• by Mantoe Phakathi (swaziland)
• Wednesday, December 15, 2010
• Inter Press Service

Hoseya, Swaziland, Dec 15 (IPS)- Ntombikayise Mabelesa (36) is a recovering multi-drug-resistant (MDR) TB patient from Hoseya in the southern part of Swaziland.

Every day she had to travel more than 30 kilometres to the Mhlosheni Clinic to get an injection. The round-trip cost her the equivalent of three dollars, and the bus stop left her with a five kilometre walk to the clinic.

'It was difficult for me to travel to the health centre every day because I was unemployed,' said Mabelesa. She also received her monthly consignment of anti-TB drugs from the same health facility.

'Sometimes I would be too weak to walk and ask to sleep at homesteads next to the health facility but people were not always welcoming because they were scared that I’d infect them with TB,' said Mabelesa.

As a result, she started defaulting on her treatment. She became sicker and complicated a disease which was already difficult to treat.

'At some point I lost hope because it was difficult for me to access treatment given my unemployment and that I didn’t have anyone to turn to,' she said.

By the end of last year, according to the 2010 National TB Control Programme report, there were over 11,000 TB cases in the country and, of these, over 300 have multi-drug resistant TB patients. Five extremely drug-resistant cases were confirmed by the end of 2009.

Until 2007, when international medical NGO Médicins Sans Frontières (MSF), came to Swaziland to help the Ministry of Health in the response on HIV/AIDS and TB in the Shiselweni region, HIV/AIDS and TB treatment was not available at any of the region's 21 clinics. Patients had to either travel to the Hlathikhulu Government Hospital or Matsanjeni and Nhlangano health centres. These centres were located in each of the towns of the different regions in the country. A health centre is a facility that is smaller than a hospital with a few beds and does not have a theatre to do operations.

MSF worked with government to bring services to the clinics, but this was not enough because some patients were either too weak or too poor to reach even the clinics.

MSF trained 80 community caregivers, who stay very close to the patients on how to administer the MDR-TB injection. Mabelesa is one of about 25 patients injected at home. Experts from MSF would from time to time visit the patients and their caregivers to monitor if the medication is administered properly.

'I did not experience any complications while being injected from home until I completed my TB treatment in July,' said Mabelesa. 'I just went through the usual side effects such as mental instability.' Mabelesa is also infected with HIV and is on anti-retro viral therapy.

This is one case where MSF is promoting the shifting of tasks from qualified medical staff to lay trained people in the communities to help administer treatment.

Since coming into the country three years ago, task-shifting has helped in the decentralisation of HIV/TB services in the region, where trained lay people help with basic responsibilities such as collecting sputum, counselling and education.

But the availability of services at the clinics is not enough, said Aymeric Péguillan, the MSF’s head of Mission in Swaziland, because some patients are still very far from these health facilities and they need to be treated at their homes.

'Patients can now receive their treatment within their communities through the shifting of tasks from skilled medical practitioners to lay people,' said Péguillan.

While this initiative has brought the services closer to the communities at the region, TB programme manager Themba Dlamini, said he is not sure whether the administering of injections by lay people instead of nurses is the way to go.

Dlamini argued that MDR-TB injection is complicated to administer because it is injected in the buttocks where there are very sensitive nerves which, if badly handled, could lead to permanent disability.

'A person can react to the injection and the medication to counter-react is only available at the health centre,' said Dlamini.

Sibusiso Lushaba, the general secretary for the Swaziland Nurses Association (SNA) concurred, adding that a lay person cannot stand in a court of law and explain what happened to a patient when complications develop.

'We need a task shifting policy in the country so that NGOs work in line with this framework,' said Lushaba. 'Government asked MSF to help the country implement task shifting but there are not guidelines which the organisation should follow.'

But Péguillan said MSF is following the national guidelines on the delivery of drug resistant TB and community-based treatment support. He said these guidelines allow community caregivers to assist in the administering of treatment in the country.

'Injecting patients at community level is not regarded as the first option,' said Péguillan. 'But when you’re faced with a patient like this (Mabelesa), you have to make a decision on whether to participate in the patient’s non- adherence to treatment or find a practical solution.'

He said, given the large numbers of people with drug-resistant TB in the country who need to be hospitalised, the MDR-TB hospital in Manzini cannot cope with the load because it has the capacity for only 50 people. Some patients, therefore, he said, have no choice but to receive treatment at home.

He said the community treatment supporters do not work alone but are tightly supervised daily by MSF outreach nurses 'Complications are not specific to those getting treatment at home,' said Péguillan. 'All patients do undergo side effects. I must also mention that we’ve received a 100 percent adherence to treatment.'

Mabelesa bears testimony to that.

© Inter Press Service (2010) — All Rights Reserved. Original source: Inter Press Service