MDR-TB treatment comes closer but not close enough

MDR-TB treatment comes closer but not close enough

As many as about 60 percent of patients started on treatment for multidrug-resistant tuberculosis (MDR-TB) will not be cured. With odds already stacked against them, Eastern Cape MDR-TB patients face a long and costly journey for treatment.

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In 2014, activists urged South African Health Minister Dr Aaron Motsoaledi to declare drug-resistant TB a public health emergency
In 2014, activists urged South African Health Minister Dr Aaron Motsoaledi to declare drug-resistant TB a public health emergency

MDR-TB is resistant to both of the most commonly used TB treatments and takes about two years to treat. Only about 40 percent of MDR-TB patients will be cured, according to 2010 figures cited by Director of the Department of Health’s DR-TB, TB and HIV division Dr Norbert Ndjeka in 2014.*

With just 2,500 hospital beds available for MDR-TB patients, the Department of Health began decentralising treatment out of specialised hospitals and into health facilities closer to patients in 2011.

In 2014, only 63 health facilities could treat drug-resistant TB patients. As of June, more than 400 sites nationally were treating DR-TB patients. However Eastern Cape patients say that decentralisation has not bridged the distance or money between them and their treatment.

MDR-TB patient Mahlubandile Sobantu receives daily streptomycin injections as part of his treatment at his local Goso Forest Clinic near his home in Hombe village outside Lusikisiki.

The injections are only part of his treatment.

Once a month, Sobantu must travel to 50 kms to Holy Cross Hospital to collect the handfuls of pills he must take daily. To do this, Sobantu must pay for transport to travel 13 kms from his home to Lusikisiki’s St Elizabeth Gateway Clinic. He and other patients can for wait hours at the clinic for planned patient transport to arrive and take them to the larger Holy Cross Hospital.

“Patients are told to arrive at St Elizabeth Gateway Clinic around 7 am to wait for patient transport that will transport them to Holy Cross,” said Sobantu, who added that like many unemployed patients he must borrow money in order to get to St Elizabeth Gateway Clinic.

“The waiting can be so frustrating,” he added. “On top of being sick and weak, now you wait long hours.”

Ambulances allegedly commandeered as patient transport

Sobantu has alleged that when planned patient transport vans does not arrive, ambulances sometimes ferry patients to Holy Cross. Neither patients nor ambulance drivers appreciate the situation, he said.

“The ambulances would be overloaded as they are not as big as the bus,” he told OurHealth.

“(The) attitudes of ambulance drivers made this road even worse for patients,” he added. “Drivers would tell us they are not employed for transporting MDR-TB patients, but that they are employed to transport sick patients that need emergency medical attention.”

[quote float= right]Drivers would tell us they are not employed for transporting MDR-TB patients… (They said that) even the traffic officers would find them guilty if they were to see (ambulances) overloaded”

“(They said that) even the traffic officers would find them guilty if they were to see (ambulances) overloaded,” he added.

The struggle for transport would not end there as patients said they also wait long for transport to take them back to Lusikisiki from Holy Cross Hospital. Sobantu remembers one particularly long wait.

“After we consulted nurses and were given treatment, (we) waited for transport but it didn’t arrive,” said Sobantu, who added that nurses waited with them as patients pooled money to buy food. “I will never forget the day where transport came at 12 midnight to collect us from the hospital (to go) back to Gateway Clinic.”

“If the government can change the system of referring Lusikisiki people to Holy Cross for MDR-TB treatment and decentralise medication to Gateway Clinic things would be better” he added.

According to the Treatment Action Campaign’s OR Tambo District Coordinator Noloyiso Ntamehlo said the organisation’s Lusikisiki branch is pressuring district health officials to move MDR-TB treatment into area clinics.

Qaukeni District Health Manager Nomahlubi Mayekiso said that she was not previously aware of the problems and would investigate the issue.

In March, the South African Human Rights Commission held a hearing into the alleged dearth of emergency and planned patient transport in the Eastern Cape.

The hearing drew hundreds of people from across the province. About 25 percent of those at the hearing reported having called for ambulances that never came. The commission is anticipated to release its report in coming weeks.

*[Updated 12:35 pm 10 September. This sentence was changed to correct an error. The sentence originally read that “about 60 percent of MDR-TB patients will be cured.”]

An edited version of this story also appeared on Health24.com