Patients are passing TB on to hospital staff
Health centre staff are increasingly being infected with tuberculosis ( TB ) and multi-drug resistant TB ( MDR TB ) as they come into close and protracted contact with patients, the first national TB conference has been told here.

SOUTH AFRICA: TB treatment programmes failing
DURBAN, 4 July 2008 (PlusNews) - TB cure rates in South Africa have remained stubbornly low – about 60 percent nationally, but less than 50 percent in many districts. A number of studies presented at the national TB conference in Durban this week looked at some of the reasons why South Africa's programme is failing.

XDR TB causes havocThirty-three of the 82 patients with extensively drug-resistant (XDR) TB admitted at the Brooklyn Chest Clinic in Cape Town have died and only four have been cured.
This was revealed by Dr Sweetness Siwendu, TB specialist at the clinic, at the national TB conference in Durban on Wednesday.

Overworked doctors can't contain Super-TB at Humansdorp hospital clinic any more... warning
• TB treatment mobile clinic closed and patients are not getting their medicines... only 3 doctors, working 120-hr week...
July 14 2008 - Die Burger newspaper reports from Port Elizabeth that serious personnel shortages at the Humansdorp government hospital are creating 'super-Tuberculosis' because TB-patients are not given their medications correctly and on time. This 'creates extremely-drug-resistant Tuberculosis' and thus is now endangering the entire region's population, warns Elza van Lingen, the deputy-chair of the hospital board.

South Africa's Killer-TB -- explained by Voice of America:
http://www.youtube.com/watch?v=INdBNgOc5ls

Van Lingen rang the alarm bell by going to the news media -- warning that there was no cooperation from the health department in Bisho to get them more doctors and nurses to help combat the TB-epidemic in the region.

She said the entire community -- and the many thousands of visitors travelling in this hugely popular tourism area -- were being greatly endangered due to lack of health-care delivery.

Patensie township's mobile clinic -- which is supposed to distribute the medication for all of the area's Tuberculosis and Multiple-drug-resistant Tuberculosis patients (and also for HIV-patients) had come to a screeching halt because there aren't any medical personnel available to man it. She didn't say how many patients required their medication each day.
http://www.ecdoh.gov.za/hospitals_and_healthcare/district_health_services/hiv_and_aidsstitb

\"None of our diagnosed Tuberculosis and HIV-infected patients are now getting their treatments at all -- and because they don't get these properly administered, we are ourselves actually 'creating' extremely-drug-resistant Tuberculosis.'

This is not only highly infectious and thus very dangerous to the entire community, but also is totally incurable and spreading like wildfire.

See the SA health department's poor information about TB - and its lack of information about XDR-TB:
http://www.ecdoh.gov.za/diseases_and_conditions/3/Tuberculosis

The Humansdorp district hospital manager Johan Wiggill confirmed her dire warnings. He said things were becoming totally untenable for the hospital: the doctors' shortage has also forced them to close down their emergency departments after hours and on weekends -- because doctors are simply not available.
• The three remaining doctors now have to work an average 120 a week - instead of the 40 hours they are actually allowed to work each week.
At the end of June, three other doctors had left the hospital because of the overwhelming work-load, and two other part-time doctors had already quit in February. And nearly 50% of the nursing posts were vacant.

Doctors who work 120 hour-weeks...
\"We can't keep this hospital open with such shortage of doctors. They now work totally unhealthy, impossible hours. We have a modern hospital with excellent equipment, but the personnel cannot keep up this pace. They usually last three months before looking for less strenuous jobs.'

Wiggill says he's constantly trying to transfer as many of the Humansdorp-district's patient-workload to provincial hospitals in Port Elizabeth.
• Die Burger tried to get comment from Sizwe Kupelo, the spokesman for the East-Cape health department in Sipho which handles the entire administration for health-care delivery for this region. He hasn't answered his two cellphones for the past two weeks, they report.
http://www.ecdoh.gov.za/reports_and_publications.asp?cid=10&mid=49
It's almost as if the entire Eastern Cape government's health department has come to a total-standstill.
http://www.dieburger.com/Stories/Streek/OosKaap/18.0.664100391.aspx
sources:

South Africa's Killer-TB explained by BBC:
http://news.bbc.co.uk/2/hi/health/5317624.stm
http://news.bbc.co.uk/2/hi/health/4375179.stm
South Africa's spindoctoring about XDR-TB treatment programme:
http://www.mrc.ac.za/public/xdrtb280208.htm
View the lousy website for its municipality, called 'Kouga\":
http://www.kougamunicipality.gov.za/

'Focus on untreated TB patients'
One of the province's top TB experts has said it was \"a waste of time\" trying to isolate multiple drug resistant TB (MDR) and extremely drug resistant TB (XDR) patients against their will, while they completed lengthy periods of treatment.

Super-TB+AIDS epidemic explodes in South Africa
'We are sitting on a time-bomb - but is anybody listening? '- desperate SA doctors
Augst 5 2008 -- But will the international AIDS-conference deal with this crisis which is overwhelming South Africa's crumbling health-care system? The international health-care community still deal with AIDS as a stand-alone disease - yet in South Africa, AIDS has mutated with Tuberculosis, becoming an airborne monster: deadly within a month yet takes six weeks to diagnose; untreatable with present drugs -- and no effective vaccine exists against it...
Video - Voice of America:
http://www.youtube.com/watch?v=INdBNgOc5ls
Video - Virgil Walsh, BBC:
http://www.bbcworld.com/Pages/ProgrammeFeature.aspx?id=106&FeatureId=765
How much longer can the world 's tourism- and sports-world, for instance, still go on ignoring this growing international health threat - with hundreds of thousands of international soccer fans expected to travel there for the FIFA World Cup in 2010 in South Africa?
http://www.telegraaf.nl/binnenland/1619242/__Koenders_hamert_op_aids-preventie__.html
Journalist Anso Thom reported in the Cape Times in July 2008 that 'an explosive situation is developing at all of South Africa's hospitals and health clinics'.

5,4-million AIDS/HIV patients also co-infected with Tuberculosis
According to Medicines Sans Frontieres, South Africa has an estimated 8-million people with AIDS/HIV - and 67 % of them (5,4-million) are also co-infected with Tuberculosis.

They base this assessment on their findings at the combined TB+AIDS clinic they operate at Khayelitsha, WCape. In the rest of SA, tuberculosis and AIDS co-infected patients have to go to two seperate clinics for their treatments and health assesments.

And the doctors, nurses, kitchen employees, drivers and laundry-workers dealing with this rapidly-growing army of (increasingly angry) patients are also rapidly being infected with super-tuberculosis.

Dire warnings were issued last month by many of these workers that many colleagues have already died recently -- within just a month of infection with extremely-drug-resistant tuberculosis from their patients -- mainly because the health authorities are completely ignoring the need for countrywide infection control.

Due to the present political turmoil which has left the country 's leadership in limbo and indecisive, at least two provincial health departments - the Eastern Cape and North West provinces -already are so badly managed that they are nearly defunct - leaving thousands of underequipped, underfunded health workers out in the cold, combating a rapidly-spreading killer-epidemic all on their own.


Picture left: this child was recently photographed by the BBC at a crowded TB clinic in the Western Cape -- where infected and healthy people sit in the same waiting room and thus quickly infect one another. Patients are not given any infection-control warnings and not even masks are worn by such patients anywhere in SA. This dangerous lack of infection-control is routine, health workers warn.

140 TB patients all trying to deliberately cough on you at the same time...
One counsellor working in the Eastern Cape described the situation at the TB hospitals as 'out of control.'
\"We see patients deliberately trying to infect health workers when they become angry at being locked up to prevent them from spreading the infection,\" she said. \"And when things get out of hand and you sit with them to hear their grievances, you have 140 patients all deliberately coughing their bacillae all over you at the same time.\"

A bus driver transporting patients was infected with TB, a chief nurse died of MDR-TB, five staffers treating 16,000 prisoners were infected, 100 staffers at one KZN hospital got TB;

These were only some of the frightening tales told by delegates at a 'skills' session presented by the SA HIV Clinicians Society at the national TB conference in Durban . Worried nurses, bus drivers, and laundry and kitchen staff said that they were becoming very frightened of dealing with these patients, as their colleagues and family members were being killed at a huge rate by the killer-lung-infection contracted through their jobs. In South Africa, most of the XDR-TB deaths occur among people with the AIDS-virus.

And the authorities are completely ignoring their plight, health workers complain.
\"'Poor infection control measures, such as poor ventilation, the failure to provide masks, and the forced institutionalisation of TB patients were largely to blame,\" delegates said.

Natalie Beylis of the National Health Laboratory Services, said that two of the 54 people who died when extensively drug-resistant (XDR) TB was first identified at Tugela Ferry, KwaZulu-Natal in October 2006 were health workers.
Chief nurse died of Super-TB: but staff get no masks...
A health worker employed at an HIV clinic at one of Johannesburg's large hospitals said it had taken her two months to get the hospital managers to buy a box of masks after the chief nurse was infected with MDR TB and died very quickly.

A doctor from Chris Hani Baragwanath Hospital said five staff members treating more than 16,000 inmates at a nearby prison had become infected over the past two years, two now suffer multiple-drug-resistant Tuberculosis, which can be treated with only two available drugs.

TB-vaccine is useless
XDR-TB has no cure at all -- and even people who have been vaccinated with the only available TB vaccine, die from super-TB. This once so effective vaccine - which brought Tuberculosis under control all over the world, now is becoming practically useless.

A bus driver who for years had been transporting patients in a poorly-ventilated bus from the hospital to a step-down facility next door was also recently infected with TB, she said.

The doctor said highly-infectious MDR-TB patients were being taken to the Sizwe TB hospital 40km away inside ambulances and buses that were in no way equipped to protect any of the staff accompanying them. Health workers in SA have to be vaccinated against TB - but this is giving them no protection against XDR-TB at all.

100 staffers infected in KZN:
Another doctor from a hospital in rural KwaZulu-Natal said 100 staff members, including nurses, laundry workers, kitchen workers and cleaners, had contracted TB since 2000.
'Super-TB patients sit in the rear of the bus - that's the
only infection control...'

Another doctor from this hospital said 200 MDR TB patients were sent every month to the King George Hospital in Durban on an overnight bus. \"They are transported in the same bus as patients going to see other specialists at the tertiary hospitals, including HIV-positive patients,\" the doctor said.
\"The best infection control we could put in place was to put the MDR patients at the back of the bus.\"We are really sitting on a time bomb. We know about it, but we need to ask whether anyone is listening out there.

\"We need to put infection control more firmly on the agenda. We are the ones getting infected, but I remind myself every day not to think about it too much or I wouldn't be able to continue with my job.\"

Health nurses are often HIV-positive already...
A nurse working at an MDR centre in the Eastern Cape said it was becoming increasingly difficult to recruit staff. \"Health workers are often HIV-positive and there is no way you can expose them to the risk,\" she said.

Police often have to be called in to protect doctors assessing whether Super-TB patients could go home, the counsellor said.
All the health workers complain that countrywide, infection control measures 'poor or totally absent'. Often, where ventilation systems or UV lights had been installed, these were out of order or inadequate.

TB is just ignored:
\"I find it laughable that when we have one meningococcal meningitis case then there is an uproar,\" a doctor said. The patient is placed in a side room and prophylaxis is given to everyone who comes into contact with the patient, but TB is just ignored.\" Delegates have called for the conference to take a strong stand on the urgent need for infection controls.

---

SOURCES:
Overworked doctors can't contain Super-TB in Humansdorp -- health officials warn
Humansdorp district hospital manager Johan Wiggill warns that 'things were becoming totally untenable for the hospital, there are only three doctors left who have to work an average 120-hour week. The mobile TB-clinic treating hundreds of rural patients hasn't been out in the field to distribute medication since June 2008 as some 50% of the nursing posts were vacant. And the East-Cape health department which arranges new appointments hasn't answered its telephones for weeks.

---

Medicines Sans Frontieres Khayelitsha:
http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371%2Fjournal.pmed.0040162
http://news.bbc.co.uk/2/hi/africa/934435.stm
http://www.int.iol.co.za/index.php?set_id=1&click_id=125&art_id=vn20080703054613602C836123
XDR-TB epidemic in SA hospitals 'out of control' warn health workers
'Perfect storm’ of AIDS plus killer-TB lashes SA mineworkers
Recent report by Fergus Walsh of BBC-TV:
http://news.bbc.co.uk/player/nol/newsid_7260000/newsid_7268200/7268204.stm?bw=nb&mp=wm&news=1&nol_storyid=7268204&bbcws=1
http://www.plusnews.org/report.aspx?ReportID=79107
http://www.abkhazia.com/content/view/912/67/
Super-TB in SA - could it become a worldwide health threat? News summaries:
http://groups.msn.com/crimebustersofsouthafrica/alertsonhealth.msnw?action=get_message&mview=0&ID_Message=3166&LastModified=4675670165285815775
SA doctor cleared for showing AIDS as cause of death on death-certificate
April 8 2008 - Dr Wagner, former chief pathologist of the Free State and Solidarity trade union member, was cleared of any wrongdoing by the South African Health Professions Council (SAHPC) for showing AIDS as a cause of death on a death-certificate, for which he had been arrested.
World Health Organisation XDR-TB info:
http://www.who.int/tb/challenges/xdr/en/index.html

XDR-TB: SA on the edge of the abyss…
We know that in South Africa there are in excess of five million people who are infected with HIV/AIDS. If even a small fraction of those with HIV/AIDS contract XDR-TB, the consequences are dire for public health. TB is airborne, and the XDR variety is deadly. If the situation spirals out of control, it is not alarmist to imagine that South Africa will experience millions of deaths from the combination of TB and HIV in the coming years.
At the end of July, the Cape High Court authorised compulsory isolation of XDR-TB patients, but this is unlikely to prove effective. Hospitals are reporting that the patients escape on a regular basis, normally by taking off their masks and threatening to infect anyone who stands in their way. With treatment, HIV/AIDS is a chronic condition that can be managed in most cases, but couple this with XDR-TB and we have a lethal cocktail that could have disastrous consequences for South Africa's population.
…
The authors of a report entitled XDR-TB in South Africa: No time for denial or complacency argue that the government response to the crisis has been ‘lethargic', and that the disease is likely to become a ‘serious global health threat'. Perhaps the department of health will respond appropriately to this threat. A countrywide TB survey is planned which will give us a better picture of the already serious state of affairs. We know that between 1996 and 2006 the number of cases of TB rose from 109 328 to 342 315, an increase of 213% in ten years. Things cannot be allowed to continue at this pace.
If this disease continues to spread, it could easily escalate into a global health threat, not to mention the disaster it represents for our own country. The ball is now squarely in the health department's court, we can only hope that it is dealt with in a manner that acknowledges the seriousness of the situation.