SA hospital struggles with deadly TB

TUGELA FERRY, South Africa – In a country where AIDS kills 900 people each day, full hospitals and beleaguered doctors are nothing new.

But at one hospital in rural KwaZulu-Natal province, what could be a new public health nightmare is taking its toll as doctors and nurses grapple with a new, highly drug-resistant form of tuberculosis. At least 74 people, including staff, at the Church of Scotland Hospital in Tugela Ferry have died since January 2005 after catching the drug-resistant strain.Most were HIV-positive and their immune systems were already weakened.The new strain is resistant to most if not all of the lines of defence against the highly infectious lung disease spread through coughing and sneezing.Left untreated, TB attacks the lungs and can travel to other organs, the brain and bones.In December, South Africa’s health department said 263 cases of extremely drug-resistant TB, or XDR-TB, had been recorded in KwaZulu-Natal, with about 30 new cases being reported each month.Another 40 cases have been recorded in other regions.XDR-TB is particularly deadly for those whose immune systems have already been weakened by HIV-AIDS – terrible news in KwaZulu-Natal where almost 40 per cent of the adult population is believed to be infected with the virus.”Everything changed in 1990 with AIDS.We had TB under control then, maybe 100 patients.Now we have 800,” said the Christian-run hospital’s chief medical officer Theo Van Der Merwe.”With XDR-TB more people are dying.It’s depressing because we can work longer hours but I don’t see it slowing down.”The World Health Organisation said last month the new strain could become a major killer in AIDS-hit parts of Africa where governments have been slow to roll out TB control programmes.HYGIENE AND HEALTH Experts say the best way to fight AIDS and TB in Africa is to overlap strategies.But no new antibiotics have been developed for TB in 40 years and it will be at least 2020 before new treatments are widely available.Poverty and lack of resources complicate the problem.In KwaZulu-Natal, the well-kept modern Church of Scotland hospital is a stone’s throw from dilapidated shacks where running water and reliable electricity are luxuries and bucket toilets are standard.The poor residents settled in the lush hills nearby are a target for acute diseases.About 1,3 million of KwaZulu-Natal’s 9,2 million people are HIV-positive.The hospital waiting-room is packed with patients who eke out a living as subsistence farmers or sell small items like single cigarettes or fresh produce at roadside stalls.Inside the TB ward, the windows are wide open – fresh air makes it hard for TB germs to stay alive – but the breeze offers little comfort to the bedridden and fatigued.Dozens are kept in crowded rooms.There are no vacancies and a waiting list of around 50.Staff strap on surgical masks and patients cough into cloths to prevent spreading the illness.Doctors and nurses are on call day and night, stretched to breaking-point because the hospital is short 20 medical staff and efforts to recruit are hampered by a lack of specialists.UNCERTAIN THREAT “My neighbour stopped coming over to visit.Finally she yelled (across the yard) that she no longer wanted to sit with me because I work with XDRs,” said Thobeka Majola, 24, a nurse at the hospital.”I’m scared too.”In many ways, life has changed remarkably little on the streets of Tugela Ferry despite the arrival of the deadly TB strain.Friends greet each other with outstretched hands, huddle to chat and stroll arm-in-arm on the town’s rutted roads.But there are fears the disease might not be fully understood in an area which has lost many of its educated residents to urban centres.”I am not 100 per cent sure but I’ve heard that you can die from it,” said Jaheni Majolo, 36, who tested positive for the deadly strain and is being treated.The mother-of-five, a widow, said she expects to survive.Elena Jordaan, the hospital’s chief nurse, said she cranks up the volume in the TB ward when Zulu-language television programmes talk about XDR-TB in an attempt to teach sufferers.”In some ways I don’t think patients understand the graveness, in other ways it could be denial,” she said.Doctors researching the outbreak theorise that the tuberculosis bug may have become virulent after TB patients skipped treatment – a relatively common occurrence.Medical experts say XDR-TB is present in other communities but the strain in KwaZulu-Natal is alarming because of the high number of deaths in an isolated region.Critics say the government dragged its heels while the death toll mounted, but the hospital’s chief medical officer Van Der Merwe said authorities have now pledged N$53 million in funds to fight the disease.”We had hoped it would be something that we would get past but we didn’t,” said Van Der Merwe.”The fact is we don’t know what caused it but we hope there is an answer.”Nampa-ReutersAt least 74 people, including staff, at the Church of Scotland Hospital in Tugela Ferry have died since January 2005 after catching the drug-resistant strain.Most were HIV-positive and their immune systems were already weakened.The new strain is resistant to most if not all of the lines of defence against the highly infectious lung disease spread through coughing and sneezing.Left untreated, TB attacks the lungs and can travel to other organs, the brain and bones.In December, South Africa’s health department said 263 cases of extremely drug-resistant TB, or XDR-TB, had been recorded in KwaZulu-Natal, with about 30 new cases being reported each month.Another 40 cases have been recorded in other regions.XDR-TB is particularly deadly for those whose immune systems have already been weakened by HIV-AIDS – terrible news in KwaZulu-Natal where almost 40 per cent of the adult population is believed to be infected with the virus.”Everything changed in 1990 with AIDS.We had TB under control then, maybe 100 patients.Now we have 800,” said the Christian-run hospital’s chief medical officer Theo Van Der Merwe.”With XDR-TB more people are dying.It’s depressing because we can work longer hours but I don’t see it slowing down.”The World Health Organisation said last month the new strain could become a major killer in AIDS-hit parts of Africa where governments have been slow to roll out TB control programmes.HYGIENE AND HEALTH Experts say the best way to fight AIDS and TB in Africa is to overlap strategies.But no new antibiotics have been developed for TB in 40 years and it will be at least 2020 before new treatments are widely available.Poverty and lack of resources complicate the problem.In KwaZulu-Natal, the well-kept modern Church of Scotland hospital is a stone’s throw from dilapidated shacks where running water and reliable electricity are luxuries and bucket toilets are standard.The poor residents settled in the lush hills nearby are a target for acute diseases.About 1,3 million of KwaZulu-Natal’s 9,2 million people are HIV-positive.The hospital waiting-room is packed with patients who eke out a living as subsistence farmers or sell small items like single cigarettes or fresh produce at roadside stalls.Inside the TB ward, the windows are wide open – fresh air makes it hard for TB germs to stay alive – but the breeze offers little comfort to the bedridden and fatigued.Dozens are kept in crowded rooms.There are no vacancies and a waiting list of around 50.Staff strap on surgical masks and patients cough into cloths to prevent spreading the illness.Doctors and nurses are on call day and night, stretched to breaking-point because the hospital is short 20 medical staff and efforts to recruit are hampered by a lack of specialists.UNCERTAIN THREAT “My neighbour stopped coming over to visit.Finally she yelled (across the yard) that she no longer wanted to sit with me because I work with XDRs,” said Thobeka Majola, 24, a nurse at the hospital.”I’m scared too.”In many ways, life has changed remarkably little on the streets of Tugela Ferry despite the arrival of the deadly TB strain.Friends greet each other with outstretched hands, huddle to chat and stroll arm-in-arm on the town’s rutted roads.But there are fears the disease might not be fully understood in an area which has lost many of its educated residents to urban centres.”I am not 100 per cent sure but I’ve heard that you can die from it,” said Jaheni Majolo, 36, who tested positive for the deadly strain and is being treated.The mother-of-five, a widow, said she expects to survive.Elena Jordaan, the hospital’s chief nurse, said she cranks up the volume in the TB ward when Zulu-language television programmes talk about XDR-TB in an attempt to teach sufferers.”In some ways I don’t think patients understand the graveness, in other ways it could be denial,” she said.Doctors researching the outbreak theorise that the tuberculosis bug may have become virulent after TB patients skipped treatment – a relatively common occurrence.Medical experts say XDR-TB is present in other communities but the strain in KwaZulu-Natal is alarming because of the high number of deaths in an isolated region.Critics say the government dragged its heels while the death toll mounted, but the hospital’s chief medical officer Van Der Merwe said authorities have now pledged N$53 million in funds to fight the disease.”We had hoped it would be something that we would get past but we didn’t,” said Van Der Merwe.”The fact is we don’t know what caused it but we hope there is an answer.”Nampa-Reuters