Floating above the top of the white mask stretching across her face, Lydia Pinzie's dark brown eyes are spirited and alert, despite nearly three years on toxic tuberculosis treatment.
Some white, some grubby, some askew, some too large over the faces of toddlers; the sea of masks in the waiting room at a South African TB clinic harbour an often deadly drug-resistant form of the virus.
Every day Pinzie, 35, comes to this centre in Khayelitsha, some 40km outside Cape Town, to receive handfuls of medication in the long and painful process to banish resistant tuberculosis from her body, already battling Aids.
"It is hard sometimes, you feel like vomiting and you feel dizzy, you cannot do anything," she tells AFP at the clinic in the massive township which is home to half a million people, over half of whom are jobless.
However, unlike patients in other parts of South Africa, after taking her medicine Pinzie gets to go home again to her husband and child in a pilot project which monitors treatment in the community.
Hospitalising patients suffering from multiple drug-resistant (MDR) and extensively drug-resistant (XDR) TB in order to isolate them from their crowded communities has often proved disastrous in South Africa.
Bored, depressed and ravaged by the treatment, which causes daily nausea and leaves 20% deaf, patients escape from the hospitals and abandon treatment, which encourages drug-resistance in the disease.
"I (would) run away. It is boring to stay in hospital without my family. As a mother, if you are not at home everything just falls apart," said Pinzie.
Change approach to TB treatment
The clinic in Khayelitsha, where pioneering doctors first implemented highly successful HIV treatment centres years before the government agreed to roll out treatment, is trying to change the approach to treating TB and remove the stigma around the disease.
"It's a revolution," says Doctors Without Borders medical coordinator Dr Eric Goemaere.
It is hoped that shifting treatment away from specialised hospitals to TB clinics where patients and their families are counselled and taught infection control, will improve adherence to the medication regimen.
With new drugs still far off "the only gain we can make is adherence", says Goemaere.
Determining that a patient has a drug-resistant TB strain can be arduous. Pinzie took normal TB medication for six months, fell sick again, was on medication for another eight months and only then was diagnosed with the resistant form.
Now she has six months left of the two-year treatment for MDR-TB, which costs almost R250 000.
TB/HIV one-stop service
With nearly three-quarters of TB sufferers also HIV positive, providing a one-stop service has had a high level of success.
The World Health Organisation estimated that there are around 14 000 cases of MDR-TB in South Africa, around 10% of which are XDR-TB, but these figures are believed to be a drop in the ocean.
Fear of XDR-TB has exacerbated the stigma of TB since it was first discovered in Kwazulu-Natal in 2006. In one case, all but one of a group of 53 people with the strain died within 25 days of diagnosis.
"We don't know the size of the problem. We have no clue how many people are dying of drug resistance. They are dying before diagnosis is made," said Dr Virginia Azevedo, district manager for the city's health department.
The clinic in Khayelitsha has cured 77% of its infectious cases.
Khayelitsha has a TB incidence rate of at least 1 500 per 100 000 people, of which 60 are drug resistant, one of the highest rates in the world. - (AFP, March 2009)
Drug-resistant TB an uphill battle
What is XDR-TB?