Prison over-crowding spreads TB and HIV
‘Our prisons are 140 percent full. In a cell supposed to hold 20 inmates, you might find up to 80 inmates,’ King Kumalo, provincial deputy director of health services in the Department of Correctional Services (DCS), told the annual meeting of Hospice Palliative Care Association yesterday.
So far this year, 120 prisoners have died of ‘natural causes’ (diseases) and eight of unnatural causes in KwaZulu-Natal.
‘When I started in the department, we used to have more unnatural deaths such as murder and suicide than natural deaths,’ said King.
Last year, 168 prisoners died of natural causes while 14 died of natural causes.
As a result of the high death toll, the DCS has brought in hospice workers to assist them to treat people with advanced disease who are in need of pain relief.
The HPCA, cares for over 70,000 patients at 200 sites countrywide, also has a memorandum of understanding with the SA National Defence Force to provide palliative care (pain relief).
However, hospice workers reported that HIV and TB ‘ particularly drug-resistant TB – were challenging their resources.
‘There is a shortage of beds for patients [with drug-resistant TB], patients have to travel long distances for treatment and many of the local clinics don’t do monthly tests on people with drug-resistant TB because they are scared of becoming infected,’ said Nonnie Mdaka from St Francis Hospice in the Eastern Cape.
Mdaka said hospice needed to start working with patients who had been hospitalised with MDR TB for a long period but were not responding to treatment, as these patients are ‘very depressed and worried about death’.
Hospice workers also expressed frustration that their HIV positive patients were still dying of TB, simply because it was not being diagnosed. TB often manifests outside the lungs, the normal site of infection, in people with HIV.
Dr Margie Hardman from ACTS Clinic in Mpumalanga said less than half of their HIV-TB patients in 2009 had pulmonary (lung) TB.
However, she said TB was relatively easy to pick up using a questionnaire that identified the symptoms of TB.
Sure signs, said Hardman, were ‘weight loss of more than a kilogramme in the last month, night sweats, persistent cough for over two weeks and swollen lymph glands’.
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