Exposing TB crisis helped save lives
Three years ago, the Church of Scotland Hospital at Tugela Ferry, in the rural Msinga district of KwaZulu-Natal was the epicentre of a deadly outbreak of extreme drug-resistant tuberculosis (XDR-TB). Chris Makhaye visited a number of facilities tasked wit
CHURCH OF SCOTLAND HOSPITAL
THE HEADLINES said it all. Fifty-two of the 53 patients initially diagnosed with extreme drug resistant tuberculosis (XDR-TB) at the Church of Scotland Hospital died within a month of contracting the disease. It was resistant to both of the first-line antibiotics used to treat TB, as well as two classes of second-line drugs.
People living with HIV are particularly susceptible to TB and most of the XDR-TB patients at Tugela Ferry were co-infected with the virus.
The story received national and international attention and may have come as a blessing in disguise.
Today the hospital is internationally recognised for its handling of TB cases, including multidrug-resistant (MDRTB) and XDR strains.
Some of its doctors have presented their insights at international conferences on how best to deal with the disease.
After the crisis, international aid poured in from the Stop TB initiative run by the World Health Organisation, Yale University, and various NGOs. South Africa’s Department of Health also began prioritising the area.
The government sent more than 100 tracing and tracking teams of specialist doctors, nurses, pharmacists and community health workers to comb Msinga and the surrounding areas, looking for new TB cases and patients who had defaulted on their treatment.
At the peak of the epidemic in 2006, Msinga was contributing more than two-thirds of the XDR-TB and MDR-TB cases in the province.
Since then, 488 cases of XDR-TB and 356 cases of MDRTB have been diagnosed
Tony Moll, Principal Medical Officer at the Church of Scotland Hospital, has led the efforts to turn the tide against have these strains from spreading (them) to others,” she said. “If we are to win the war on TB, we need to use this hospital as a benchmark.”
In 2008, South Africa recorded 576 new cases of XDR-TB, 6 219 new cases of MDR-TB, and 388 802 cases of ordinary TB.
“The numbers are still rising” Mvusi said, “but we are implementing new measures and hope by 2015 these figures will start to come
down.” the deadly TB strains, but says there is still more work to be done. “The TB prevalence rate is still very high. We get about 150 new TB cases every month.”
A member of the tracking and tracing team, who gave his name only as Themba, said that before their arrival, large numbers of people had defaulted on their TB treatment.
“Now almost every patient in the community is taking their drugs. They know it is a matter of life and death.”
Dr Lindiwe Mvusi, head of the national health department's TB unit, said the Church of Scotland Hospital and the district as a whole had been very successful in identifying potential TB cases, diagnosing patients, and quickly putting them on treatment.
The hospital achieved a TB cure rate of 83 percent in 2008, against the national rate of 60 percent.
“They have handled it well; they have achieved a high cure rate and prevented people who
KING GEORGE HOSPITAL, DURBAN
A TEAM of nurses and doctors wear their protective masks as they prepare to enter a ward and administer medication.
They are about to enter the S1 ward in Durban’s King George Hospital where patients diagnosed with the deadly extreme drug-resistant TB (XDR-TB) arrive from all parts of KwaZulu-Natal for lengthy treatment.
The facility also cares for patients with multidrug-resistant TB (MDR-TB) from the eThekwini district.
On the S1 ward, MDR TB patients are kept near the entrance and those with XDR are kept in a large isolated room at the end of the ward.
The vigilance of these medics is understandable considering that these TB strains are highly contagious and the cure rate is only about 20 percent.
The majority of these XDRTB patients are also at an advanced stage of HIV/Aids infection, and according to health authorities, die within weeks or months in spite of starting treatment.
King George’s chief medical officer, Dr Iqbal Master, said the hospital has 192 beds for both MDR-and XDR-TB patients. Thirty two of these beds are reserved for children under the age of 15 – who are treated in the paediatrics wards.
At any given time there are an average of 50 XDR-TB patients at the hospital.
“Most of the patients who are admitted here arrive in an extremely weakened state,” said Masters.
“We treat them for about two months, then refer them to the nearby Fosa hospital – which doesn’t admit patients directly, but is a step-down facility – where treatment is continued.”
He said most (49 percent) of the MDR patients admitted were from the eThekwini district, and the largest number of XDR-TB cases were from Msinga, where a serious outbreak occurred three years ago.
He said many of the patients with XDR-TB from Msinga had been admitted to the Church of Scotland Hospital.
Master said that because of overcrowding there, it was possible there had not been sufficient control measures to contain the spread of the disease.
“These control measures are now in place and we’ve seen that the numbers of people with XDR-TB from that area are slowly decreasing,” he said.
However, according to statistics, Msinga still accounts for 37 percent of KwaZulu-Natal XDR-TB cases, while Ethekwini district accounts for 32 percent.
On a tour of the hospital, we met Sizwe Shezi* in the XDR-TB section of S1 ward. He had been a TB patient at the hospital about four years ago. He said he had completed his directly observed treatment (DOT) TB course before he was sent home.
Earlier this year, he got very ill and his sputum test confirmed that he had developed XDR-TB. He was then sent to King George and he has been there for a month and two weeks.
“So far the treatment is working. My chest is not as heavy as when I came here and I can now breathe and walk easily,” he said.
Master said only 20 percent of XDR-TB patients were treated successfully. About 51 percent die, often just weeks after starting a XDR-TB regimen, which lasts for at least 24 months.
“We tend to focus on the negative because so many of our patients waste away and finally die. Some of them suffer from these strains and they are HIV-positive and their bodies cannot cope with so many drugs,” he said.
“(On) some of them, especially the XDR (patients), we try so many treatments and they don’t respond.
“The hospital has only so many beds and if they don’t respond they are referred to as failed treatment cases and are sent back home. Their lungs continue to decline and they usually die after some time,” he said.
“But there is a positive side. It gives us joy to see a person who arrives here as a scarecrow and who cannot not walk on his own recover after a few weeks of our treatment and starting to gain weight. Those are the good times.
* Not his real name.