Time to translate words into action
‘I can’t hear you,’ says Don Enarson, cupping his hand behind his ear.
‘I am stopping TB,’ the more than one hundred nurses and TB care workers reply, this time louder.
Enarson smiles: ‘How many people in this room can say this?’ he asks.
‘We have to do better than we are doing now. We have seen a miracle in South Africa over the past years and I believe we can soon start to turn the corner,’ he tells the health workers from various Cape Town clinics, meeting to receive certificates and trophies for outstanding cure rates, improvements and various successes, often against great odds.
‘I am encouraged by the figures I have seen today,’ Enarson says after the ceremony.
Enarson is the director of Scientific Activities at the International Union Against Tuberculosis and Lung Disease, a body formed to help lower-income countries assist with technical advice around TB and lung disease.
He believes it should be possible to eliminate TB. ‘It should be possible, but are we going to? That is another question,’ says the Canadian professor, who has in the past acted as a TB advisor to the South African health minister.
‘We would have to turn socially and economically against the germ, then we can get somewhere. This means people have to advance socially, but the gap between rich and poor promotes TB.’
Enarson strongly believes that, in South Africa, it is time to translate political commitment into more human resources.
‘I am encouraged by the TB figures I saw today for Cape Town, but they are achieving this against great odds. These health workers are amazing. If you make the calculations for Khayelitsha, you would need one nurse per 100 patients, which means you would need around 53 TB nurses in this district.
‘That’s what they are doing in Tanzania, Malawi and Mozambique, but too often the response is we can’t do it (hire more people). But it’s lack of human resources that is killing patients.
‘This is why I am saying some areas are achieving results against all odds. It’s a miracle, but it is not correct to put this kind of pressure on people. These are super human beings,’ says Enarson, gesticulating with his hands.
One of Enarson’s main concerns is the carelessness around infection control. ‘The combination of TB and HIV is frightening and we need to be more careful. It’s a pity that it took something like Tugela Ferry (where extensively drug-resistant TB was diagnosed) for people to take action.
Commenting on South Africa’s insistence on institutionalising drug-resistant TB patients, Enarson points out that international opinion is the opposite.
‘We need to treat people in their homes and in the community. There is a greater chance that you are going to mix vulnerable HIV people with drug resistant TB patients in an institution. You can’t keep people for months on end. They have a life to live. This is not the way forward,’ he says.
Enarson also believes the international community ‘has no clue where we’re at’ when it comes to extensively drug resistant TB (XDR TB). ‘We really have no information or clinical experience,’ he says.
Enarson says that if he had to list the top ten priorities in TB, nine would be developing a vaccine. ‘It is remarkable the amount of money that is now going around, compared to 10 years ago.
People I trust tell me that they kind of think developing a vaccine is impossible, but even if it is, we need to pour enormous amounts of money into it, proving that it is impossible.’
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