Too few resources to fight drug-resistant TB
Although cases of multi-drug resistant tuberculosis have increased dramatically at King George V Hospital, not enough resources are being allocated to fight the disease.
In addition, the hospital ‘ KwaZulu-Natal’s only referral hospital for MDR TB ‘ has had to discharge 150 patients who have not responded to any drug treatment at all.
‘They are resistant to all the TB drugs and we can do nothing for them,’ says Dr Garth Osburn. ‘A number of these patients are teachers, policemen and taxi drivers. While we told them that they should not to go back to work because they can spread MDR TB in their communities, it is very difficult to enforce this.’
Cases of MDR TB at the Durban hospital have doubled between 2000 and 2003, rising from 202 cases to 435 cases, says Osburn.
Since 1997, of the 3 200 patients treated for MDR TB, 650 have died.
At present, the hospital’s eight doctors oversee the treatment of around 500 MDR TB outpatients a month, as well as 240 inpatients. This one of the biggest MDR TB case loads in the country.
The hospital is being revitalised and three new TB wards accommodating a further 80 patients are being built. However, this is not enough to meet current demand.
In the past, the hospital could accommodate over 1 000 TB patients but the province has cut down despite the massive increase in TB cases in the province.
MDR TB is very difficult and expensive to cure, costing an estimated R60 000 pe patient.
The hospital’s cure rate is around 45%, including patients who have defaulted on their drugs or died, says Dr Aruna Ramjee.
‘We see them wasting away slowly. It is so heart-wrenching to tell them that we can do nothing for them,’ adds Dr Iqbal Master.
MDR TB can only be diagnosed from a culture that is grown from a patient’s sputum (mucus) and tested for drug resistance.
However, it takes three months before a patient is diagnosed with MDR TB at King George V because the hospital’s laboratory cannot afford to use the liquid MGID test that yields a diagnosis in six weeks.
This means that communities are exposed to highly infectious MDR TB patients for longer than necessary while their results are being processed.
‘It would help a lot if there was a shorter time between testing and diagnosis,’ says Dr Osburn.
In addition, there are no separate wards for MDR TB patients. It is thus likely that some patients with ordinary TB pick up the multi-drug resistant variety of TB from fellow patients.
‘Most of the children with MDR TB that I am treating do not have family members with MDR TB. Some could have picked it up in the wards,’ says Dr Sheila Bamber.
Ideally, MDR TB patients need to be admitted for four months for intensive drug treatment. Thereafter, they need to continue taking the medication for a minimum of a further 14 months and coming to the hospital for monthly check-ups.
However, many patients refuse to be admitted for such a long time. Others battle to reach the hospital for their monthly check-ups, according to Bamber.
A large proportion of the hospital’s patients come from northern KZN, and travel 600km to pick up their drugs.
Ideally, say the King George V doctors, one of the hospitals in the north of the province should become an MDR TB treatment centre. Patients with MDR TB should also get help with transport to ensure that they finish their medication.
Sfiso Nzama has been in the male medical ward for five weeks since being diagnosed with MDR TB.
It is the 28-year-old’s second bout of TB. ‘I had TB in 1993. My father also had TB and he passed away in 1992,’ says Nzama.
‘Yes, the nurses have told me how important it is that I must finish my treatment,’ smiles Nzama.
Nzama is one of the lucky ones. He is responding to the drug treatment and is starting to put on weight. However, worldwide around half MDR TB patients are cured. Those who do not get cured have a life expectancy of five years.
Dr Master says that MDR patients do tend to return to King George when possible ‘because we have built up a relationship with them. They’ve been admitted for some months and then you see them for another two years or so, so we have managed to build up a good relationship with them.’
* The Medical Research Council estimates that KZN has the highest TB rate in the country, with an estimated over 1 700 TB cases per 100 000 people and an estimated 174 000 cases last year.
E-mail Kerry Cullinan
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