KwaZulu-Natal is a province hard hit by tuberculosis. In December, Department of Health head, Dr Sibongile Zungu, said according to statistics from 2013, there were 99 067 cases of TB in the province, of which 6 916 were children under the age of five.
The province has the highest co-infection rate, with 65 percent of those infected with TB also being HIV positive.
According to the World Health Organisation (WHO), TB is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs.
It is spread from person to person through the air.
When people with lung TB cough, sneeze or spit, they propel the TB germs into the air and a person needs to inhale only a few of these germs to become infected.
But the issue is about far more than health for community-care groups on the ground. Eradicating TB encompasses fighting social stigmas and enlisting the help of the very people on the front lines of the battle.
For TB programme manager of the SA Red Cross Society, Sikhumbuzo Biyela, recruiting volunteers from the areas they were trying to help including their traditional leaders – was something of a no-brainer.
“When it’s someone from your area, someone you trust, knocking at your door you’re more inclined to listen to what that person has to say. The message will be delivered more effectively,” he said.
Biyela said tapping into this available resource allowed the organisation access to people who normally shied away from seeking help if they nursed suspicions of being ill.
“They are more likely to reach out to people who they are familiar with. We also give our volunteers some training to help them deal with this.”
The organisation provides courses in basic counselling; HIV and TB awareness; home-based care; and psycho social support and mental health programmes.
It supports prevention, treatment adherence and care for 23 000 adult and 23 000 orphaned and vulnerable children annually, within seven municipalities, including Ugu, Umgungundlovu, eThekwini, Uthungulu, Amajuba and Sisonke.
The KwaZulu-Natal TB programme has more than 1 500 volunteers and 194 staff supporting this group of more than 40 000 people infected and affected by the pandemic.
“The care also consists of assistance with grant application, collection and monitoring of medications, provision of food parcels, training and income generating activities.”
The organisation, since its inception in 2007, has raised awareness on the issue to more than 1.9 million people.
“We are seeing huge differences in the attitudes towards those who are infected.
“When we first started, we saw disturbing trends as a result of the stigma attached to the disease. People were locked in separate rooms. People were killed. Now, we see many more people coming forward, seeking help,” Biyela said.
Where people had been guarded and even resentful of the group’s “interference” in their areas, they now seemed more appreciative of efforts, he said.
Traditional healers were also vital in gaining the trust of the people in the communities they served.
“People, if they are ill, often consult sangomas. They don’t go to the clinic so we knew that we needed to furnish these healers with the information on TB and HIV that they could share with their clients.”
The healers advise people on how to live with and prevent infection, and what to do in the event of becoming infected.
“They are one of our most important stakeholders.”
A pilot project – carried out last year by the US Aid TB Programme, Durban University of Technology, the KwaZulu-Natal Health Department and KZN Traditional Health Practitioners in the rural areas of KwaZulu-Natal – found at least 41 percent of TB patients used traditional healers first before Western medicine.
Researchers also found that 84 percent of TB patients would rather have a traditional healer as a treatment supervisor than public health supervisors.
About 40 percent said they had been seen by a healer at some point before their diagnosis.
During the course of the project, 500 traditional leaders had been trained.
Of the almost 20 000 patients they saw, they referred more than 360 suspected of being HIV positive for testing and 559 more for TB testing at hospitals.
Using the influence of these healers is nothing new. During a 2001 study conducted in Hlabisa by the Medical Research Council, 89 percent of those whose treatment was supervised by traditional leaders completed the course, as compared to those supervised by a community health care worker.
The 25 healers were trained in one-day directly observed therapy short course (Dots) programmes in TB management.
“Our findings suggest that traditional healers are a potentially important resource to integrate TB control programmes… In Africa, south of the Sahara, the ratio of traditional healers to the population is about 1:500, in contrast to the doctor to population ratio of 1:40 000.”
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The Disease in numbers
* Tuberculosis (TB) is second only to HIV/Aids, the greatest killer worldwide, due to a single infectious agent.
* In 2013, 9 million people fell ill with TB and 1.5 million died from the disease.
* More than 95 percent of TB deaths occur in low- and middle-income countries, and it is among the top 5 causes of death of women aged 15 to 44.
* In 2013, an estimated 550 000 children became ill with TB and 80 000 HIV-negative children died of TB.
* TB is a leading killer of HIV-positive people causing one fourth of all HIV-related deaths.
* Globally in 2013, an estimated 480 000 people developed multidrug resistant TB (MDR-TB).
* The estimated number of people falling ill with TB each year is declining, although very slowly, which means that the world is on track to achieve the Millennium Development Goal to reverse the spread of TB by 2015.
* The TB death rate dropped 45 percent between 1990 and 2013.
* An estimated 37 million lives were saved through TB diagnosis and treatment between 2000 and 2013.
(Source: The World Health Organisation – WHO)