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MDR

I am flicking through the pile of TB culture results back from Durban. All the sputum from patients with TB requiring culture are sent to the massive hospital there to be cultured. As always there are a few which have been identified as multi-drug resistant (MDR-TB).

MDR-TB is South Africa’s other health crisis. The TB epidemic has exploded, fuelled by the HIV epidemic. The biggest single component of our outpatients work is TB related – people with chronic cough, people with TB related complications, people deteriorating despite TB treatment. And if people do not complete their treatment, or take their drugs erratically there is a risk that the organism will become resistant to standard drugs. They will then fail treatment and stand a good chance of passing their resistant organism on to someone else. When that person develops symptoms they will unwittingly be put on treatment to which the organism is already resistant and continue to deteriorate for weeks or months (coughing all over their family) before the treatment failure is recognised.

Experts say that MDR-TB is evidence of a failed public health system: if everyone got treatment and was compliant, completing the whole course, resistance could not develop and they would be cured.

I hand the results to the coordinator of the TB tracing team. He will track the patients and we will try to arrange follow up for them in Durban. We are not allowed to start people on MDR-TB treatment – it is felt, perhaps not unreasonably, that if just anyone started MDR treatment exactly the same failures that led to the creation of the MDR epidemic will result in an epidemic of even more resistant TB: the dreaded XDR-TB. Last year there was an outbreak of XDR-TB in Tugela Ferry, another KZN town – embarrassingly enough it appears many of the cases were transmitted within hospital. I think of our wards and cannot even try to pretend exactly the same thing could not happen here.

An hour later the coordinator returns with the details of the patients. Two are fairly well and one is sick – they are bringing him to the TB ward. I phone Durban to book them appointments at the MDR clinic.

“What?” barks the doctor at the end of the line.

“I would like an outpatients appointment for three people with MDR.”

“Oh God. I have no appointments. We are in complete crisis! Complete crisis! We have no staff.”

“Well when can you see them?”

“I don’t know. No idea. What is your phone number?” I give it. “I will phone you sometime. How many men and how many women?” I tell him and hang up despondent. Sometimes it can take weeks before appointments come up. And in the meantime well patients infect their families and sick patients get sicker. I go to the ward and cast an eye over the patient admitted there. He looks fairly well at the moment. I hope he is still when Durban calls.

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