Fx’€¦ People in a busy hospital.

Prof. MARY EDGINTON: Do you know why this is TB Week and, in fact, the 24th of March is World TB Day? Well, it’€™s because on the 24th of March in 1882 Dr Robert Koch, who is a German physiologist and microbiologist, announced to the world at a meeting in Berlin that he had identified the organism that caused TB ‘€“ the mycobacterium tuberculosis ‘€“ under a microscope. And this revolutionised our thinking about TB’€¦ Now we had proof that it was a germ.

KHOPOTSO: This lesson in medical history on the corridors of the TB Care Centre at Chris Hani Baragwanath Hospital, by Prof. Mary Edginton, is more relevant today as most South Africans seem ignorant about TB. Bafana, from Senaoane township in Soweto, is a young man in his early 30s. Until a doctor at Chris Hani Bara informed him last week ‘€“ on the 16th ‘€“ that he has TB, he had his own thoughts of what TB was.

Fx’€¦ People in a busy hospital.

KHOPOTSO: I met up with him at the TB Care Centre at Chris Hani Bara.

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KHOPOTSO: In a quiet consultation room he spoke to a nurse.  

BAFANA: Bengingazi’€¦ Bengazi nje ukuthi umuntu uma uneTB uyakhohlela’€¦ Ukwazi kwami lokho.

KHOPOTSO: He had no knowledge about TB. All he knew was that if someone had TB, they coughed a lot, he says. Sister Rosina Sekwati, the nurse in charge of the care centre, spent some 20 minutes talking with Bafana about the disease.

SISTER ROSINA SEKWATI: Asiyistopi i-treatment. Siyiqala until the end. And umauhamba, mhlambe uya ekhaya, thatha i-green card. Lauyakhona e South Africa yonke i-treatment ye-TB iyafana, ama-card ayafana. eClinic eduze lauzabeukhona uthatha i-card, uthola i-treatment yakho until uzeubuyele ngapha lauhlala khona, neh?

SISTER ROSINA SEKWATI:  I educate Bafana about TB because he doesn’€™t know what TB is. He has never heard of TB.

He thought TB is all about coughing’€¦ I educate Bafana about the importance of compliance to his treatment, the duration of the treatment, the importance of good nutrition ‘€“ what he must eat. I counsel Bafana.

KHOPOTSO: During counselling, it emerges that Bafana is unemployed. This is a concern for Sister Sekwati, who has been advising him to include lots of vegetables in his diet. In a curt response in isiZulu, Bafana informs her that he gets a government grant.

BAFANA: Ngiyahola angithi.

KHOPOTSO: Sister Sekwati then urges him to use the money to buy food, to take care of his body.

SISTER ROSINA SEKWATI: So, ngicela ukuthi usebenzise yona, baba. Utheng’€™ ukudla unakekele umzimba wakho, neh?

KHOPOTSO: He simply nods his head in agreement. Bafana’€™s left leg is amputated from just above the ankle and he walks on crutches. It’€™s with great difficulty to rise from his chair and step up on the scale for Sister Rosina Sekwati to measure his body mass. We hold him up on each side for support to climb on it. He measures a mere 44kg. Bafana earlier confided to the nurse that he has no appetite.      

SISTER SEKWATI: It’€™s important because we give the number of tablets according to the patient’€™s weight. Like Bafana, I prescribed 3 Rifafours for him. And the 3 Rifafours are for his body mass. Immediately the patient is on treatment he retains back his appetite. We expect him to gain that weight. So, we are using that as a baseline information.

KHOPOTSO: Rifafour is one pill – a combination of four tablets prescribed throughout six months of TB treatment. Bafana is initiated on the medication and then, referred to a clinic nearest to him.

SISTER ROSINA SEKWATI: I’€™m giving Bafana Rifafour for five days. I’€™ve educated Bafana to go to the clinic with the green card and the pink referral form because if he doesn’€™t present the two, then, he won’€™t be seen. The clinic is going to turn him back to us and it’€™s time consuming.

KHOPOTSO: What’€™s the purpose of the green card?

SISTER ROSINA SEKWATI:  Inside the card, every day after taking the treatment Bafana must tick, like it’€™s March here, the month. It’€™s the day. It’€™s the date. It’€™s the 16th today. Bafana took the first dose of his Rifafour’€¦ Now, I have ticked for him. For the 17th, I expect Bafana to tick. By the 20th, when Bafana reports to the clinic he must have ticked five times. I’€™m sending him to the clinic on the fifth day.  

KHOPOTSO: Bafana was diagnosed while admitted into a ward at Chris Hani Baragwanath Hospital two days earlier, on the 14th of March.

Prof. MARY EDGINTON: We did a small study in 2001/02 and found that only 50% of patients diagnosed with TB who were referred from the hospital to clinics in Johannesburg got there on time’€¦ And that we measured, seem(s) to be because patients didn’€™t have adequate knowledge about their TB or about where to go. And it meant that the hospital-clinic link was weak and the referral process wasn’€™t happening as it should have. We also found that there was a totally inefficient and incomplete system of notifying patients, so the hospital had no accurate record of how many patients were being diagnosed.                        

KHOPOTSO: Prof. Mary Edginton, manager of the TB Care Centre, explaining why it was formed. A year after its operation research was conducted to gauge the impact.

Prof. MARY EDGINTON: We found that 7 200 patients had been registered in those first 12 months’€¦ And that most of them ‘€“ 94% of them – had successfully reached a clinic, which meant that the education referral process taking place in the TB centre was effective’€¦ So, we then thought we’€™d proved that the hospital-clinic link had been established and that break was repaired.

KHOPOTSO: After the initial counselling and referral of the patient, focus on that particular client shifts. Knowledge of whether the patient, in this case Bafana, was sufficiently empowered to go to his nearest clinic in Senaoane for further counselling and treatment, will only occur once the clinic returns a detachable slip at the bottom of the pink referral form Sister Rosina Sekwati handed him. But, says Prof. Edginton, the system is not the best there could be.

Prof. MARY EDGINTON: We’€™re having difficulty in persuading clinics to do that diligently.