TB Chronicles: A leading example of community-driven approach in Eastern Cape South Africa

Dr Diana Wangari, CNS Special Correspondent, Kenya
Learners from Masakhe Primary School
in Duncan village, East London
In Kenya, there is a phrase ‘serikali saidia’ which translates to ‘government help us’ and it is often that you will find that this phrase appear in conversations of victims of disaster situations. Therefore, if a bridge is swept away during a flood, you are bound to hear the villagers explaining how fundamental the bridge is to their day-to-day activities and their plea to the government is that it builds a stronger and wider bridge next time.

During dry seasons when food supplies have been depleted in some communities and members of the communities are making a support plea, the government’s help is often invoked. If there is a particularly dryspell of weather, once again the government is called upon. A ‘rogue’ elephant destroys some farms…government help us. There is a hike in food prices…government help us.
 Now, I am not saying that it is wrong to seek the government’s assistance-- after all what is the purpose of having a government if not to benefit the people. But if we were to all sit down and wait for the government to come to our rescue for every single problem we encountered, we might as well surrender ourselves to chaos.

But what if we decided to do ourselves the little that we can?

I happened to be part of an engagement tour organized by Lilly-Donald Woods Foundation MDR-TB programme in Buffalo city in the Eastern Cape Province of South Africa, just prior to the 46th Union World Conference on Lung Health in Cape Town. What I saw made it evident that when the community decides to take action the results can only be described as life changing. The partnership, which through its programmes aims to assist the Department of Health in the effective management of multi drug resitant TB (MDR-TB) in the province.
Tour group outside isolation wing
at Nkqubela hospital with clinch staff

South Africa is one of the countries with a high burden in MDR-TB with approximately 1.8% of TB patients being new MDR-TB cases, according the WHO Global TB Report 2015. Therefore, the increasing spread of MDR-TB and XDR-TB has an already burdened system overwhelmed.

Projects such as the Lilly MDR TB Partnership, therefore, come in handy. And after the tour one could easily see why.

Our first stop was Masakhe School where the children are periodically screened for TB as most children are often infected from their parents and awareness sessions are held for students and parents are encouraged to attend. At this point, I found myself reflecting on how true it was that children are a vulnerable population and it is paramount that intensified prevention measures are applied.

Our next stop was the maximum security section of Fort Glamorgan Prison. The programme here involves not only the screening of prisoners but also the training of some of them to be peer educators. I found myself reflecting on the fact that prisoners are classified as a high risk group for transmission of TB on account of the often crowded poorly ventilated facilities in prisons. In Fort Glamorgan there were approximately 40-45 prisoners in a cell. However, the programme drive was beyond screening and subsequent referral of TB patients to the hospitals. Speaking to CNS, Rose Ewing, the Donald Woods Foundation programme manager said, “The training of the prisoners to be peer educators is more than just awareness and prevention. It motivates and inspires the prisoners as well because they get to see that they are not forgotten and in fact they do receive a diploma that once out they could use.”

Nkqubela Hospital executive manager
Mrs N Fekande, Lilly SA Thandekile Essien
Our next stop was Dimbaza Community Health Centre which works as a primary health care centre. It is here that we learnt that patients often have to walk over 50 km to come for their monthly check ups or to receive maintenance dosage. Some patients have to walk from their village to the nearest town where they can at least get a car or ambulance, often a one day journey, only for the drive to thereafter take another day. But that does not even begin to describe the challenges, as let us not forget, the patients are very ‘migratory’ and hence often easily lost to follow up.

The programme had peer educators who often do home visits, sometimes utilizing their own funds for transport, only to arrive at the home address to find that the patient has moved. And when the peer educators spoke, it was not to complain but to request if only they could get even bicycles to facilitate their work. In addition, there are plans to establish a call centre.

Our last stop was Nkqubela TB hospital which, alongwith Fort Grey TB hospital, has a 320 bed capacity dealing specifically with MDR-TB and XDR-cases and is the initiation point for treatment for these patients. In these hospitals, there were peer educators stationed in every ward and their major role was support. Patients testified to the fact that they would have long given up on treatment if it were not for the encouragement and moral support they received from these educators. Furthermore, once patients were discharged they were able to do follow up as well education for the family members.

At this point, I was reminded of how treatment of patients was more than medicines alone and that it should include psychosocial support as this also improves the quality of life. Here was a team that strived to do just that and even went beyond their call of duty.

It was the recognition that there is a problem: MDR-TB, and hence the need to act now.  The people of Eastern Cape could have waited but they recognized that the little they could do they would do.

The latest MSF DR-TB 2015 report shows that the decentralised model of MDR-TB care increases access to treatment with more than 90% of those diagnosed started on treatment (compared to the national average of 42%), thus reducing infection rates in the community, and reducing costs by up to 40%.

The partnership between Eli Lilly and the Donald Woods Foundation was thus one that aided in this cause and not by saying ‘serikali saidia’ but by working alongside the government, doing the little they could do.

(Credit for all photographs: Alan Eason for Donald Woods Foundation/ Lilly MDR-TB Partnership)

Dr Diana Wangari, CNS Special Correspondent, Kenya
6 December 2015
(Dr Diana Wangari MD, is providing thematic coverage from the 46th Union World Conference on Lung Health in Cape Town, South Africa, with kind support from Lilly MDR TB Partnership. Follow her on Twitter: @diana1wangari)