Buddy system

SOUTHAfrica has one of the highest burdens of tuberculosis in the world, third only to India and China. World Health Organisation statistics indicate an estimated half-million new cases of active TB in South Africa in 2011.

And as we were reminded on Tuesday, World TB Day, TB is still the leading cause of death in South Africa.

For those of us who feel we’re unlikely ever to become infected with TB, there is another scary statistic: the website TB Facts.org says it is estimated that about 80 percent of all South Africans are infected with TB bacteria. Most show no symptoms at all, but should their immune systems be compromised, the disease could strike.

Given our vulnerability to TB, the Western Cape Department of Health appears to have taken a retrogressive step.

It has moved away from its longterm and successful TB DOTS – directly observed treatment, shortcourse – strategy; a therapy that had outpatients swallowing their medication in the presence of a volunteer.

Apart from prolonging the course of the disease, failure to take the medication can lead to the development of the frightening multidrug-resistant (MDR) TB, and the even worse extreme drug-resistant (XDR) TB.

HOWEVER, the good news seems to be that a strategy that empowers the patient, rather than having to be supervised like a schoolchild, seems to be working even better than DOTS.

This strategy has been borrowed from that used for Aids patients, who were put on an empowerment programme on self-management and treatment literacy.

The patient still has a partner, now known as a buddy, who visits the patient weekly, does a pill count, provides counselling and support, and educates the patient on the phases of the disease.

There are now 700 of these buddies or community care workers across the city, and the department has reported that the TB defaulter rate has improved in the metro, and so have TB cure rates.