The stereotype of a TB patient looks something like this: poor, black, malnourished, probably HIV-positive and living in overcrowded, unsanitary conditions.

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Poverty does make you more vulnerable to the disease, as does HIV, but no-one – especially in a country with one of the highest TB rates in the world – is immune.

I learnt about Bronwyn Thompson’s TB in a most unlikely context for someone in recovery from a serious respiratory disease: during a veldfire.

Bronwyn (22) and I had recently qualified as members of Cape Town’s Volunteer Wildfire Services (VWS), and were chatting during a lull in the action on one of our first fires when she mentioned matter-of-factly that she was undergoing treatment.

I was struck not only by how “against type” she looked – white, middle-class, athletic and (beneath the soot) glowingly healthy, but also, given the stigma of TB infection, how open she was about it. Still, I chose my words carefully when I approached her for an interview.

I needn’t have worried – she was enthusiastic about telling her story.

The “I-can’t-get-it” mindset
Bronwyn recalls the first signs that something was wrong, in August 2006: “My immune system was down. I had respiratory tract infections, a productive cough, and general flu-like symptoms that didn’t clear up for weeks. I also had pink eye. I was used to chest infections, because I’ve had asthma from childhood – so it didn’t seem that unusual.

“My boyfriend Tarren had in fact suggested I get tested for TB, but I had the ‘I can’t get it’ mindset. Also I didn’t have typical symptoms like weight loss – and the cough was fairly mild.

“But you don’t realise how long you’ve been coughing. In my case, it was easily six months.”

Bronwyn works as a medical technologist in a pathology lab, but it’s difficult to determine if that’s where she contracted TB. “It’s hard to pin down exactly where I might have got it. You can be standing in a supermarket queue and someone coughs, and that’ll be enough to get infected if you’re unlucky.”

Despite her ongoing health problems, Bronwyn, who was training in gymnastics at the time, continued to push herself. “It was increasingly difficult to do full exercise routines. My lungs would burn and my legs feel like lead. But I tried to just push through.”

In October 2006, Bronwyn took part in the SA Aerobics-Gymnastics National Championships. She was required to have lung function tests to prove to the South African Institute for Drug-Free Sports that she needed to take asthma medication, and these showed that her lung function was down – an indication of various respiratory conditions, including TB.

In early 2007, Bronwyn went to see a pulmonologist, who changed her asthma pumps. Then, with back pain caused by a suspected infection of the pleural cavity (between lung and chest wall), she went on more antibiotics and hydrocortisone.

“Eventually, my doctor did a TB culture – really just to eliminate it as a possibility.”

But this, together with chest X-rays, confirmed the diagnosis. The TB was fairly advanced: it was mostly in the left lung, with some tissue scarring, and there was also minor involvement of the right lung.

“It doesn’t happen to people of my ‘class’ ”
“When the doctor called with the news I burst into tears. My mother was at work with a client, and I just walked straight in and said ‘I’ve got TB’.

“I was distraught, but also ridiculously ashamed: my thinking was: it’s what you’d expect to find in the rural areas, in contexts of poverty – it doesn’t happen to people of my ‘class’."

The stigma around TB also doesn’t help when you have to tell those closest to you that you might have infected them.

“I had to tell my family and the group of interns I’d been working with. I was sure Tarren was infected (he wasn’t) – just before the diagnosis we’d gone on a camping trip and spent four or five days together in a tent! In the beginning I was really anxious I’d infect people, and did things like putting bars of disinfectant soap around the house.

“But I was never once made to feel rejected or isolated: when I told people they literally just put their arms around me.”

Treatment: the long haul
Because of her work background, Bronwyn knew what was in store in terms of treatment: many months of strict adherence to a drug regimen.

What she wasn’t expecting, however, was that she would have an acute reaction to one of the first drugs, resulting in hospitalisation.

“I’ve never been that sick – nausea, vomiting, abdominal cramps. There was injection after injection, because they had to test different drugs to see which I could tolerate.”

After discharge from hospital, Bronwyn started an intensive two-month treatment with four different drugs. Usually, this is followed by a period of fewer drugs or lower doses. Unfortunately in her case, she proved resistant to one of the drugs, and would need to continue with the full drug regimen for 12 months.

On top of the TB symptoms, the drugs had side-effects: “I felt very lethargic, and often at work I’d go and have a nap in the car at lunchtime. Also I had occasional nausea, and started getting irritable bowel syndrome and headaches.

“You’re forced to slow down. Especially, you can’t push yourself in terms of exercise: you have to learn to listen to your body. My energy levels varied – some weeks I wouldn’t go to gym, other weeks I’d feel up to going four times."

"It's hard to stick with the treatment. The side effects get you down, and just the fact of having to take all these drugs - my room looks like a pharmacy. And at first you feel like everyone's staring at you at the clinic, when you head to the - clearly marked - TB section with your sputum bottle. But you get over that!"

An unsuitable job for a TB patient
Bronwyn’s diagnosis coincided with the start of firefighter training for the 2007/08 summer season, but she was determined not to let TB get in the way:

“I’d been planning and looking forward to joining the firefighters for a year. I love the mountain and it meant a lot to me to get involved in this way; Tarren was already a VWS member.

“I got the pulmonologist to sign the VWS medical form early on, before my diagnosis. Anyway I thought I’d be cured by the start of fire season. I didn’t ever mention ‘firefighting’ to the doctors (who would’ve certainly objected, as my parents did!)

“And I didn’t mention TB to the VWS manager until the end of the training: I thought he’d be less likely to kick me out if I’d already qualified! Finally, when I’d passed the fitness test, I explained why I’d struggled a bit and was so out of breath. As it turned out, he’d had TB himself. He reckoned that as I was in the non-contagious phase, there was no reason I shouldn’t take part in VWS activities.

“So far the firefighting has involved short bursts of activity, and I’m able to keep up. I have to be careful about smoke inhalation: I step back if the smoke’s too thick… That’s what everyone has to do, but I just step back a bit sooner. I tell the crew leaders I have TB, and they’re not fazed: they just tell me to keep behind them and say if I’m struggling.

Essentially 100 percent curable
With only two months left to go of treatment, Bronwyn has travelled a long road towards an acceptance and openness about her illness.

“Yes, it’s potentially life-threatening, but I’m also not incapacitated by it. I'm fortunate in that I have good medical care, good support - and that mine was a relatively simple case. I haven’t had to go through what XDR and MDR patients do.

“There’ve been times it’s been very limiting and frustrating, and sometimes I’ve had a good cry about it. But my family hasn’t allowed me to indulge in self-pity too much!

“These days I’m happy to talk about it – it’s vital to get the word out. It’s so unnecessary people die from what is essentially a curable disease, purely through stigma and lack of knowledge.

"The most important thing I could say to anyone who's just been diagnosed is: keep taking your medications. Don't skip a dose, even on days the side-effects make you feel really bad. They'll pass, and, eventually, so will your illness. You'll get there.”

- Olivia Rose-Innes, Health24, March 2008

Update: Bronwyn has now completed her treatment and is enjoying a busy, active lifestyle - which includes training for the upcoming 2008/09 summer fire season. - Olivia Rose-Innes, July 2008

Why TB is a global emergency

More info on the VWS: www.capefires.com
 

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	Bronwyn's story response 3/19/2008 7:46:33 AM I was very dissappointed by what the author wrote " was struck not only by how “against type” she looked – white, middle-class" This is a stereotype thinking and it goes to show that people still associate diseases with race. If you did your research thoroughly I dont think you would have made such a comment. - Gezani   BRONWYNS STORY 3/19/2008 8:22:03 AM I LOVED THE STORY IT EXPLAINED A FEW THINGS I DIDNT KNOW. I LOOKED DOWN ON PEOPLE WHO HAD TB BUT NOT ANYMORE. THANKYOU AND KEEP IT UP. - ANASTACIA   stereotypes 3/19/2008 8:37:01 AM Hi Gezani Yes, absolutely: it is is sterotyped thinking. What I'm trying to say is that many people do ignorantly associate diseases with race -I described my own initial 'knee-jerk' reaction to Bronwyn's disclosure of her TB as an example. We all need to guard against that kind of thinking, because it's one of the major obstacles in beating this serious disease - and many others. - Olivia Rose-Innes   Deseases attacks all colors and social classes 3/19/2008 8:52:27 AM Despite her positive attitude while undergoing medical care, advice to others and intelligence she displayed, her reference to class and color makes her comments appalling and paradoxal. Money can help to get a better medical care. But skin color will never excuse anyone from disease contamination. All human beings are equal:- They are Born, die and disintegrate physically in the same way, no matter how expensive is their coffin. Bronwyn failed to go beyond her intelligence.- Maxi - Maxi   Lay off! 3/19/2008 9:06:57 AM You guys are being totally unfair and missing the point here: the article is about stereotype-busting! Bronwyn should be applauded for her courage and honesty. It's hardly going to encourage people to come out and talk about the issues around TB and disclose theri satutus if they get slammed when they do! - Andy   You Go Girl! 3/19/2008 9:33:43 AM Well done! Thank you for telling your story - Clarice   All colours and classes 3/19/2008 10:02:40 AM Hi Maxi The subject line of your posting could have been the title of the article: that's why we wrote it, to make that point exactly. By the way: Bronwyn received her TB treatment from a state clinic, which is a free service for all TB patients. - Olivia Rose-Innes   No Stigma 3/19/2008 11:57:29 AM Why is there a stigma? I dont see a reason at all. My father had severe TB in the 50's and carried on to live a healthy life until he died at 86. Lets forget about stigmas - they are a waste of time. - Paul Gaydon   To all disgruntled readers 3/19/2008 12:12:58 PM I agreed to help Olivia with this story purely as a way to try to eliminate the stereotypical points of views that people may have about TB. I think the point we were trying to get across is that it doesn't matter how active or hygienic you are and what colour you may be, anyone can contract this disease. - Bronwyn Thompson   Bronwyn's response (cntd) 3/19/2008 12:16:08 PM Money plays no role in this disease as you can have free testing, x-rays, treatment, counselling etc at the state clinics and this is exactly where I received all my treatment. Every month I sit in the queues just like everybody else to receive my medication. - Bronwyn Thompson   Well done 3/19/2008 12:18:57 PM Well done ..it is a pity when skin colour or race gets mentioned in any article it gets a negative reaction.. it is not about the skin colour or the race we all are forced to integrate why not teach to learn form each other instead of slamming the point the writer wants to make .. only through showing tolerance for ignorance can we move forward.. Congrat girl you did well! - CAT   Bronwyn's response (cntd) 3/19/2008 12:19:19 PM Maxi, you are 100% correct when you say skin colour or class doesn't excuse anyone from becoming contaminated. Perhaps we went about that comment the wrong way. When I have told people that I have TB their initial reaction is shock. They can't believe a young, healthy girl who hates crowded areas and loves the outdoors could get this. But once they are over this shock I quickly try to explain that it can happen to anyone standing in a shopping queue. - Bronwyn Thompson   Bronwyn's response (ctnd) 3/19/2008 12:21:36 PM That comment was not so much a comment from me but rather a response of people whom I have told. I hope I have not offended anyone with any comments, I'm just trying to make people more aware of the fact that it can happen to you just as easily as it happened to me. - Bronwyn Thompson   Almost there... 3/19/2008 12:37:45 PM It's sad, in South Africa, how everything has to be race based. I see the focus of the article to be on the struggle of a very positive, strong willed person who tried as much as possible not to let the desease affect her life. I must commend her on her perseverence and positive attitude throughout the treatment. Well done Bronwyn. - Tarren Smith   Bravo! 3/19/2008 1:07:17 PM I just want to applaud Bronwyn on informing everyone on how anyone can get TB. I understood the meaning of the article and don't know why some choose to critisize it because colour was mentioned, She was just trying to show that colour doesn't matter, anyone can get it! It's a perception people have that should be broken. - Melrsa   Nice to see 3/19/2008 1:22:30 PM the knee-jerk race-card players have found this page too. how are you guys? :) For those KNRCPs who couldn't get past their immediate reactions, you completely missed the point of the article. The point is it's about anyone and everyone being a possible victim, not just the stereotype poor black person. Get over yourselves please. - Anymouse   TB & Me 3/19/2008 1:27:26 PM I had TB in '89, and as coloured person living a healthy and clean life didn't think it could happen to me - it did. My parents reacted badly, my now wife and collegues were wonderful. I would have thought that with the levels of education, the stigma would have dissipated - it obviously did not. I have given a number of talks to people over the years, and i advise those that do have the disease, be open about it - you/we have nothing to be ashamed of...Donovan - Donovan   my brother 3/19/2008 3:08:54 PM Well done Bronwyn for speaking up. I know you will get well soon & thank you for letting everyone know about this, to everyone out there making negative comments, you are just selfish. My brother had TB when he was 7 (1990) years old, just out of the blue he got sick, thin & just really ill. My mother is a nurse & had him checkedfor TB, eventhough the Dr said it's not possible. It can happen to anyone! - terina   Bronwyn Thompson - TB 3/19/2008 4:21:54 PM As Bronwyn's grand mother I can-|-ure everyone that she is a kind, considerate and very caring person. I have personally witnessed all the emotions and suffering she has had to endure, and all the time without complaint. Her sole putpose in sharing her story was simply to enlighten and encourage others. Come on guys give credit where it is due and rather consider encouraging this young and plucky girl who devotes much of her life to the wellbeing of others. - Margaret Gibbs   Bronwyn Thompson 3/19/2008 5:56:43 PM You go Girl! Very proud of you for sharing your story. I'm sure that it will go a long way in helping others. - Tracy Bunn   Bronwyn Thompson 3/19/2008 6:53:23 PM A sincere account of living with the disease. Thank you for sharing a story that cannot always be very easy to relate. - Jenny Dodd   The strong minded 3/20/2008 9:49:37 AM I coached Bronwyn in Aerobic gymnastics and she always tried to the best of her ability no matter how she was feeling. When she phoned me about her TB I was shocked but never had a bad thought. I think it is wonderful she has spoken out about this disease and what she has been through. She is showing you that when you get a disease of this magnitude you dont sit back and wait to 'die' you fight to the bitter end. She is a fighter (fires too) and always will be. Keep fighting Bronwyn - Donna Marriott   That Blerrie Nonsens 3/26/2008 8:05:13 AM Hi Babe, Thought u might find this useful. - Queen Mathosa   TB and Me 3/26/2008 8:54:23 AM I had tb last year.It took me six months to cure the disease and anyone can cure it. - Douglas Bujela   Well Done! 3/27/2008 3:18:09 PM I've printed the article "TB and the girl next door" and all I can say about it is "Well done!" And to those fault finders, I think the article wasn't for scrutiny 'finish & klaar'. To Bronwyn, keep your head up high because you’ve done what most of us are still afraid to do... Thanks. - Zakhele   Excellent stuff 5/8/2008 11:12:03 PM Great job done Bronwyn! very hard to find such a positive article in the web... - Lokshini   Absolutely loved the article 5/16/2008 1:57:39 PM I was diagnosed 5 yrs ago with disco-vertebral TB, and I was surprised to learn that the best place to be treated for TB was the state clinics/hospitals. I also know that Bronwyn was very fortunate to have been diagnosed on time because whether we like it or not, TB still has that racial and class stereotype to it, and people not falling under the 'expected' categories can easily be misdiagnosed and die unnecessarily. Thanks for sharing your story, so all can know that nobody is immune to TB - Vuyelwa
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