Swaziland's deadly TB nightmare
What if I told you that a third of the world’s population is latently infected with a deadly disease? And that the disease has mutated into a more deadly form that can’t be treated with normal drugs? And that, in some places, the disease is completely untreatable? Oh, and that the disease is airborne—just sitting next to someone who has it could be enough to catch it? And although fifty million people worldwide are infected with the mutant form, the only drugs that treat it can make you vomit, lose your hearing, or become psychotic?
Well, TB is back and bigger than ever. It's the world’s
second most common adult infectious disease after AIDS. And the
drugs don’t work.
In the kingdom of Swaziland, one of Africa’s smallest
countries, the TB rate is the highest in the world. It also has
the world’s highest HIV/AIDS rate, with over 26 percent of
the adult population infected. Put those two statistics
together, and you have the very real problem of an average life
expectancy of just 49, which is lower than Somalia or
Afghanistan.
But Swaziland isn’t a basket case—the water is
clean, the roads are tarmacked, and everyone goes to secondary
school. Arriving at Manzini International Airport and driving
into town, the scenery is reminiscent of Napa Valley, except the
fields are abundant with pineapple crops and sugar cane instead
of grapevines and illegal Mexican workers.
The hospitals and health clinics are where it hits you. Instead
of seeing sickly old people and infants, it’s the grannies
and kids who look healthy and the young adults who are barely
able to walk. Plenty of HIV positive people look
healthy—HIV/AIDS is now a chronic disease, so if you take
your pills every day there’s no reason not to live a long
life (or at least one that's longer than if you ate shitty fast
food three times a day). In Swaziland, it’s the TB cases
who look really bad.
Visiting the TB ward, infection control is rigorous.
You’re instructed on how to put your mask on, pinching the
top part to ensure that no air can get through, and even though
most of the TB patients also have HIV/AIDS, there’s a
small risk of catching TB even if you’re HIV negative.
The problem is, in Swaziland one percent of the population has
TB. And if you have the mutant form, called Multidrug resistant
TB (MDR-TB), your treatment will take around two years. The
Swazi government has a slightly more touchy-feely approach than
Kenya, where people who don’t take their drugs properly
are locked up for eight months. But the treatment is hard
going—many people give up.
The Swazi government soon realized that they just couldn’t
cope with the epidemic in 2007. Not only did they have a huge
number of patients to treat, but many of their most talented
healthcare workers had succumbed to AIDS, while foreign wages
continue to tempt the remainder overseas. The result is a
severely depleted workforce.
Eventually, Medecins Sans Frontieres/Doctors Without Borders
(MSF) was asked to intervene. The international medical aid
agency—usually seen in warzones and
earthquakes—started working in hospitals which were very
different from those in Haiti or Somali: in Swaziland
they’re not routinely covered in shit, blood and body
parts and they're reasonably well-equipped.
But treatment is tough. If you're an MDR-TB patient, you're
gonna require daily injections for the first six months of
treatment. If you live 15 miles from the nearest clinic, and you
can’t work because of the side-effects, this is a big
problem. And if you need to take your tablets on a full stomach,
but you can’t because you haven’t got enough money
for food, well, that's another big problem. Finally, if this is
going to continue for the next two years, you’re probably
going to think that it simply isn’t worth it.
Ngetie, a woman with HIV and a family who I met in Swaziland,
thought like that sometimes. When she was diagnosed with MDR-TB
in 2007 she sometimes felt like giving up. But her family was
relying on her to get through. Close to the end of her
treatment, she realized she was pregnant. Riddled with guilt,
knowing that the potent drugs could affect her unborn child, she
told her family.
Sinetsemba Nkambule was born three months later. A girl weighing
just over 7.5 pounds, the baby was HIV negative and had no
health problems. Ngetie went on to complete her treatment and is
now a social worker for MSF.
“I help to motivate the patients, so that they take their
treatment correctly, and I encourage them. When I tell them my
story and they understand that I’ve been there and that
they can get through it, it gives them hope,” she says.
Ngetie and her team provide practical and psychological support
to the patients, as well as practical support, including bus
fares and food vouchers. If people are sleeping in the same room
as others, MSF will build an extra room to ensure that other
family members don't get infected too.
Another person I met, Benson, lives with his wife Florence and
their three kids. Benson has AIDS and caught drug-resistant TB
when he was working in a mine. When he was first diagnosed he
had to trek five miles each day to have his injections. When he
didn’t have money for the bus fare he had to walk, which
was not exactly easy as the medication made his legs swell up
like balloon animals.
“I felt like I was lifeless when I first started taking
the medication. I felt as if I had already died. When the people
from MSF came to speak to me, to give me counselling, I felt
like my life had meaning and that I had the strength to carry
on."
The family is not rich and the food packages make an enormous
difference. “Even if we don’t have much food, I
don’t feel nearly as stressed about it, because I know
that we’ll get food packages and that we’ll be
OK,” says Florence. “Taking care of my husband is so
much easier because people come to visit us regularly. I feel
sure that Benson is going to be cured now.”
The only way to beat drug-resistant TB is with a long and
arduous treatment. Better drugs and a shorter treatment course
are desperately needed. But relatively cheap and simple measures
can make all the difference to those people who are managing to
stick to their treatment. People like Benson and Ngetie, for
whom it's no exaggeration to say that the situation is literally
one of life or death.
VICE
