SOUTH AFRICA: Saving lives is not always easy

Photo: Siegfried/IRIN
Staff at Sizwe hospital wear protective masks but are still at risk of contracting TB
Johannesburg, 20 May 2008 (PlusNews) - To be a nurse at Sizwe Hospital, a special facility for treating patients infected with drug-resistant strains of tuberculosis (TB), requires a thick skin and a forgiving nature.

Cecelia Mngomezulu, the hospital's head matron, has been verbally abused, spat on, assaulted and held hostage in the two years that she has worked there.

"I sometimes get angry at them, but something tells you that at the end of the day this person is projecting, and then you put yourself in his shoes and you find yourself coming back," she told IRIN/PlusNews.

The hospital, housed in a sprawling, colonial-era complex in a quiet Johannesburg suburb, is the only referral centre in Gauteng Province for treating multidrug-resistant (MDR) TB, which is resistant to first-line TB medication and can take up to two years to treat. Patients with extremely drug-resistant (XDR) TB, which is resistant to most second-line drugs and can take even longer to treat, are also referred here.

Drug-resistant TB poses an especially serious public health threat in a country like South Africa, where nearly one in five people are infected with HIV: those living with HIV are 50 times more likely to get TB.

Isolation policy

The policy of South Africa's health department is to treat all MDR-TB patients at special isolation facilities like Sizwe until they are no longer infectious. The minimum period patients have to spend away from their families, their jobs and their homes is six months, but some have been at Sizwe for as long as two years. Family members are allowed to visit, and there are games, TV rooms and other activities to stave off boredom and depression, but frustrations are still often vented on the staff.

"They try to make you feel guilty, like you're holding them hostage against their will," said Mngomezulu. "They'll say, 'You can go home and see your children, what about me? Don't you have a feeling?' Yet you're thinking of their actual families, that they'll be infected if you discharge them."

''They try to make you feel guilty, like you're holding them hostage against their will''
The degree to which facilities like Sizwe hold patients against their will is something of a grey area. According to the hospital's CEO, Rianna Louw, patients are counselled at their local clinic and sign a consent form before being admitted.

"There are problems in terms of that, because some of the patients will say they didn't get proper information, that they weren't told they were going to be admitted for a long time," Louw told IRIN/PlusNews. "It's voluntary in the sense that we're not bringing them in with police, but in terms of the policy, all MDR patients should be admitted - it's an infectious disease."

Last week, several patients at Sizwe had to be temporarily transferred to a hospital in Pretoria after becoming aggressive. A local newspaper, The Star, reported the disgruntled patients as saying that the hospital "had broken one promise too many".

Louw attributes such incidents to patients having unrealistic expectations about the length of their stay at the hospital. "I think there is this expectation that they will only be here for six months, but that's really only a minimum. The policy is that you discharge them when they're culture-negative," meaning that they are no longer infectious.

Dr Xavier Padanilam, the hospital's chief medical officer, explained that a patient must have two culture-negative test results before they are deemed non-infectious and can be discharged and allowed to complete their treatment as out-patients. A culture test takes up to eight weeks to produce results, so a patient could be non-infectious for up to four months before being allowed to go home.

Recruitment challenge

Mngomezulu's hostage experience occurred earlier this year. "They had sticks and iron bars and bricks they picked up somewhere, and they said, 'You're not going home'. They held me from four [p.m.] until the police came at seven [p.m.]," she recalled. "Amazingly, I wasn't afraid. They try to intimidate a lot."

Most of the staff have experienced verbal or even physical abuse from patients, said Louw. "Patients most of the time respect professionals, but it sometimes happens in this hospital that that respect disappears because of the anger and frustration," she said, adding that such feelings often stem from not being able to support their families at home.

The hospital has a full staff complement of seven doctors, but about 20 percent of professional nursing posts remain vacant, despite the special allowance the provincial health department recently started offering as an incentive to work there.

"It's a very big challenge to recruit," said Mngomezulu. "Knowing it's an MDR hospital, there's that fear of the unknown. Yet because we're in here we don't have a problem; we know what we're dealing with."

The staff all wear protective masks and have access to an employee wellness clinic that is open daily. "In terms of education to staff, they know if they're HIV positive there's a higher risk [of contracting TB]," said Louw. "Because of confidentiality, we can't exclude people living with HIV from working here, but we encourage them to test and then declare to us."

Read more:
 Prison-like hospitals for drug-resistant TB patients
 XDR-TB: is forced isolation the cure?
 Drug-resistant TB on the increase
Nurses occasionally contract TB despite these precautions, but none have had MDR-TB.

Mngomezulu had TB before she came to Sizwe, but was not deterred by the risk of contracting it again. "Coming here was a way of being a role model, to show you can get cured if you comply with your treatment," she said. "Because I suffered, I know how it feels to have those night sweats and chest pains, and to have to remember to swallow those tablets."


Theme (s): Care/Treatment - PlusNews, HIV/AIDS (PlusNews),

[This report does not necessarily reflect the views of the United Nations]

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