Health authorities on Wednesday reported the first known cases of virtually untreatable tuberculosis in Botswana, following fears that the highly contagious strain has spread beyond South Africa.
The health ministry said there were two cases of so-called extremely
drug resistant tuberculosis, or XDR-TB, as well as 100 cases of the
slightly more manageable multi-drug resistant TB, or MDR-TB.
Although XDR-TB has been reported in other parts of the world,
especially former Soviet republics, it is particularly lethal in
southern Africa, where Aids incidence is high, because it combines with
Aids to kill.
Spreading in southern Africa
For the past few months, health professionals have warned that
XDR-TB, although only confirmed in South Africa, had spread to other
southern African nations like Swaziland and Lesotho hard hit by the
Aids epidemic, but hadn't been diagnosed because of lack of laboratory
Batatu Tafa, permanent secretary at Botswana's Ministry of Health,
urged health workers who develop chronic coughs or other symptoms while
managing TB patients, to have check ups. She also appealed to people
with HIV to be screened for TB.
The drug resistant forms of TB have developed largely because
patients don't stick to their six-month course of treatment.
Nearly 400 cases have been reported so far in South Africa, but
there may be more cases. Testing methods are inaccurate and out of date
and many patients die before they are diagnosed. Botswana is the only
other country in southern Africa with testing facilities.
Groups like Medecins Sans Frontieres have accused the South African
health ministry of failing to take the problem seriously enough.
The South African trade union Solidarity on Wednesday appealed to
the South African health department to draw up a clear strategy on
drug-resistant TB, given the scare after dozens of patients with the
disease escaped from two hospitals in the Eastern Cape province just
before Christmas, saying they wanted to spend the festive season with
South African police mounted door-to-door searches to compel
patients to return to the hospitals, and health authorities said they
would get tougher with forcibly confining sufferers. Eight still
reportedly remain at large.
Lack of capacity
"South African public hospitals simply do not have the capacity to
provide proper care for patients suffering from these highly
drug-resistant forms of TB," the trade union Solidarity said. It voiced
particular concern about its members in the mining and metal
engineering industries who work in stuffy confined spaces where
infection easily spreads.
"These are the people who will be at the greatest risk if sufferers
are not given the correct treatment," said Solidarity spokesman Jaco
Several provinces in South Africa have taken legal action to force
drug resistant TB patients to stay in hospitals in isolation units
surrounded by wire fences and protected by guards. Last year in Cape
Town, authorities confined a minibus taxi driver - who was a potential
risk to hundreds of people every day - after he insisted he could not
afford the loss of wages by committing himself to a hospital.
Although forced confinement of patients violates most medical
ethics, authorities say they have no choice but to put the wider public
good above individual rights. Confinement for XDR-TB is at least six
months, usually much longer.
South African authorities say they do not have the resources to
enforce isolation and treatment because the number of patients is far too high. – (Sapa-AP)
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