‘€œI don’€™t mean to be the bearer of bad news, but I think it is about time we spill the beans and talk about the reality of the matter’€, Dr Thokozani Mhlongo, Director of the Mpumalanga TB unit told a meeting marking the beginning of TB month, in Witbank, recently.

The reality is not pretty. Mpumalanga means the ‘€œplace where the sun rises’€. It’€™s renowned for its spectacular scenic beauty and abundance of wildlife. The province has a population of almost four million and is divided into three districts. They are Ehlanzeni, Gert Sibande and Nkangala. Then the districts are further divided into 18 sub-districts, but due to their size and the growing challenge of both TB and HIV, it was necessary to sub-divide them. Thus, the province has 23 TB and HIV sub-districts.  The human capacity to deal with the disease burden, however, pales in comparison as critical posts remain vacant from the top to the bottom.

‘€œIn the provincial office there are only three of us managing TB in the whole province. Each district has got a TB coordinator, but the work is at sub-district level and that’€™s where our challenge is. The sub-district coordinators that are currently there are not appointed; they are actually in acting positions. And the worst of all is we have killed one service at the expense of the other because some of them have been taken from mobile clinics, others have been taken from fixed clinics. You can’€™t say you are addressing a problem by creating another problem’€, Mhlongo said.

‘€œWe have got a number of home-based carers that are alleged to be doing DOT support, but, in fact, due to the poor integration we find a situation where they are predominantly concentrating on HIV and very little on DOT in terms of directly observing the patient taking the treatment. We don’€™t have people who directly observe the patient taking the treatment’€, she added.

A former nurse, Mhlongo knows that without a treatment supporter, a patient is likely to not take their medication. Data shows that the treatment defaulter rate in Mpumalanga exceeds the national average of 5%. Death rates also surpass the national norm of 7%.

‘€œWe’€™ve got a defaulter rate of 8.8%, which is very high. We’€™ve got a death rate of 10%. In the 10 causes of death in Mpumalanga province Tuberculosis is topping the charts as the number one cause of death’€, said Mhlongo.

She said the TB burden in the province is exacerbated by poor diagnostics and a delay in the confirmation of test results.  

‘€œWe currently have 612 per 100 000 total cases of TB in the province. We have got new smear-positive cases of about 276 per 100 000. That difference’€¦ The others are still TB cases, but we haven’€™t diagnosed them through smears.

In terms of making diagnosis we have got a serious challenge where patients are put on treatment without actually having sputums collected. Doctors are actually managing patients using radiology (using X-rays); others are just putting patients blindly on treatment’€.

But for now what’€™s critical is to get the human resources to deal with the TB epidemic that has established itself in the province. That, however, is an effort that is proving difficult and requires innovation.      

‘€œWe’€™ve got a severe staff shortage in the TB facilities because of a stigma, whether it’€™s real or it’€™s just perception, those are issues we need to deal with. We have managed to advertise some of the critical posts. We also want to recruit 2 000 DOT supporters. We want to appoint DOT supervisors, which we’€™ll call them ‘€œTB ambassadors’€.  Those would be the people that have lived with TB ‘€“ be it ordinary TB or MDR (TB) ‘€“ they know how it’€™s like. They will spread the word as well’€, said Mhlongo.

Lack of staff or not, the province has managed to improve on its cure rate. In 2004, the province had the lowest cure rate nationally at 32%. However, a 60% TB cure rate six years later is still bad. The national target is to obtain 70%. The province needs to do more, especially in Nkangala district. Its TB cure rate is below 50%, one of the worst performing districts in the country.