The dark side of TB
Access to the MDR-TB unit at Klerksdorp Hospital is carefully monitored. A big notice outside the door reads in capital letters: ‘UNAUTHORISED ENTRY PROHIBITED. RING BELL FOR ATTENTION.’
KHOPOTSO: Once I’m inside the unit, hanging up on the ceiling above my eyes is yet another sign. This one reads: ‘MULTI-DRUG RESISTANT TB IS A CONTAGIOUS DISEASE. YOU ENTER THIS WARD COMPLETELY AT YOUR OWN RISK.’ At this stage you might wish that the sign was rather placed outside. Ann Preller is the TB co-ordinator for the North West province.
ANN PRELLER: MDR-TB is the dark side of tuberculosis. It’s potentially incurable. But so far, we can succeed in curing between 50 ‘ 60% (of patients) in our unit. You may contract the disease and not be cured and die within two to five years’¦
KHOPOTSO: MDR-TB ‘ what causes it?
ANNE PRELLER: MDR-TB is mostly a man-made phenomenon. You get it because people are treated for ordinary TB with an incorrect treatment regimen for too short a period of time, or with too small doses. That is usually the mistake on the part of the health system. But the other mistake is caused by the patient where he or she interrupts treatment and has to start all over again. Then you get a situation where the dormant bacilli that causes ordinary TB can be the mutations that become resistant to all the first line drugs.
KHOPOTSO: 35-year old Pride Macala is an example of an ill-effective health system. She first showed symptoms of TB in 1998, but when she went to her local clinic she was given a cough mixture and sent back home. In January 1999, weighing only 34 kgs she went back to the same clinic and only then did the healthcare workers run a sputum test to check for TB infection.
PRIDE MACALA: They gave me a bottle for sputum. After that I was diagnosed that I had TB. Then they put me on treatment. I took my treatment until month end of October 1999’¦ But it happened that after I had been discharged from the treatment I had some problems’¦ Then (in) 2000, January, I was back at square one ‘ TB again. Now that time it was so severe that I was coughing out blood. I was vomiting blood. They took me back on treatment. I had the injections for two months, but I did not recover’¦
KHOPOTSO: After further sputum tests Pride was diagnosed with multi-drug resistant TB.
PRIDE MACALA: Dr van Rensburg told me that I have MDR-TB. I didn’t know what MDR was. But she said to me: ‘It’s two things. If we don’t kill it it’s going to kill you’. Then, I was admitted in the ward on the 23rd of August 2001. I slept for four months. I took the treatment. It was so severe. I had a lot of the side-effects of the treatment’¦ My eyes were itching. They were so red. And I had a heart problem. It seemed like my heart re-acted in a sense that I had to take the TB treatment and the heart treatment because I was so swollen. They had to give me treatment that drains the water out of my body. I couldn’t walk a long distance. I had short breath. I was not normal. But, I recovered.
KHOPOTSO: Dr Marisa van Rensburg is head of the MDR-TB unit at Klerksdorp Hospital. I caught up with her at her office.
Dr MARISA VAN RENSBURG: It is five drugs we give. It’s a four-month intensive phase. The continuation phase is 16 or 20 months’¦ I call them the Big Five. The most important is an injection that we have to give for four months from Monday to Friday’¦ I usually tell the patients that the head of the Big Five is the lion. His bite is the worst.
KHOPOTSO: The drugs have serious side-effects, and that’s one of the reasons why patients often default on treatment. A total number of 316 MDR-TB cases have been treated at the Klerksdorp Hospital since the unit started operating in 2000. Of these 207 patients have completed the MDR-TB treatment and 58% are cured. Around 4% of the TB cases in the North West are MDR. Over 45% of the patients were also HIV positive and 58 have since died, mostly from AIDS-related diseases. Seven are resistant to the drugs and this is what Dr van Rensburg says of the situation.
Dr MARISA VAN RENSBURG: We don’t have anything else to offer them because there are no new drugs on the market.
KHOPOTSO: Pride Macala is lucky that she was not resistant to the drugs. She owes her life to them. She’s also lucky that when she infected her 16 year old daughter with MDR-TB she knew what to do because she had been there herself.
E-mail: Khopotso Bodibe
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