Lungani Ngema (27) from Shakaville in KwaDukuza on the KwaZulu Natal North Coast was diagnosed with tuberculosis empyema (TB empyema) in November last year. While curable, this complex form of TB disease requires specialist treatment for a period varying from six months to nine months. 

In some cases, it can even take longer to complete treatment.  The specialist care Ngema needs is not available in his hometown. Since his diagnosis he has had to make the 76km journey  to see a cardiothoracic surgeon at King Dinuzulu hospital in Durban every month. 

“I cannot afford to go to King Dinuzulu Hospital. I am unemployed. I am struggling, but for the sake of my health I sometimes end up borrowing money from people I know so that I can travel from Shakaville to Durban,” Ngema says. 

“What’s even worse is that I can’t walk properly, I use crutches.  For my safety, I always ask someone to accompany me whenever I go to the hospital in Durban. I suffer from shortness of breath and collapse regularly. That is why I need someone to travel with me. But this also increases the bus-fare,” explains Ngema.

TB empyema 

To get a better understanding of Ngema’s condition, Health-e News spoke with Dr Ngcebo Mhlongo, researcher medical doctor at the Africa Health Research Institute (AHRI). 

TB empyema is the collection of pus in the space between the two layers of tissue that cover the lungs.

“It’s one of the many different presentations or types of TB. The pus contains live TB mycobacteria, therefore it is infectious if one were to come into contact with it,” Mhlongo explains. 

Since the disease is caused by the same bacterium that causes other forms of TB, treatment is with anti-TB drugs. 

“Treatment duration depends on several factors such as response to medication, HIV co-infection, other comorbidities, the type of empyema, involvement of lung tissue, and the need for surgery. Usually this condition is treated in consultation with specialist cardiothoracic surgeons,” Mhlongo adds. 

But healthcare services are concentrated in urban centres. This is especially the case for the specialised care that Ngema needs. Transport to health facilities is a recognised barrier to care. But up until now Ngema has had to make his own way, despite being reliant on public healthcare facilities. 

The financial cost and physical strain of getting to his regular check-ups are made more difficult because of a stoma bag Ngema got after an operation.  

A stoma bag is used in people who have had an operation called a colostomy. This operation is done for several intestinal conditions such as bowel cancer, Crohn’s disease, intestinal trauma, bowel obstruction and others where a section of the bowel needs to be removed. The remainder of the bowel is then connected to an opening that is created on the abdominal wall (called a stoma) to allow the patient to empty his bowels. A stoma bag is then placed over that opening to collect bowel contents. The bag must be emptied when it’s full. A stoma can be temporary or permanent.

“I also struggle to get enough of these stoma bags from the hospital, they are scarce. This sometimes forces me to empty, wash and re-use them again which I find very difficult to do. And I don’t think it is also healthy to do so. I deserve to have enough stoma bags. I can’t live like this,” Ngema adds.

Shortages of stoma bags have been reported in various public health facilities over recent months. 

Patient confidentiality

Upon enquiry about Ngema’s situation, provincial Department of Health spokesperson Ntokozo Maphisa tells Health-e News that the department “does not discuss in the media details pertaining to the clinical management of a patient as these are confidential, and doing so would be against the law.

Maphisa says the names, photographs and cell phone numbers of public relations officers, CEOs, district directors and operations managers are supposed to be on display at all healthcare facilities in the province. 

“This is to ensure that patients who may be aggrieved for whatever reason, have a channel for recourse,” explains Maphisa.

According to Mpahisa, the department has already been in touch with Ngema to help him find the care he needs closer to home. 

Intervention 

Ngema confirms with Health-e News that he has been contacted by the Department of Health to make transport arrangements with him after our queries. He will now be included on the patient transport services bus which transfers patients from rural areas who need to attend high-level healthcare facilities in distant cities but do not have other means of transport .

“I was also told that from now on going forward I am going to get enough stoma bags to use up until my next appointment to my surgeon. I am very happy with the outcome after I made contact with Health-e News.”

Mhlongo emphasises the importance of raising TB awareness as the disease is common in South Africa. 

“TB can cause disease in every part of the body, and it can complicate badly. Conditions such as TB empyema are a rare complication of TB,” he explains. 

“People must be encouraged to go for routine annual medical check-ups, to not ignore prolonged unexplained symptoms, and to adopt a healthy lifestyle. A person with TB empyema can be asymptomatic for a long time.” – Health-e News