City Salutes Frontline TB Care Providers
Date: 24 March 2004
Venue: MRC - White Marquee
48,000 people attended the opening Super 12 Rugby Game at Newlands. Imagine if half of them were on TB treatment! In 2004 over 24,000 people were registered for TB treatment in Cape Town alone. This makes up 12% of the cases registered nationally.
There has been a 74% increase in the number of TB cases reported over the last 8 years. Informal settlements where poverty and overcrowding are rife have experienced the most significant growth in cases. Overall incidence rates in Cape Town are now up to 800 per 100,000 population, ranging from 440 per 100, 000 in Mitchell's Plain to 1,500 per 100,000 in Khayelitsha. These rates are amongst the highest in the world!
People think that once TB is diagnosed and a prescription written the problem is sorted out. In fact this is just the beginning of the much more difficult task of holding onto those patients - supporting and encouraging them until the course of treatment is completed!
The provision of healthcare in South Africa is undergoing a crisis: the HIV pandemic is placing extreme pressure on a weakened public health infrastructure; Staff attrition is high, with staff looking for more lucrative overseas options. Health care workers are sometimes HIV infected and acquire TB themselves. This negatively affects staff morale.
This emerging health workforce crisis has been recognised worldwide, especially in high burden countries below sub-Saharan Africa, threatening to undermine the health gains that have been made to date.
WHO advocates that to stem the tide of the TB epidemic, 85% cure rates need to be achieved. The Director: City Health commented "The City of Cape Town achieved 71% cure rates in 2003, with 22 (out of 99) clinics achieving 85% cure rates while 7 others improved their cure rates by 10%. Our staff must be compliment on these excellent results when compared to the national average cure rate of 53.8%."
Three TB NGOs recruit and manage a core of community volunteers to support patients receiving TB treatment. Nevertheless treatment interruption remains a problem especially in clinics with large caseloads. On a daily basis it is difficult to verify who did or did not come for treatment and still have time to recall them at home that very day. Site B and Nolungile clinics registered 1902 & 1077 patients respectively for TB treatment during 2004. Excluding the number supported by volunteers in the community, on any given day more than 400 patients attend each of those clinics for TB treatment. Even if only 10% miss treatment on a specific day this equates to 40 patients that need to be recalled.
Patient recalls are fraught with difficulties due to staff shortages and housing being such a problem. Patients stay here today and somewhere else tomorrow. Finding people in informal settlements, with no street names, no numbers or in a backyard structure is a nightmare! Some patients give false addresses due to fear of being evicted given the stigma of the disease. Others use different aliases and are not traceable.
Once irregular pill-taking behaviour sets-in, with patients attending on-and-off, it is very difficult to reverse that and it is just a matter of time before they default altogether.
TB treatment lasts 6 months for a new case of TB and 8 months for a retreatment case. What keeps patients from completing the full course of medication is human nature, rather than ignorance about the length of treatment, or lack of responsibility for their own health. Once patients start feeling better their lives carry on and they go after the promise of a job, a new place to stay or simply interrupt treatment for fear of losing their jobs due to stigma of the disease or excess sick leave.
Adherence to treatment cannot be predicted. It does not depend on knowledge or education of patients, not even on specific individual characteristics: adherence to treatment might be very good for a period of time and suddenly change due to a life-changing event. Thus ALL patients must be supported, right through the duration of their treatment.
The size of the TB problem is such that government does not and will not have the resources to tackle this alone. Each and every one of us has a responsibility to mobilize civil society. TB is air-born and we all have a 10% lifetime risk of contracting TB even if having a higher socio-economic status. HIV infected individuals have a 10% annual risk of contracting TB which is helping to drive the TB epidemic in Cape Town. In about a third of HIV/AIDS cases TB is the immediate cause of death.
For even modest improvements to be observed in programme performance, it requires a mammoth effort by staff. Over the last four years facility and community based health care workers have rallied around the fight against the disease, with many going beyond their call of duty. The focus of World TB Day this year is to recognize the efforts of frontline health care providers, the unsung heroes in the fight against TB.
The MEC for Health, Mr Pierre Uys, and Mayoral Committee Member for Health, Cllr Mlanjeni said: "We have personally seen the dedication and commitment of the clinic staff dealing with TB. They have really put the client first and are doing all in their power to support the TB patient while on treatment. Together with the Premier and Executive Mayor we salute these dedicated staff members."
This year we are acknowledging and celebrating the human element in fighting the epidemic, focusing the attention on the importance of the relationship between patient and service provider, as the critical link in reaching communities and delivering services.
City Of Cape Town
Tel: 021 400-2201
Fax: 021 419 1929
Dr Ivan Toms
Director: City Health
Tel: 021 400 2100
Cell: 084 2200 143
Dr Keith Cloete
Tel: 021 483-2518
Cell: 082 462 7229
Ms Maureen Mccrea
Health Promotion, MDHS
Tel: 021 918 1708
Fax: 021 949 8153