On 26 March, two days after World TB Day, Tembisa Hospital in Johannesburg hosted Health Minister Aaron Motsoaledi. This was in honour of the country’s official launch of the Lancet Commission Report on Tuberculosis (TB). The extensive report follows the United Nations General Assembly’s first-ever high-level meeting on TB in September 2018. Its launch signals a new hope for TB treatment and prevention in South Africa, but comes at a time where ongoing drought heightens risk in communities. Reportedly Makhanda has seen an estimated 100 new cases of TB since the beginning of the year and with rumours of Temba TB Hospital closing down, our team investigated.
Lunga Ntshebe, Manager of the Grahamstown TB Care Society, does much more than his title suggests. From working with the Society’s three community health workers to find defaulters in the community, delivering medication, and applying for lottery funding, Ntshebe is always on the go.
Since 2008, Ntshebe and his small team have worked to combat TB in Makhanda. The Society’s office sits next to Temba Hospital in Fingo Village. Temba is Makana’s only TB hospital, with the closest other facilities located in Ndlambe and Nelson Mandela Bay.
Temba is owned by the Society but leased by the Department of Health. In 2014, the province signed a five-year lease agreement, terminating at the end of 2019. With lottery funding scarce, and donations slim, the Society’s primary source of income is rent, and if the Department fails to renew the lease, the Society could crumble.
On social media the Society has called for interested future lessees or buyers for the property, fearing that Temba may close. Reportedly TB patients would be transferred to Settlers Hospital in Makhanda’s CBD. “It’s very far,” said Ntshebe. “[Temba] is walking distance for people here to come see their families.”
The hospital also hosts a garden that is open to the community to plant and harvest vegetables. “By closing down [Temba], it means the fence is going to be vandalised, and the gardens will be exposed and then [the community]will have nothing.”
In mid-January the Society posted, “Hundreds of people are infected with TB in Makana and this will remain so, because they are defaulting treatment, whereas there is a hospital suitable to contain them till they are cured.”
Ntshebe estimated that there have been more than 100 new cases of TB in Makhanda just this year.
“It’s quite a lot, especially in Joza,” said Ntshebe. “It’s gotten worse because of the water [crisis], and TB is found is the poorest of the poor areas.” He explained that water trucks cannot reach certain areas in the community, like Zolani, leaving residents no choice but to use dirty water.
Though TB is not transmitted through water, a lack of water means poorer sanitation conditions and wilting gardens; both have serious implications for immune systems and nutrition. Patients who are co-infected with HIV/Aids are particularly at risk during the water crisis. According to Ntshebe, the co-infection rate in Makhanda is around 70 percent.
To help with nutrition, the Society offers soup and bread for roughly 15 patients per clinic each week – about 60 patients in total. Should the Society close, this feeding scheme will no longer operate.
EC Department of Health Spokesperson Lwandile Sicwetsha was approached for comment on the future of Temba, as well as the number of TB cases in Makhanda, but did not provide a response. As a result, Grocott’s Mail cannot confirm Ntshebe’s estimate of 100 new cases.
One of the Society’s biggest challenges is patients who default on their treatment. Defaulting can lead to Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) TB, which Ntshebe says, is common in Makhanda.
Margaret Ngubo lives in Extension 10 with her mother and children. Ngcubo’s mother, 66, has XDR-TB and takes 18 pills each day for her treatment, “it’s an improvement!”, exclaimed Ngubo, compared to 23 pills last year. Her mother has been to four different TB hospitals including Themba, but now receives care at home from her daughter. The TB Care Society assists the family by delivering the mother’s treatments every two weeks; a heavy packet filled with six different medicines. Despite the extent of her mother’s TB, Ngubo kept a positive outlook. “I don’t take it [TB] serious as if it’s a danger”, she said. “It’s part of life”. She smiled and laughed with our reporters during the visit, joking about the cleaning and washing she still had to do. More of Ngubo’s positivity is needed in Makhanda, and the country. Photo: Stephen Kisbey-Green
“They always says it’s far for them to go to the clinic. When they’re given a week’s worth of medication that is when they default, because there is no one looking after them.”
Patients with MDR and XDR-TB are often transferred from Temba to Marjorie Parrish Hospital in Port Alfred for further treatment.
Nodida Hilda Wamba is 76 years old. She cares for her husband, daughter and grand-daughter in a small house in Extension 9. Her grand-daughter turns two next week, and was diagnosed with TB last year. Wamba struggles to keep her family healthy while piles of rubbish and filth collect on the streets outside her home. Providing food for her family is another challenge, especially to ensure her grand-daughter can follow her treatment. She gets powdered milk and peanut butter from the clinic, and buys spinach and other vegetables from the community. Wamba’s family is just one of many families that are assisted by the TB Care Society. Photo: Stephen Kisbey-Green
The Society provides outreach, family checks, counselling and a feeding scheme for TB patients in Makhanda; without funding they will be forced to close down, leaving patients and their families with almost no support.
Grocott’s Mail will continue to report.
29 March Sicwetsha responded for comment and informed that for the 2019 year the Sarah Baartman District had 259 reported cases of TB; with 233 being new cases. Out of 259 total cases, 115 are co-infected with HIV.
The Department of Health could not provide any information for Makhanda or Makana, specifically.
No response was provided concerning the future of Temba Hospital.
The Lancet Commission Report on TB recommends:
High-quality diagnostics and treatment for patients
“Invest first to ensure that high quality rapid diagnostics and treatment are provided to all individuals receiving care for tuberculosis, wherever they seek care.”
Outreach work to high-risk populations
“Reach people and populations at high risk for tuberculosis (such as household and other close contacts of people with tuberculosis, and people with HIV) and bring them into care.”
Extensive research
“Increase investment to accelerate tuberculosis research and development and bring new diagnostics, therapeutic strategies, and vaccines to clinical practice to quickly end the pandemic.”
Co-operation and co-responsibility across the globe for TB programmes
“Make investment in tuberculosis programmes a shared responsibility, increasing development assistance for tuberculosis according to the financial needs of individual low-income and middle-income countries.”
Accountability
“Hold countries and key stakeholders accountable for progress made towards ending tuberculosis.”
