Dr Dalene von Delft contracted MDR-TB as a medical student. She and her husband have started an organisation, TB Proof, to advocate on behalf of health care workers.

Dr Dalene von Delft contracted MDR-TB as a medical student. She and her husband have started an organisation, TB Proof, to advocate on behalf of health care workers.

Imagine you have been on your feet for 29 hours, running from one emergency to another, now busy inserting a drain between a patient’s ribs and thick yellow pus from a tuberculosis empyema drains out. The patient coughs and it is sprayed all over you. You perhaps worry for an instant about how much of this you have inhaled, but then again, you are too tired to give it much thought.

The only thing on your mind is your bed and the intense relief it would provide from your burning feet.

This was me, before I contracted MDR-TB. I thought I was young and healthy, immune to getting TB.

Drug-resistant tuberculosis (DR-TB) has changed the way we view this occupational disease. TB is the leading cause of death in the working class of South Africa. Health care workers are three times more likely to contract TB and up to six times as likely to contract DR-TB than the general population.

If you’re a health care worker living with HIV, the chances of contracting TB can be up to 20 times greater.

Most sobering of all, up to a third of health care workers that contract DR-TB will die as a consequence.

Studies have shown that rigorous implementation of TB infection control practices are associated with a reduction of TB transmission to health care workers and to people living with HIV. In 2009, the World Health Organisation produced TB infection control guidelines that outline evidence-based, effective and affordable administrative and environmental infection control measures required to reduce the risk of TB transmission within hospitals.

TB prevention, infection control leaves frontline worker at risk

“Senior doctors claimed it would not help to wear masks…We were supposedly ‘TB proof’ in any case.”

Despite the documented risk and the recommended guidelines, implementation of TB infection prevention and control practices at our health care facilities remains poor for multiple reasons, ranging from structural, financial and human resource limitations, to professional apathy, and most sinister and neglected of all, stigma.

During my years of training as a medical student, we had very limited teaching in infection prevention and control practices and were not encouraged to protect ourselves from TB. Our senior doctors claimed it would not help to wear masks as we had all been infected with latent TB, or a dormant form of the disease, already. We were supposedly “TB proof” in any case.

Medical staff tend to be “uncomfortably relaxed” about taking precautions against the disease.

“If one does wear an N95 mask you are glared at by nurses and doctors alike,” said a senior medical student. “Why do we knowingly expose ourselves and our colleagues to this deadly disease?’

False beliefs or blame-seeking attitudes stigmatise the disease, and explain why health care workers don’t protect themselves or talk about it when they fall ill. Like other patients, their struggles remain hidden.

In an attempt to understand and eliminate mistaken and unfair beliefs an international campaign called Unmask Stigma was launched this year. On World TB Day, groups across the globe wore masks as an act of solidarity with TB patients and their carers.

Health care facilities should be places of healing, not contagion, and it is imperative that medical staff and the population they serve, are protected.

This starts with an acknowledgement that TB could happen to anybody; it is nothing to be ashamed of. In fact, surviving TB, particularly drug-resistant TB, is a feat of endurance worth celebrating.

By supporting every individual that becomes ill with compassion and understanding, I believe we can win this battle against the white plague and create a TB, and stigma, free generation.

This opinion piece was originally published in the NSP Review, released today at the South African TB Conference.