TB wreaks havoc in Lesotho

MASERU — Smoke emerges from the cracks of an old wooden door.
As you get closer to the house a pungent stench almost over-powers you.
It is in Ha-Leqele in Maseru where 39-year-old ‘Matebatso Tlali lies on a make-shift bed.
Tlali is suffering from tuberculosis (TB).
Tlali pants heavily for fresh air.
She is weak and emaciated and can barely hold up her X-ray photograph.
Tlali looks tired and just to get her to speak seemed to require monumental effort.
Each word that she spoke was a laboured process.
Tlali shares her small single room with her elderly mother and 16-year-old daughter.
Her body is frail.
She has protruding shoulders, a sign that she has lost weight.
“I am tired all the time. This X-ray photograph is so heavy. I cannot hold it longer than a minute,” said a visibly irritated Tlali.
She said it all started as a common cold. She thought it would go away after a few days.
Days soon turned into weeks but the “cold” did not go away.
Instead it got worse.
“I did not get better. I got worse. Before long I was not able to wake up from my bed,” she said.
She said she was forced to stop her “piece jobs” which helped her to put food on the table for her family.
As a result she had no money to consult a doctor.
“I did not have money to pay for the medicals services. I had to wait until my mother found someone who could lend us some money.”
While she was still scrounging for the money her health deteriorated.
She said she thought she was going to die.
“I had almost given up. In less than a month I had seriously deteriorated. I could not eat or talk. I thought I was dying,” she said.
All hope appeared lost, she said.
“Mother was at her wits end as to how to take me to the clinic. She could not carry me on her back. She also could not afford to hire a van to take me to the clinic,” she said.
Eventually her mother went to the local clinic and begged for an ambulance to take her daughter for treatment.
Tests that were carried out confirmed that Tlali was suffering from TB.
She said she was asked to start TB treatment immediately.
Her mother gave her the medication as prescribed.
Health care workers from the clinic also visited her regularly to monitor her. “The results were amazing. After three weeks I was better. I started to eat and go to the toilet on my own,” she said.
Four weeks after she began treatment, she felt much better. In fact, she thought she had completely recovered from the disease.
“I was back on my feet. I felt fit enough to do my home chores. By the end of two months I was well again,” she said.
Tlali said she felt too excited by her recovery and fell into the usual trap for TB patients – stopping their treatment.
“I was taken by the recovery and how quickly it had happened. I thought I was not going to get sick again.
“But little did I know that I was putting myself into big trouble again,” she said.
Five months after she abandoned treatment, she said she fell sick again.
This time, the pain was worse than before.
“I had unbearable chest pains. I was bleeding from the nose and I vomited some bloody substance. My feet were swollen and painful. They were burning hot.”
Tlali said she went back to the clinic for a check-up.
Her fears were confirmed. She had a TB relapse and her condition had worsened, she was told.
“I was told that the condition was worse than before. I could die if I stopped the treatment again. I was shivering and sweating at the same time,” she said.
It was a difficult time for her and her family, Tlali said.
Recovery was slow and painful, she said.
A few metres from Tlali’s house in Ha-Leqele, is a couple Suoane Ramakau and his wife ‘Mampoetsi.
The 30-year-old Ramakau and his wife discovered last December that they were HIV positive.
For the past months the two had accepted their condition and thought they could live with it.
Recently nurses told them they had to re-run their TB tests after they constantly fell sick with symptoms of the disease.
“The nurse told us that we had to test for TB again. He said we had symptoms. He has taken our sputum for tests,” Ramakau says.
The two are however still waiting for their results.
Ramakau said he suspects they could be suffering from TB as well due to the persistent chest pains and coughs they have been experiencing lately.
He said he suspects there is a big chance that they could have developed TB.
“We have developed the symptoms similar to our neighbour‘s (Tlali). Our feet are swollen and very painful. We are both sweating at night. I have also developed some regular colds,” he said.
A local NGO, Partners In Health, which deals with HIV and TB, said the tuberculosis epidemic was ravaging Lesotho.
“Lesotho’s TB rate is the fourth highest in the world, and TB spreads rapidly and is particularly deadly where many people’s immune systems have been weakened by HIV,” says Partners in Health on its website.
The high prevalence of HIV in Lesotho was contributing to the spread of TB cases.
The Partners In Health says it seeks to bring HIV and TB care and treatment to poor, rural communities that have largely been neglected by other Aids programmes and non-governmental organisations’ intervention.
The World Health Organisation says HIV positive patients in Lesotho are at a higher risk of catching the drug-resistant TB.
“Lesotho has one of the highest rates of HIV in the world. Lesotho also has a high prevalence of TB with an estimated 695 cases per 100 000 people.
“Ten percent of patients with smear-positive TB are estimated to have multi-drug resistant TB,” says the WHO.
Health practitioners say even though the government had taken huge steps to fight TB the disease was still spreading because patients dodge treatment.
They say this behaviour puts many lives in danger as the smear-positive TB can turn into multi-drug resistant TB.
They also say treatment for multi-drug resistant TB is still scarce in Lesotho.
“Lesotho has just one multi-drug resistant TB hospital. Services are still scarce,” said a government TB clinic health worker who refused to be named.
“HIV patients are more vulnerable to TB due to their failing immune systems. Most of them die of TB,” he said.
He said some Basotho men who work in South African mines were also infected with TB.
“Most have not taken treatment appropriately, exposing themselves to multi-drug resistant TB.”
The AIDS and Rights for Southern Africa, a rights group, says at least 25 percent of the drug-resistant TB cases treated in Lesotho since August 2007 were referred from mines in South Africa.
“The relationship between the South African mining sector and the TB epidemic in Lesotho is unambiguous. Recent studies showed that close to 40 percent of adult male TB patients in three of Maseru’s main hospitals were working, or had formerly worked, in South African mines.”