Drug resistant TB poses greatest risk to healthcare workers
Until recently, Mandla* was a nurse at a Durban hospital. But for the past few months, he has been a patient trying to shake off multi-drug resistant (MDR) TB.
‘I became sick with TB in August last year. By January, I had finished my normal TB treatment but I still wasn’t cured and that is when they found I had MDR TB,’ says Mandla, a tall, thin man in his thirties.
‘I took my treatment properly without a break and this is the first time I have had TB,’ adds Mandla, who said he had lost both his appetite and energy.
It is highly likely that Mandla picked up MDR TB from one of the patients he cared for.
Healthcare workers are the most at risk of getting MDR TB ‘ and its incurable cousin, XDR TB.
‘MDR and XDR TB are no more infectious than ordinary TB,’ says KwaZulu-Natal provincial TB manager Bruce Margo. ‘These are not super-bugs that can infect people more easily.
‘South Africa has a very high TB rate, and there are a lot of people with active TB coughing and sneezing in their communities. So ordinary people are most at risk of getting TB.
‘But healthcare workers are most at risk of getting MDR and XDR TB as they are more likely to come into contact with them than ordinary South Africans.’
Margo estimates that in KwaZulu-Natal alone, there are around 40 000 people with active, infectious TB.
‘We know that we have under-estimated the cases of MDR TB, but even if we triple our figures, this would mean that there are 3 000 cases of MDR TB in KwaZulu-Natal. This poses far less of a risk than ordinary TB to ordinary people,’ says Margo.
However, the serious, drug-resistant cases were most likely to end up in hospitals cared for by nurses like Mandla and doctors like Dr Igbal Master, a long-term TB doctor at King George V Hospital, the Durban hospital with the greatest cases of MDR TB in the country.
‘About 10% of people with normal immune systems who are exposed to the TB bacillus develop TB,’ says Master.
‘If you are healthy, you are unlikely to get TB. I have been exposed to TB and MDR TB over many years and have not developed active TB. But there is a chance that, as I get older and my immune system weakens, MDR or XDR is waiting for me,’ says Master with a rueful laugh.
People with HIV are at great risk of getting TB, yet many healthworkers are reluctant to reveal their HIV status to their employers ‘ and they thus endanger their own health by working on wards with TB patients.
Since the public outcry over XDR TB, special masks are available for health workers but only one nurse in the male TB ward at King George was wearing a mask.
Masters says that most of the doctors have stopped using the mask, which is really uncomfortable in the tropical climate and ‘interferes with doctor-patient relations’.
Dr Shamila Maharaj, the hospital’s medical manager, says that it is hard to attract doctors to work at her hospital. Nurses’ salaries have been hiked to the highest grades to attract staff.
‘I had a young doctor interested but then he came back and started asking many questions about his risks and compensation if he became infected,’ says Dr Maharaj.
‘I think there should be some kind of incentive, like the inhospitable or scarce skills allowance, to attract health professionals as we are really struggling to get doctors,’ she said.
The many research institutes wanting to study drug-resistant TB could also help by providing sessional doctors, she adds.
At present, there are only seven doctors at King George V to oversee the 100 MDR TB patients, 30 XDR patients and 200 weekly outpatients who attend the bi-weekly clinics. These doctors are also assisting to treat patients at a new 120-bed facility opened in Durban’s Clairwood area which only has one doctor at present.