pro­por­tion­ate num­ber of pris­on­ers come from so­cio-eco­nomic dis­ad­van­tage pop­u­la­tion where the bur­den of disease may be al­ready high and ac­cess to med­i­cal care lim­ited,” she fur­ther stated.

She said prisons re­main more vul­ner­a­ble and the level of TB in­fec­tions had been found to be 100 times higher than those of the civil­ian pop­u­la­tion. She said that cases of TB in prisons may ac­count for up to 25 per­cent of Le­sotho’s bur­den of the disease.

“Late di­ag­no­sis, in­ad­e­quate treat­ment, over­crowd­ing, poor ven­ti­la­tion and re­peated prison trans­fers en­cour­age the trans­mis­sion of TB in­fec­tions. HIV in­fec­tions and other patholo­gies more com­mon in prisons, for ex­am­ple mal­nu­tri­tion and sub­stance abuse, en­cour­age the devel­op­ment of ac­tive disease and fur­ther trans­mis­sion in prisons,” Dr At­syo said.

She urged gov­ern­ment and var­i­ous stake­hold­ers to unite in or­der to erad­i­cate TB.

Health Min­is­ter Dr ‘Molotsi Monya­mane also at­tended last week’s com­mem­o­ra­tion and as­sured in­mates that gov­ern­ment would not ne­glect them in the fight against TB.

“When I look at you, I see my sib­lings, neigh­bours and com­mu­nity mem­bers and you are not for­got­ten. You are still very much part of us and be­ing in this cor­rec­tional in­sti­tu­tion does not take away the fact that you are part of us,” Dr Monya­mane said.

“The min­istry will con­tinue to en­sure med­i­cal per­son­nel visit you be­cause be­ing taken into pub­lic health­care fa­cil­i­ties em­bar­rasses you.”

Dr Monya­mane also urged the in­mates to ed­u­cate each other about the dan­gers of TB.

“Please con­tinue to ed­u­cate each other and your vis­i­tors about the dan­gers of TB. It is not a good thing that Le­sotho is the high­est in the world with new TB in­fec­tions. It is also un­for­tu­nate that in Le­sotho, HIV and TB are now part­ners,” Dr Monya­mane said.

“Dur­ing last year’s TB screen­ing cam­paigns, over 1200 per­sons tested pos­i­tive and these were mainly re­peat-of­fend­ers or MDR.”

The min­is­ter said peo­ple liv­ing with HIV do not cough like other TB pa­tients, mak­ing it dif­fi­cult to de­tect the deadly disease at an early stage.

OF­FI­CIALS at the World Tb Day com­mem­o­ra­tion win­dow-shop in­mates’ dif­fer­ent crafts. The crafts are sold at dif­fer­ent prices.

lcs com­mis­sioner ‘Matefo Makhalemele joins the in­mates’ choir as they en­ter­tain masses at the World Tb Day com­mem­o­ra­tion.

health Min­is­ter Dr ‘Molotsi Monya­mane (right) hands over a health en­try book to his coun­ter­part Min­is­ter Moeketse Malebo.

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