Updated 16 January 2017

MDR-TB treatment comes closer, but not close enough

With odds already stacked against them, Eastern Cape patients with multidrug-resistant tuberculosis face a long and costly journey for treatment.

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.

Read: Let fresh air blow those TB germs away!

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.

Decentralising treatment

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.

Read: Khayelitsha clinic leads the way for new TB drug

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.

The long wait for help

“Patients are told to arrive at St Elizabeth Gateway Clinic around 7am 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.”

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.

Read: Taxis look to ditch ‘deadly TB passenger’

“The ambulances would be an overload as it is not as big as the bus,” he said.  

“(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.”

An overload of passenger patients

“(They said that) even the traffic officers would find them guilty if they were to see this overload,” 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.

Read: MPs shun public TB testing

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.

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Professor Keertan Dheda has received several prestigious awards including the 2014 Oppenheimer Award, and has published over 160 peer-reviewed papers and holds 3 patents related to new TB diagnostic or infection control technologies. He serves on the editorial board of the journals PLoS One, the International Journal of Tuberculosis and Lung Disease, American Journal of Respiratory and Critical Medicine, Lancet Respiratory Diseases and Nature Scientific Reports, amongst others. Read his full biography at the University of Cape Town Lung Institute.

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