Sfx (SOUND OF SIREN)

KHOPOTSO: The siren signals that it’€™s time for lunch at the SANTA (South African National Tuberculosis Association) hospital in Springs, east of Johannesburg. SANTA is a non-profit, volunteer community-based organisation with a special focus on Tuberculosis. It’€™s usually quiet at this time as patients take some time off, except for those who are critically ill in the high-care unit.

MATRON ANNA-MARIE DANIEL/KHOPOTSO:

I’€™m Anna-Marie Daniel. I’€™m the matron of SANTA Hospital. Our hospital consists of 350 beds. We’€™ve got a high-care unit, a male ward, a female ward and a children’€™s ward. We also have an OT Department ‘€“ occupational health department ‘€“ where we teach the patients that are here an occupation, so when they go out they’€™d at least be skilled to generate an income if they need. So, let’€™s follow into our high-care unit’€¦

Sfx’€¦ (SOUND OF FOOT-STEPS and VOICES OF PEOPLE TALKING)

MATRON ANNA-MARIE DANIEL:

In the high-care unit, you can see we’€™ve got intravenous therapy for the patients. If they are having a lot of diarrhoea and vomiting we give them intravenous fluids.

KHOPOTSO: What about this patient that’€™s secluded in glasses there?

MATRON ANNA-MARIE DANIEL:

This patient is isolated because he’€™s got an abscess in his lung caused by the TB. Now his breath is very foul-smelling. And it’€™s very embarrassing for the patient to lie in an open ward where patients are with him in the ward. Therefore, we put him in this unit. There are extractor fans in the roof that take out the smell, so that the patient doesn’€™t feel embarrassed. So, we put the patient in there till the abscess is gone and then we bring him into the general ward…

As you can see our patients are on care’€¦ We do temperature monitoring for them. We do feeding. You can see the condition of our patients’€¦ Most of them are dually infected with HIV and AIDS’€¦ Our ward sister, that’€™s in charge of our high-care unit, Sister Lorna.

SISTER LORNA: All the very ill patients are in this ward. And all our admissions start here before we transfer them to the ambulant wards. When they are getting better we transfer them to the ambulant wards.

KHOPOTSO: How long, on average, does a patient stay in the high-care ward?

SISTER LORNA: It depends on the condition of the patient. Some stay for about three to four days, others stay longer.

KHOPOTSO: The high-care unit has forty beds and there is an occupancy rate of 70 ‘€“ 80% each day. It is interesting to learn that patients in this ward do not only have TB or are dually infected with HIV. Some have diabetes, skin conditions, and hyper-tension. These are all conditions that make it easy for one to get tuberculosis. But a huge proportion of admissions at this hospital are due to HIV-related tuberculosis.        

JAMES LEGODI:

I’€™m James Legodi, staying at Kwa-Thema. I’€™m 35 years of age’€¦ At the present moment I’€™m unemployed and HIV-positive. I’€™ve got this from 1999’€¦ In 2002 I was admitted at this hospital for tuberculosis and I was discharged. The tuberculosis was cured. In 2005, in January, I came back. The tuberculosis came back.              

KHOPOTSO: What is the reason for that – why your TB actually came back?

JAMES LEGODI: After I completed my treatment I got back to smoking, drinking liquor, and even the diet was not good because I told myself that the sickness has been cured.

KHOPOTSO: And what do the experts say? Here’€™s Matron Anna-Marie Daniel, again.

MATRON ANNA-MARIE DANIEL:

A healthy lifestyle, no drinking and smoking, eat healthy and do exercises, that’€™s the only way to boost your immune system to keep you healthy. And if you’€™re, like this gentle-man were telling you, drinking and smoking, then surely you will re-contract TB because your immune system is very vulnerable.          

KOPOTSO: Tuberculosis is the terrible twin of HIV. Coupled with Multi-Drug Resistant TB, HIV-related TB is a major threat to the control and management of the lung disease, which means that early detection in people infected with HIV can save lives.

MATRON ANNA-MARIE DANIEL:

One thing I really must stress is: TB is curable even if you’€™re HIV-positive.

KHOPOTSO: Until recently, people dually infected with TB and HIV could not be on simultaneous treatment for the two infections. One had to first be on TB treatment, whose protocol requires that you should be on treatment for six months to be cured. HIV treatment would only kick in after that period.

MATRON ANNA-MARIE DANIEL:  

The first thing that we do is we treat the TB’€¦ If a patient is very ill and it’€™s life-threatening, the HIV is more important at this stage than TB. Then, the doctor will first put the patient on the HIV treatment for two weeks. After that we’€™ll re-evaluate. The doctor will see whether the patient’€™s condition is better and then we will resume the TB management’€¦ Our patients that are at Stage 4 – where the CD 4 count is very, very low ‘€“ those patients will be put on antiretrovirals by the institution that has been accredited by the Department of Health’€¦ Here at SANTA the institutions that we make use of are Far East Rand Hospital, Tembisa Hospital and Natalspruit.      

KHOPOTSO: Most of the patients at SANTA Hospital in Springs are young, suggesting that they might have HIV. The oldest could be about 45. Daniel is not forthright as to what proportion of patients is dually infected with HIV.

MATRON ANNA-MARIE DANIEL:

Some of the people who come here know their status. But some of the people don’€™t want to know their status. We give them voluntary testing and counselling’€¦ and it’€™s an option for the patient whether they want to test or not. Once they know their status we do staging in HIV to see if they’€™re at Stage 1, 2, 3 or 4. If they’€™re very weak we send them to one of the sites where the doctor will then put the patient on antiretroviral treatment. Once they’€™re on antiretroviral treatment then we continue here in the hospital, to give them the treatment and monitor the progress’€¦ The ones that’€™s given us permission to disclose we’€™re having 37.7% of our admissions that are positive’€¦ If they don’€™t disclose we don’€™t give out any figures.

KHOPOTSO: We earlier spoke with James Legodi, one of the patients who disclosed their HIV status and is now on antiretrovirals and TB medication. Let’€™s hear how he’€™s doing.    

JAMES LEGODI:

Now I’€™m feeling alright’€¦ There’€™s much, much more progress. Since I’€™m taking the tablets I’€™m no longer coughing; my weight is coming back; for these months I’€™ve been staying here I’€™m eating a lot, the diet is alright.            

KHOPOTSO: Even though he’€™s HIV-positive and also has TB, James Legodi’€™s condition is satisfactory and he can be discharged soon. He’€™s left with three months to complete his six-month long TB treatment. But the cure for his TB lies squarely on his shoulders as only he alone can make the right lifestyle choices to ensure that he does not have a recurring tuberculosis.

e-mail: Khopotso Bodibe