Home / 2008 - Episode 10 - MDR and XDR-TB

Episode 10 - TB and HIV

Tuberculosis is a devastating disease. As South Africa has the second highest incidence of TB in the world, it is vitally important that we are all exposed to the reality of this disease. As HIV positive people are even more susceptible to becoming infected with TB, educating the public on how to treat this disease properly becomes even more urgent. This week's episode of Siyayinqoba Beat It! explores the relationship between TB (Tuberculosis) and HIV in South Africa. Due to immunodeficiency, the chances of catching TB are considerably higher if the patient is already HIV positive. HIV also alters the clinical course of TB, making it difficult to diagnose. The rapid spread of the disease often makes it fatal.

Shalom Ncala: Sanobonani siyanamukela ehlelweni  i-Siyayinqoba Beat It! Lolu hlelo elwabo bonke abahlanganayo nababhekana nezitselelo zokunqoba isandulela ngculaza nengculaza. Namhlanje sizogxoxha  ngesifo sofuba nazo zonke izintobo zazo. Ndiyalamkela ithimba elikhuthazayo. Esikhathi esifutsane esidlule lapha eNinguzim Afrika sisando kubona ukunyuka kwezinga lokungasebenzi  kwamakhabi okwelapha isifo sofuba. Lokhu kwenza kubenzima ukwelapha kwesi sifo sofuba, akulula ekwelapha ngoluhlobo  yingakho kunempikiswano yokuthi abantu abaye na esibhedlela noma balatselwe ekhaya. Ukuzodingida lesisihloko nathi namhlanje sino dokotela Eulah Mothibe. Udaba lwethu lokuqala luvela eMp umalanga Koloni. Asike silubuke. (IsiZulu) Hello! Welcome to Siyayinqoba Beat It! The programme for everyone meeting and beating the challenges of HIV and AIDS! Today we are talking about TB and its related illnesses. Welcome to the support group. Recently in South Africa, we have seen the emergence of what is known as drug resistance TB. This is a much more potent from TB that is almost impossible to treat and there is a huge debate around whether people should be forced to remain in hospital or if they can be treated at home. With us to discuss this topic today we have Dr Eulah Mothibe. Our first story is from the Eastern Cape. Let's go check it out.

Amanda Funani: Namhlanje sikwi  sibhedlele iJose Pearson eBhayi . Siza kudibana no Doctor Bongani Lujabe ozakusigcachisela banzi ngale TB ibambelelayo i-XDR. (IsiXhosa) Today we are at Jose Pearson Hospital in Port Elizabeth. We'll be talking Dr.Bongani Lujabe who will be telling us more about XDR TB.

Dr Bongani Lujabe: Ndingu Bongani ka Lujabe. Ndiyi Chief Medical Office walapha e Jose Pearson TB Hospital. Ingxaki iqala nge TB normal TB xasithe asangayityi kakuhle itreatment. Okanye kwenzeke itreatment yakho umntu ayaphule nokuba kungoluphi na uhlobo. Umzekelo kukho abantu abaqalisa  ukutya itreatment bathi sebe phakathi mhlawumbi ngemela bayitye  itreatment ye TB  for inyanga ezintandathu . Asuke mntu kusaphela inyanga ezintathu, azibone ingathu ubhethele abaone nokukhohlela ingathi kwehlile azive ingathi iweight iyenyka alibale ukuba akakayiqhibi itreatment. Isiphume kengoku ube kukuba uthi xa eke waphinde wagula lomntu kuthi xa kuphindwa kusetyenziswa le treatment abeyisebenzisa kuqala kufikwe ingasasebenzi its no longer useful. It no longer works he has became resistance to that treatment. Rifampicin and INH zezona zitsiphu ngokwe price but zezona zikawulezisayo iTB ukuyiyohlula ziyoyise. Nokuthi ziqala zoyiswe zona singena engxakin kuthiwe une multi -drug resistant TB lento sithi yi MDR TB. Sifikelela kwizinga loba kwezi drugs ngakumbi kwezidrugs zimbini okuthiwa yi Ofloxacine nokuthiwa yi Amicasine okanye Canamisine y injection ke leyo. Once phezulu kwala Rifampicin ne INH kungenelele ezi zimbini nayo kufunyaniswe xa itsekitswa ngokwa se lab kufunyaniswe ayisaseenzi  lamagciza sithethangawo. Ithetha ukuba ungene kwalaqondo loba ngu XDR TB ken goku. Ufunanise kunzima its very difficult ukuba abantu xa bene XDR bakawuleze ukutsintsa izikhohlela zabo  ziyeke okwasulela babe non infectious its very difficult because the drugs are much weaker  and they are much more expensive and they take much longer  zithatha ixesha elininzi phambi koba ziyoyise lontsolongwane. Enye ye problems that I can point out at the moment yinto yokuthu ingxaki is that itests that are done to diagnose MDR and XDR are very slow. If you do a test it takes up to 2 months before you know if this person has got the germ it's alive and whether he or she will respond to a particular drug. (IsiXhosa) I am Bongani Lujabe. I'm the chief medical officer at Jose Pearson TB Hospital. The problem starts when the patient has not adhered to the treatment or has stopped treatment for the normal TB before the end of their course. For example, there are people who start TB treatment and don't complete it. They stop half way through the six months course. After 3 months, they see an improvement, the coughing gets better and they start gaining weight, and so they don't bother to finish the treatment. The result is that when the person gets sick again and is given the same treatment as they were given before, it no longer effective because the person has became resistant to that treatment.  Rifampicin and INH are used because they're cheap and they also treat TB faster. When these 2 drugs are defeated you are in trouble because now you have multi-drug resistance TB also known as MDR TB. We then move to another 2 drugs as Ofloxacine and Amicasine or Canamisine which is an injection. Once Rifampicin and INH are mixed with these two drugs are tested, and it is found that the drugs don't work, that means you have XRD TB.  It is very difficult to treat the sputum of XDR patients to make it non infectious because the drugs are much weaker, they are much more expensive and take much longer to kill the bacteria. One of the problems I can point out is that the tests that are done to diagnose MDR and XDR are very slow. If you do the test it could take up to 2 months before you know if the person has the germ, if it's alive, and whether they will respond to a particular drug.

Busi Maqungo: Mna gqirha eyona nto indenze umhla yingcaciso ka gqirha Bongani phaya uba sele sibe sibene XDR, because zizinto ezintsa ezi zale XDR zage siyazi ukuba kukho i-XDR siyazi iTB iyiTB qha. Ungakwazi ukungena ngokubanzi because nyani ukuba ubone ngathi i-symptoms zimkile uvele u decide ukuba ndiphilile. (IsiXhosa) What caught my attention is the explanantion by Dr Bongani. We didn't know about MDR, the only thing we knew was that TB is TB. Can you explain to us in depth what happens when someone stops treatment? When people see they no longer symptomatic, they stop treatment.

Dr Eulah Mothibe: I-TB ngengoba uthetha nje i-TB qho iyalapheka but njengokubana ugqirha selechazile le MDR noma XDR izima ukulapheka . And le MDR ne XDR iphuma ukuthi mangabe une TB esaqalisayo iyalapheka yona kodwa awuwatyi kakuhle amayeza akho and the uzakuhamba uwashiye two weeks, one month, three months uyashiye. Mawubuya ke lamayeza akasasebenzi. (IsiZulu/IsiXhosa) T B can be treated but just as the doctor said, MDR and XDR TB is very difficult to treat. MDR and XDR TB come after you have had TB that can be treated. If you don't take your treatment for two weeks, a month or three months, when you start treatment again the treatment won't work.

Busi: Ndisebenza ekliniki kwa Langa abantu abaninzi abane TB baziswa begula ubone ukuthi uyagula nyani uyabonakala angabona nangubani ukuba uyagula lamntu lowa. Now into eynzekayo xa sele eyiqalisile iTB treatment yena umntu uzibona sele ngcono akasafunqulwanga akazaziswanga nge trolly esibhedlele uyazihambela, uyavuka aziphekele azenzele yonke into zonke ezozinto why should I think into bana ndisenayo I-TB? (IsiXhosa) I work in a clinic in Langa, and people who have TB come to the clinic when they are very ill. When they start treatment and they see that they are getting better they are not being carried to the hospital, they can cook for themselves and they can do everything for themselves, why should they think that they still have TB?

Dr Eulah: That is why kubalulekile ukuthi bafundiswe abantu ngethuba le six months ugqibe. And then  lama symptoms e-TB mawuqalisa ukuba ne TB unawo, and once lama yeza asebenze  emzimbeni  wakho ama symptoms azophela . But akutsho ukuba leligciwane seli phelile sowunyangekile. Ama symptoms yiwo akaqalayo ukuphela i-night sweat ne appetite ayakho uzatya kamnandi uzakukhuluphala . But ukuthi sithi wena you are cured le TB iphelile ufanele uyiqhibe le six months. (IsiZulu/IsiXhosa) That is why it is so important to teach people about the six month treatment. When you have TB, you will have symptoms but once the treatment starts to work, you won't have then anymore. That does not mean the TB is gone. The symptoms like night sweats and loss of appetite start to disappear. For you  to be cured, you need to finish the six months course of treatment.

Busi: So lilonke uthetha ukuthi le treatment ndiyityo iyaseenza xa i-symptoms singayo. But iyikayibulali completely the bug ekhoza ukubana ndibe ne TB isekhona. Enokuthi uvuke xa ndinokuthi ndiyeke treatment ndingayigqibi . (IsiXhosa) Are you saying that when the symptoms start to disappear the treatment is working but the TB germ is not completely killed, it is still there? It could come back if I don't finish my treatment.

Dr Eula: If awuyityi for six months uzakuphinda ubuye ubenayo le MDR noma yi XDR TB (IsiZulu) If you don't take your treatment for the full six months, you will get MDR or XDR TB.

Nokubonga Yawa: Umntu one XDR ingaba xa ekosulela wena mntu ongazange abene TB okosulela ngala XDR okanye ngale MDR? (IsiXhosa) If someone with XDR TB infects you, if you never had TB, will you have XDR or MDR TB?

Dr Eulah: It's possible ukuba ngingakusulela ngayo le MDR. So bakhona although sithe kea bantu abathwala i-MDR ilaba bantu abangawatyanga kakuhle amayeza from first time. But once ngine MDR mna ngiyakwazi ukusulela wena Shalom ngikunikele i-MDR TB. That is why it's so dangerous. In the end sizakuba nantu abaninzi abane MDR. Its important leyo education to understand why umuntu kufanele aswe e-isolations so that angasuleli abanye abantu. (IsiZulu) It's possible for me to infect you with MDR. As we have said, people with MDR are those who did not finish their first -line treatment. Once I have MDR, I can pass it on to you. That is why it is so dangerous. In the end there will be a lot of people with MDR TB . It's important for people to know why they are isolated so that they don't pass it on.

Shalom: But into e-important that we need to understand how does one contract MDR and XDR transmission yayo ungasi explain?

Dr Eulah: I transmission ye MDR ne XDR iyafana ne normal TB. Njengobana uyakhohlela uyathetha uyathimla. Le germ kuthiwa microbacteria tuberculosis izakungena ngamakhala ngomlomo . Iyokuhlala kwi lungs zakho embhanjeni zakho and then from ilungs that is why abantu abaninzi abane TB bagula ngesifuba. So iqalisa ingene emzimbeni wakho iye esifubeni sakho then from isifuba sakho iyakwazi ukuya everywhere emzimbeni wakho. So abanye abantu uzakuva kusithiwa bane bone TB, Kidney TB but the common on eyi TB yezi lungs (IsiZulu/IsiXhosa) Transmission of MDR or XDR TB is the same as normal TB. You can get it from sneezing, coughing and talking. The TB germ is a microbacteria that enters through your nose or your mouth. Then it goes into your lungs, that is why a lot of people with TB complain of chest pain. It starts in the lungs, then it spreads to the other parts of the body. People can contract bone TB, kidney TB but the most common is TB of the lungs.

Simphiwe Ngongoshe: Umbuzo wam uma sikhuluma nge normal TB ne MDR noma ngu XDR, izimpawu si similar (IsiZulu) When we are talking about the normal TB and MDR or XDR, are the symptoms the same?

Dr Eulah: I-symptoms ziyafana except i-severity. (IsiZulu) They are the same except for how severe it is.

Shalom: (Sesotho) I would like to know , since we've explained that XDR, MDR and normal  TB can be contracted the same way, what can we do to combat this bacteria in our homes ?

Dr Eulah: (SeSotho) Firstly, when you look at the TB bacteria and what type of environment it grows in, it likes to grow in environment where there is no light. TB grows in places where there is no fresh air. We can prevent it by opening our doors. It's cold but at least during the morning while the sun is shinning, open the doors, open the windows and clean the house, so that it's clean and there is sunlight and fresh air. This will stop the TB from growing.

Shalom: Unganyakazi , siyabuya khona manje (IsiZulu) We will be back. Stay where you are.

Shalom: Siyakwamkela futhi kwi Siyayinqoba Beat It! Sikhuluma ngesifo sofuba. Udaba lwethu olulandelayo uqambuka eMpumalanga Koloni. (IsiZulu) Welcome back to Siyayinqoba Beat It! Today we are talking about TB. Our next story is from the Eastern Cape.

Amanda Funami: Sise Jose Pearson Hospital eBhayi. Sizakuthetha no -Nomvuyiso ogula yi XDR TB. (IsiXhosa) We are at the Jose Pearson hospital in Port Elizabeth. We are here to speak to Nomvuyiso who is sick with XRD TB.

Dr Bongani: The governments' protocol is to admit every MDR and XDR patient in an institution for purposes of isolation which is basically an infection control policy. Now that is governments' position. But for a long time there have been grey areas in terms of the legality and the legitimacy of forcing people to stay in hospitals (yokunyanzelisa intobana abantu bahlale behleli ezibhedlele bengaphumi yinto yokuqala ibiyingxaki leyo.)(Urhulumente) Government has been struggling because of the constitutional issues (zokuthi) there are human rights involved and so on and on. (Kodwa ekugqibeleni) In the end ( kuyanyanzeleka ukuba) the broader interest of society has to prevail. So government (urhulumente ngoku) is actually moving and enforcing and even testing courts through i-cases intoba people will be forced to stay in isolation n order to protect the general public.

Amanda: Ufumanise nini ukuba une XDR? (IsiXhosa) When did you find out you had XDR TB?

Nomvuyiso Mkita: Into eyenzekayo ndaye ndakhohlela for two weeks. After two weeks ndaya ekliniki , ekliniki bandi tsekitsa ababona nto . Ndaya kwagqirha e Prime Cure ndathi mandifakwe kwi X-ray because ndiya penika kuzakuphela inyanga ngoku. Then X-ray yathi iyabona ikhona into, mandiphinde  ndibuyele back ekliniki . Xa ndibuyela ekliniki   bathi ndine TB ndayatya itreatment phaya. Ukutya kwam itreatment ndathi ndizakufika ku five months bathi no ndine MDR mandize e-SANTA. Ukufika kwam e-SANTA ndatya itreatment for 4 months kwathiwa no ndine XDR. (IsiXhosa) I had a cough for 2 weeks.  After 2          weeks I went to the clinic and they found nothing. I went to the doctor at Prime Cure and requested and x-ray because I had been coughing for a month. The told me they have found something and I should o back to the clinic. They told me I had TB and I started treatment. After about 5 months on TB treatment, they told me I have MDR and I should go to SANTA. I was at SANTA for 4 months on TB treatment, and I was told to come here because I had XDR TB.

Dr Bongani: In this particular instance yale Escape in December, I've already indicated that security was not strong enough, sobebekwazi uku break through the fence baphume. (IsiXhosa) In this particular instance of the escape in December, I've already indicated that security was not strong enough, so they could break through the fence and leave.

Amanda: Yintoni le yakwenza ubaleke? (IsiXhosa) What made you want to escape?

Nomvuyiso: Into eyayisenza siqweshe esibhedlele yayi ngu December and sifilisha ukuba basibe ne family zethu. And kubo bonke oDecember  apha esibhedlele ama patient aqele ukuba ne family zabo. Ayingo December yokuqala lo ama patient ephuma esiya ezi famelini zabo. Qha loo ngu December ukuba ku stop iweekend off kunye no December holiday. So ama patients apenika because awaboni nto itsintsileyo because i-TB iseyila TB kuqelwe ukuphuma ngayo . So khange abone need yokuba ne esibedlele. (IsiXhosa) The reason we escaped from hospital in December was to be with our families. Before, patients could be with their families during December, so this was not the first December for patients to go to their families. This was the first December that weekend off and holidays were stopped. So patients panicked because there was no change in their, TB condition, so felt there was nothing keeping them at the hospital.

Amanda: Sisi kwakutsiwo ukuba ulapha awuguli kakhulu ungaphuma but mhlawumbi naningagcingi ukuba yi risk kwi family members' zenu yabona. (IsiXhosa) Were you not told that if you're too sick, you could go home? Didn't you think you're putting your family members at risk by escaping?

Nomvuyiso: Sikwi treatment azange sigcinge singosulela sikwi treatment . Because xa ukwi treatment andiyiboni into eyosulisayo. Mna andikhohleli indawo yokuqala. So mna zange ndiyi understander into bana mna mandixelelwe into yokubana andizokwazi ukuphuma emveni kokubana ndina seven months ndisesibhedlele ndinga khohleli. Ze kuphume umntu ona two months efikile ogulayo abanjwayo ukubhekiswa egeyitini. Zange ndikwazi ukuyi understander that is why ndazixelela ukuba mandihambe. (IsiXhosa) We were on treatment. I don't see how we could infect someone with TB when on treatment. Firstly, I'm not coughing so I couldn't understand when I was told I can't go home after 7 months in hospital. Where as there was someone who was here for 2 months and could hardly walk yet they were allowed to leave. I couldn't understand, that is why I left.

Dr Bongani: Ama patient ethu kumaxhesha amaninzi abanengxaki in terms of understanding the concepts ne principals about i-infection controls and the dangers abazenzayo that they can pose phaa ngaphandle xabathe baphuma you know. (IsiXhosa) Our patients have a problem understanding concepts and principles about infection control and the danger they pose when they are on the outside.

Nomvuyiso: Ugqirha uyayithetha lento ayithethayo yena ne on his medical side. But mna for mna njengokuba ndandingahambanga ndi believe kulanto yayithethwa ngu gqirha yayizakundibulala nam lanto. Istress naso siyabulala ekugqibeleni siyabulala istress. Yayizaku ndistressa ukubana ndihlale apha mna andikwazi ukubonana ne fameli yam nbdiyakwazi ukuzenzela yonke  into yam. What yi Christmas yokugqibela lena bendizakuyifumana? What if ngo January ndiyabhubha andizophinde ndibonane ne fameli yam? (IsiXhosa) The doctor can say what he wants on his medical side. If I was to listen to the doctor and stay in the hospital, that was going to kill me. Stress also kills in the end. Staying here and not being able to visit my family was going to stress me out. What if it was my last Christmas? What if I had died in January?

Amanda: Ifemeli zona zazi testiwe kengoku emva kwayo yonke lento? (IsiXhosa) Were your families tested after that?

Nomvuyiso: Zatestwa (IsiXhosa) Yes, but no one was infected.

Amanda: Akho mntu owasulelekayo. (IsiXhosa) Was there anyone infected

Nomvuyiso: No not okwangoku. Andazi ke mhlawumbi uyakuvela okanye kwenzeka ntoni but okho mntu usulelekileyo. (IsiXhosa) I don't know what will happen later but for now nobody got infected.

Amanda: Yinto eyakwenza ubuye ngoba uthi wazi buyela? (IsiXhosa) What made you come back?

Nomvuyiso: Ndandizibuyele ngoba apha ndazizela uba ndifua ukuphila. Into eynzekayo emva koba simkile abanye bayokulandwa ngamapolisa kwa fika i-sheriffs basiyina abasayinayo babuya . But mna ndazibuyela (IsiXhosa) I came back because I wanted to get well. What happened was, some of us were fetched by police and some were summoned by the sheriffs. I came back on my own.

Amanda: Igranti niyayifumana xa nileli apha esibhedlele? (IsiXhosa) Do you receive a monthly social grant while in hospital?

Nomvuyiso: Okwalo mzuzu sisa lindile asikayifumani . Abanye iyathathwa besando kufika apha kuthiwe akanokwazi urhulumente ukukunika igrant because uyatyiswa ngu government. (IsiXhosa) We are still waiting; it was taken away from some patients. They say you can't get a grant while supported by government in hospital.

Amanda: So mhlawumbi ayiyo enye yenzinto eyenza abantu baphume esibhedlele bafune ukuyo kuhlala emakhaya ayiyo? (IsiXhosa) Is that one of the reasons why people want to go home?

Nomvuyiso: Yenye yazo because umntu ebegranta mhlawumbi omnye ejopha ebengaphangeli na permanent ngoku xa ezohlala apha athi u-government andizokunika grant aba bantu ebebatyisa bazakutyiswa ngubani  ngala job. Andithi uzofelisha ingathi usemandleni qha ubupenikile yawa ekliniki wafumanisa ukuthi uyakhohlela. Ad the Xa ufika ekliniki waqonda ukubana hayi man ndine nesi ku le SANTA because ndiyafuna ukuphila. Akhange uyazi uzobanjwa apha kanti uyetrongweni kulendawo uyakuyo. Beause mna kuba ndandiyazile ukuba ndiza kule trongo ngengazange ndize e-SANTA. (IsiXhosa) Yes it is, some patients didn't have permanent jobs so who is going to feed those at home if the government takes their money and they are stuck in hospital. As a patient, you go to SANTA to get well and you're not aware it's like a prison. If I knew I was coming to this prison, I would never have come to SANTA.

Simphiwe: Yena kuthiwa lomuntu une normal TB kodwa ama signs and symptoms akhona kuyena akana mandla, uyaqhutsulwa kuthiwe go home uyodla imedication. But lona uno MDR kuthiwe hlala so abantu baya confuzeka. So abantu baya confuzeka  mhlawumbe doc usibekele nje ukuthi kwenzakalani? (IsiZulu) There are people with normal TB who have the symptoms and are weak, and then they are told to go home, and take their treatment at home. There one's with MDR are told o stay this is confusing.  So people are still confused, maybe the doctor can explain better.

Dr Eulah: If uthatha i-normal TB first time umuntu ubane TB uzakunikwa itreatment including INH and Rifampicin. After two weeks of taking leyo Rifampicin especially then isikhohlela sakho is not infectious anymore. Even though umzimba usesephantsi, you are still thin, awuka gaini weight usase weak, usakhohlela but isikhohlela is not infectious. So ku easy ukuthi isibhedlela sikwazi ukuku dedela ukuthi uye emphakathini because you won't be a risk to the community. But if une MDR  TB, two weeks will not be enough ukuba isikhohlela sakho sitsintse singabi infectious, one month is not enough, six months seven months is not enough. Uzakuzibona wena so ugainile iweight seven months, eight months ,nine months usitya itreatment, but bathi you must stay inside because you are still infectious. Infectious ukuthi ustrong but mangathi ungaphuma apha uzakuthelela umphakathi ngale MDR TB yakho . When we take away these people from the community for the safety of the broader community, then we need to look at how are we going to support ifemely yalo mntu . Whether its grants so they need to put their heads together and see what can be done to support that family. (IsiZulu) If someone has normal TB for the first time, their treatment will include INH and Rifampicin. Two weeks after taking the Rafampicin, your sputum is not infectious anymore. Even tough your body is still weak. You are thin, you haven't gained weight, you are weak, you are still coughing but your sputum is not infectious. So it's easy for the hospital to let you go home because you are not at risk to the community. If you have MDR TB, will not be enough for your sputum to  not be infectious, one month is not enough, six or seven months is not enough. You'll see that you have gained weight, seven months eight months nine months on treatment, but you still have to stay inside the hospital because you are still infectious.  Infectious in away that you might be strong, but if you leave the hospital you will infect the rest of the community with MDR TB. When we take away these people from the community for the safety of the broader community, then we need to look at how we going to support the family. Whether its grants so they need to put their heads together and see what can be done to support that family.

Nokubonga: Njengokubana ebesitsho losisi esithi igranti iyathathwa after engine phayana kubana uyondliwa phayana wenzelwa yonke into. Then xa ndihleli phayanandibona lagrant isabalulekile kum ngoba kufuneka ndondle abantwana abandinabo endlini. If bana bendihleli endlini itreatment ndiyitya ndihleli endlini umhlambi bendizakukwazi ukuphakama ndiyokuphangela. (IsiXhosa) You have already said that if a person is admitted they lose their grant, because they are fed and taken care of in hospital. While I am in hospital, I need the grant because I need to take care of my children who are at home. If I was taking my treatment at home, I could go out and fend for my children.

Dr Eulah: These are active people like the lady in the insert she is not sick, she is fine (akaguli irite nje.) (Uzakungeniswa esibhedlele) She was taken to the hospital to sit and do what all day? Again (mangabe bangaphakathi esibhedlele) if they are in hospital we need to look at the conditions in the hospital. These have been productive people when we put them inside what do we expect then to do?

Simphiwe: Ndingathi ingu msebenzi wethu even nathi kumakliniki  nase zibhedlele nakwi community ukuthi siba encourage abantu bathathe amapilisi abo ngendlela. Sibakhuthaze abantu ukuma abantu bene TB ayocelela ukuthi ahlolwe for i-HIV. (IsiZulu) I think we as health workers in the community should encourage people to take treatment. We should encourage people who test for TB to test for HIV as well.

Dr Eulah: So abantu bafanele ukuthi bafundiswe the difference between yeloo normal TB the treatment and MDR ne treatment yakhona. And perhaps mna I come from I come from HIV experience look at how si educator abantu be HIV around HIV treatment and how to take care of themselves. (IsiZulu) So people need to be taught the difference between normal TB and the treatment and the MDR TB and the treatment. And perhaps I come from HIV experience is look at how we educate HIV positive people around HIV, around HIV treatment and how to take care of themselves.

Shalom: Sisathatha ikefu siyabuya khona manje (IsiZulu) we're taking a quick break. Be back now

Shalom: Siphinde siyanamukela ehlelweni i-Siyayinqoba Beat It! Namhlanje sixhoxa ngesifo sofuba nokulatswa kwaso. IninguZim Afrika ine nani eliphezulu emhlabeni wonke jikelele labantu abanesifo sofuba esaziwa ukuthi yi XDR. Ngempela kunenginka ngohlelo lwethu lokulatswa kwesisifo. Abantu kufanele kufuneka baqonde indlela yokwelapha isifo sabo sofuba. Ngengoba sinendlela efundisa ngokwelatswa kwesifo sengculazi ngokufanayo sidinga  uhlelo olufanayo elisakufundisa lokulapha abo banesifo sofuba . Uma uyokuhlola izifo segciwane lengculaza cela ukuba bakuhlole nesifo sofuba. Uma uyohlola isifo sofuba nxusa ukuhlolelwe isifo segciwane lengculaza.  Lena yindlela entle yokuzivikela nokuvikela abanye. Lamabengela atso ukuthi sizibophezele futhi siyazaivikela . Protect yourself protect others. Size siboname ngeviki elizayo. Impilo entle. Goodbye (IsiZulu) Hi guys, welcome back to Siyayinqoba Beat It! Today we are discussing TB and TB treatment. South Africa has the highest number of XDR TB cases in the world. Clearly, there is a problem with our existing treatment system. People need to understand their TB treatment. Just like we have treatment literacy programmes for HIV, we need to have treatment literacy for TB patients too. When you go for an HIV test, you should ask for a TB test. If you go for a TB test, you should ask for an HIV test. This is a way to protect yourself and protect others. These bangles are showing that I am taking responsibility and keeping it safe, Protect yourself protect others. Until next week Goodbye!