EPISODE 7 - MDR-TB

In Fort Grey Hospital, Port Elizabeth, Busisa Simandla is looking healthy and pretty. She is a good weight, has clear skin and is enjoying feeling better. Busisa is recovering from drug resistant tuberculosis (DR TB). She is also living with HIV. When she arrived at Fort Grey "it was like a prison," she says, but  then two things happened, she saw people getting better and going home and the Health Department made a real effort to improve the environment for people having to spend long periods in hospital. Her room looks more like a bedroom at home than a hospital, with frilly curtains and pretty coloured cushions decorating a comfortable bed. Busisa is on daily doses of ethionamide and daily injections and has to take anti-nausea pills 30 minutes before her TB treatment.  After that she takes the rest - 15 pills in all and an hour later she takes her ARVs. "The treatment works - the pills help. The treatment is not available at the clinic so you have to stay here and get better," Busisa says. She advises people to check for TB while they are still well as, "You can get in a taxi and not know if there are people with TB there".

Drug resistant TB emerges out of normal TB when people do not complete their full six month treatment for normal TB. TB patients begin to feel well and put on weight a month or two after starting treatment and as a result many then stop taking their medication. This allows the TB germ, which is not completely gone, to become active again - and this time it may not respond to the medication that worked before. This is drug resistant TB. Worse, the drug resistant strains of TB can be passed on from someone who has them to someone who has never had TB before.

Dr Tony Moll is the softly spoken, greying doctor from the Church of Scotland Hospital at Tugela Ferry, who first raised the alarm about this new strain of TB that didn't respond to the normal TB drugs. Dr Moll was seeing more and more patients dying from what appeared to be an incurable form of TB.  In Tugela Ferry they have 150 new TB cases every month, about 2000 patients a year. Many of these patients have drug resistant TB and their numbers are overwhelming the ability of the hospital to treat patients.

Many patients can't tolerate two years on medication and abscond from hospital - possibly spreading drug resistant TB to others. In Tugela Ferry, Dr Moll and nurses like Sister Nonhlanhla Msomi have developed methods of treating people at home. They ask patients to stay in hospital until the sputum they cough up from their lungs is clear of TB, and then they allow them to go home and continue treatment there. Sister Msomi and her team of eight nurses use off road vehicles over rough terrain to reach up to ten patients who live in remote locations.  They give them daily injections of streptomycin and three times a week kanamycin. These dedicated nurses also train the families to support someone with drug resistant TB. They teach them to always cough into your sleeve, cover your mouth and nose when you sneeze, wash hands regularly and, most importantly, keep the windows open. Someone with DR TB should sleep in a room of their own if this is possible. Following these simple rules makes it extremely unlikely that anyone else will be infected with DR TB.

There is new hope in the fight against DR TB as there is a new drug on trial which can be used to treat drug resistant TB. Known only as TMC 207, it's the first new drug for treating TB in 30 years. Patients being treated with it have been free of TB within two months. It is very important that the trials of this drug be sped up and if it is safe and effective it needs to be made available urgently to people struggling with DR TB.