TB

2010-03-26 00:00

TB has permanently altered the lives of a number of health workers, who are six times more likely to get drug-resistant TB than the general public.

In 2002, Dr Nerissa Pather was 26 years old and doing her community service at King Edward Hospital in Durban, when she got TB meningitis.

Eight years later, instead of enjoying a rewarding career, marriage and motherhood, Pather is a paraplegic with extensive nerve damage that causes her excruciating pain.

The TB meningitis, which caused swelling on the brain, also damaged her spinal cord. Pather has lost the use of her legs and bladder. She also suffered a stroke which paralysed her right side, while the TB spread to her sinuses and spleen.

Complications from various operations to relieve the pressure on her brain and spinal cord have caused extensive nerve damage. As a result of all the medication, Pather has taken, she has developed osteoporosis, deafness, liver damage and kidney infections.

Pather is unable to mother her eight- year-old daughter Kyla properly, while her husband, Dr Shane Maharaj, whom she married while they were at medical school, has become her doctor.

Maharaj has had to watch the woman he loves descend into a dazed twilight world of pain, and at times he has been forced to rush home from his Verulam medical practice three times a day to take care of his wife.

“It’s hard to cope when you see the woman you love go to the point of no return and you have this [medical] degree. You know the medicine. You know the theory very well. And you’ve got this black bag with all these expensive drugs in and you can’t do diddly squat. You can’t. The only things you can do is live and try to pray and trust God,” says Maharaj.

“There are days when my daughter comes home from school and because Nerissa is screaming so much from the pain we literally have to prevent my daughter from coming into the house,” says Maharaj.

“This is primarily because of the amount of damage that has occurred at the spinal-cord level as a result of the TB. Currently, Nerissa’s left arm feels like it is on fire. If you just touch the arm it’s as though you are electrocuting her,” adds Maharaj.

Despite the nightmare that has stretched over eight years, the family has yet to receive a cent from the Department of Labour’s Compensation Fund.

Four years ago, King Edward Hospital stopped paying her salary, describing her as “a ghost in the system”, despite Maharaj submitting regular reports on her condition. He then submitted a file detailing her plight but was subsequently told that her file was “missing”.

Maharaj’s lawyer has taken the matter up, but there has been no progress. In the meantime, he has had to pay for all her care, including two nurses to take care of her day and night.

“To be honest, it’s not about money. It’s about responsibility. If you look at her career and what could have been. If you look at her future and what could have been. Oh boy, you cannot quantify it,” he says.

“My daughter does not know what a normal mother is because for as long as she can remember, her mother has been sick. As a husband and as a man, our relationship has obviously changed. All that is expected of the government is to come forward and stop the bureaucratic paperwork,” says Maharaj.

Pather is one of a number of health workers whose lives have been permanently altered by TB which they picked up from their patients. Yet none has received the government compensation that they are entitled to.

South Africa has one of the highest TB rates in the world, and health workers are at high risk of getting the disease. More recently, there has been a surge in drug- resistant TB which, in some cases, is almost impossible to treat and involves highly toxic drugs with life-changing side effects such as permanent deafness.

KwaZulu-Natal health workers are six times more likely to get drug-resistant TB than the general public, according to a four-year study released last year.

Professional nurse Dumisane Mdletshe has worked at King George V Hospital, KwaZulu-Natal’s specialist drug-resistant TB hospital, for the past 12 years — and has lost a lung as a result.

“When I started at the hospital, I was screened for TB and I was clear so I know I got TB while working at the hospital,” says Mdletshe.

First, Mdletshe got ordinary TB. His sickness was “straight forward” and he was cured. But he then contracted MDR.

“It was very distressing. I felt like I was going to die. The treatment is harsh. I lost a lot of weight. Sometimes I couldn’t walk and I felt like I was not going to make it,” says the slender 39-year-old quietly.

Although he was eventually cured of MDR, Mdletshe’s lungs were permanently damaged: “One day in 2007, I started to cough up litres of blood. The residual effects of the TB had weakened my lungs. So I had to have one of my lungs removed.”

Although this is a work-related injury, Mdletshe has never received compensation. He now works in the staff clinic of the hospital and is protected from the hundreds of TB patients.

Dudu Danca, a professional nurse at the same hospital for over 15 years, is hovering on the brink of extensively drug-resistant (XDR) TB after being treated for multi-drug resistant (MDR) TB.

“Although I am supposed to wear a mask to protect myself from TB, many of my patients are deaf as a result of their medication. They lip read so I can’t wear a mask when I talk to them,” says Danca.

She has been on treatment for almost two years, but her strain of TB has become steadily more resistant to treatment. It is now resistant to one of the MDR drugs, which makes her condition pre-XDR, according to Dr Iqbal Master, head of clinical services at the hospital.

Danca, a woman in her forties, has endured nine months of injections, five days a week, and has had to swallow handfuls of pills every day. Her last test showed her body was clear of the disease, but in January she was still testing positive.

“I am very scared to come back to work in the hospital,” says Danca.

Between 2003 and 2008, 288 health workers were treated for drug-resistant TB at King George V Hospital and 23 of these had XDR, according to a study by Boston University’s Max O’Donnell and others. The researchers concluded that health workers are six to seven times more likely to get drug-resistant TB than the general public. “The higher incidence rate among the health-care workers is explained by occupational exposure and not other risk factors,” said O’Donnell.

South Africa has the highest number of people co-infected with TB and HIV, and one of the highest rates of drug-resistant TB in the world.

Lack of infection control is a major weak point in South Africa’s TB programme.

 

 — Health-e News Service.

DURBAN healthworkers who treat patients with drug-resistant TB should be given special incentives such as “danger pay”.

This is according to Dr Iqbal Master, head of clinical services at King George V Hospital in Durban, the province’s specialist hospital for drug-resistant TB.

King George V Hospital is struggling to find staff willing to work with drug-resistant patients, and has been trying to get itself declared “inhospitable”. This would mean that staff would get an “inhospitable allowance” added to their pay.

“Health workers at Sizwe Hospital, Gauteng’s referral hospital for drug-resistant TB, get an inhospitable allowance as do staff at Prince Mshiyeni Hopsital in Umlazi. We have asked for King George to be recognised as inhospitable but so far we have failed,” said Master.

There are few incentives and plenty of risks for health workers.

“I don’t know any young doctors who want to come and work in TB,” says Master.

“Of the nine doctors working here, five are over the age of 55 and only one is under 40. At our FOSA step-down facility, three of the four doctors are over 60.”

Every year, at least 10 staff members from the hospital get TB, while, in the last decade, 14 staff members have died of the disease. One is currently being treated for the deadly extensively drug-resistant (XDR) TB.

Master and his eight fellow doctors also have a huge workload, and nurses are also reluctant to work at the hospital.

The hospital does not have the staff or beds to isolate patients with XDR-TB. The XDR patients are thus kept in the same wards as patients with multi drug-resistant (MDR) TB, although efforts are made to keep them in a different section.

XDR-TB currently has a cure rate of around 20% and treatment of the virulent strain of TB takes two years and involves daily injections five days a week for at least six months and up to 16 pills a day.

However, the need for health workers and treatment facilities for people with drug-resistant TB continues to grow.

About 180 people with drug-resistant TB are waiting for treatment at King George V Hospital. One hundred of these people need to be admitted but they face a six-week wait for a bed, while another 80 are waiting to join the hospital’s outpatients’ programme.

King George V Hospital can accommodate 200 inpatients and 700 outpatients, but the demand for treatment for drug-resistant TB in South Africa’s worst-affected province shows no signs of abating.

There are almost 400 beds in eThekwini for drug-resistant TB patients, and four satellite MDR clinics in other districts have been open since March 2008.

Master believes that there will “never be enough beds” and that the province’s move towards treating more people as outpatients is the only option.

But he admits that this “can only work if people are monitored by mobile health units to make sure that they are taking their treatment”. — WR.

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