Three years ago Khayelitsha had a cure rate of just over 50%, but last year it had jumped to 72%.

While Khayelitsha carries almost a quarter of the city’€™s TB caseload load, 5 500 patients in one year, several clinics recorded cure rates of over 80%.

Site B TB Clinic in the heart of Khayelitsha is one of the star performers, an sees more patients that the whole of the Northern Cape.

 

Thobela Mhlubulwana, clinic manager at the Site B TB Clinic, proudly shows visitors around the facility which consists of prefabricated buildings centred around an undercover waiting area where TB and HIV services are offered under one roof. Showing that different spheres of government can co-operate, the city takes care of the TB services and the province provides the HIV services.

 

‘€œEvery TB client is offered voluntary counselling and testing and we will do all the blood tests if the patient agrees,’€ explains Mhlubulwana, a former professional nurse who has exchanged his nurse’€™s uniform for a suit.

 

Site B Clinic used to be one of the city’€™s worst performers. In 2003 the clinic recorded a dismal cure rate of 26%. By December last year the cure rate had increased to 59%.

 

Mhlubulwana ascribes its success to having access to statistics every three months and the allocation of extra nursing staff and clerks. ‘€œWe are able to very quickly identify problems,’€ he adds.

 

The clinic has also been streamlined with each of the five professional nurses taking responsibility for specific services such as new patients, re-treatments or the 37% of the patients who are treated in their communities.

 

‘€œSo, if there is a problem I can quickly check where it is and address it,’€ says Mhlubulwana, who reveals that the clinic is aiming for a cure rate of 70% by the end of March.

 

‘€œI know we are being ambitious and it will not be easy because of the workload,’€ says Mhlubulwana.

 

Those nurses responsible for the new cases see between 130 and 150 patients a day while the nurses looking after the re-treatment cases see between 100 and 120 a day.

 

Mhlubulwana says it is not easy to keep staff motivated. ‘€œI allow them to vent and try to have individual meetings as often as possible.’€

 

Sister Manasa Mchiza slaps the open palm of her hand onto the wooden desk. ‘€œTouch wood I have not had TB. You pray to God that at least you don’€™t get XDR. But what can we do? Somebody needs to come to work,’€ says Mchiza who sees around 120 patients a day.

 

‘€œThey only thing you can do is try to boost your immune system and eat healthy,’€ says Mchiza, her black shoulder length hair touching the epaulets on her navy and white uniform.

 

Mchiza, who has been working at the clinic for over two years, says her motivation comes from seeing her sick patients get better.

 

‘€œThose are my people sitting out there. These are people who can’€™t afford to go anywhere else and if we don’€™t help them there is nobody else.’€

 

It is also no coincidence that the huge improvement in Khayelitsha’€™s cure rates coincided with the appointment of Dr Virginia Azevedo as the sub-district health manager.

 

However, Azevedo declined to be interviewed saying her staff deserved the credit.

 

Dr Ivan Toms, Executive Director for City Health, believes he knows the secret of his team’€™s success.

 

He leans on the massive oak table dominating his 22nd floor office with a breathtaking view of the city: ‘€œYou cannot manage a programme unless you have information (statistics) and we have taken ownership of the information we gather and closed the loop.’€

 

Extra human resources were also allocated to overstretched clinics thanks to funds from the province. Toms also credits NGO partners such as the TB Care Association, Medecins Sans Frontieres and Lifeline with contributing to the city’€™s success.

 

He acknowledges that in the past TB was left to the overworked TB nurses in the various clinics.

 

However, that has changed with the sub-district managers and clinic managers being held responsible.

 

‘€œWith the information at hand we are able to quickly identify areas where we can effect improvements. Often if you only access the information 12 months later it’€™s too late and patients are already dead and buried,’€ says Toms.

 

Toms does a patient head count every six months and re-allocates staff to various clinics depending on what the figures reveal. ‘€œI don’€™t think this is done anywhere else,’€ he proclaims.

 

Last year 12 clinics in the city showed a year on year improvement in their TB cure rates, this year the figure has risen to 26 clinics.