We are always at risk, say doctors
Durban - With the death of Dr Nerissa Pather from a drug-resistant strain of TB, many in the medical community are calling for more to be done to fight the disease and for safer working environments.
In the well-publicised case, Pather contracted multidrug-resistant TB in 2002 while completing her community service at a KwaMashu clinic in KwaZulu-Natal. Her disease was complicated by spinal TB, which rendered her paralysed.
The South African Medical Association (Sama) extended its “heartfelt condolences” to her husband and family.
“The loss of a doctor to a communicable disease contracted in the course of duty is an incalculable tragedy. We have seen this repeated many times in the Ebola viral disease outbreak. This time, however, it strikes far closer to home. TB continues to ravage our country and the risk to all healthcare workers remains,” said Dr Phophi Ramathuba, president of Sama.
The Sunday Tribune spoke to doctors working in public hospitals and found most believed the situation was dangerous. One, who has been serving at the Mahatma Gandhi Memorial Hospital for the past year, believed the safety measures at public hospitals were insufficient and felt under threat. She asked not to be named as she is not authorised to speak to the press.
“One of my colleagues contracted TB a month ago as well. We are not safe. As much as our job is to save lives, we also need to be protected. Protocol is often not followed at public hospita, and this is a problem,” she said.
She said that she was always exposed to needles and the risk of contracting HIV because 80 percent of the patients she treated were HIV-positive.
“Sometimes we run out of safety equipment and have to make use of the little resources we have. This also puts us at risk. These types of incidents can be prevented if the correct measures are taken,” she said.
Another doctor working at Stanger Hospital, who also asked not to be named, agreed.
“It’s a tricky situation for doctors. We are caught between saving lives and protecting ourselves. We are exposed to all kinds of diseases.
“There was once a shortage of surgical gloves in my department. As ridiculous as it sounds, I had to wait for gloves to get to me and there was a patient desperately in need of my assistance. What do we do in a situation like this?” the doctor asked.
Dr Indira Govender, who has been serving in Sierra Leone in the fight against Ebola with MSF (Doctors Without Borders), described it as “tragic” that doctors and nurses in South Africa were being infected with TB through occupational exposure.
“The personal protective equipment is available and should be easily accessible in all health facilities. Infection control measures must be prioritised, especially in places with an excessive incidence of TB. There are many good examples of facility-based innovations in some provinces such as KwaZulu-Natal and the Western Cape,” she said.
“TB and multidrug-resistant (MDR-TB) tuberculosis can be cured and the course of infection is slow; yet the sad reality is that we are made aware of it only when a life is lost,” said Govender.
“Because it is a disease of poverty, health-care workers on the front line in communities ravaged by TB every day quietly fight this battle along with their patients, and live with the fear of infection.
“As there is no consistent campaign aimed at eradicating TB, it continues to compromise the quality of life in our country,” said Govender.
Sama reiterated its call to all health departments and facilities to ensure that basic TB prevention methods were available to all health-care workers in the country.
“Importantly, the N95 mask must be available as a basic means of preventing infection when caring for TB patients. Sadly, this is not the case in many hospitals and clinics and continues to place health professionals at enormous risk.
“The potential consequences of infection and even contracting drug-resistant TB are tragically evident in the death of Dr Pather,” said Ramathuba.
“The right to a safe work environment is a basic condition of employment that is flouted all too often, resulting in extreme incapacitation of doctors, who have to take off work for months. There are profound personal and professional consequences. Sama bows its head to a colleague who has paid the ultimate price,” said Ramathuba.
Ramathuba added that Sama had commissioned research into the number of health-care professionals who had contracted communicable disease such as TB.
“We have a team collecting the data. Most doctors don’t report having contracted TB, for example, but we can definitely say that an increasing number of doctors, nurses and radiographers have been affected,” said Ramathuba.
The Department of Health said definitive statistics on the number of health-care professionals who had contracted TB and other communicable diseases while on the job was not readily available.
Regarding safety measures, the MEC of Health, Dr Sibongiseni Dhlomo, said infection control and clinical protocols exist in all health institutions
“We continue to train our health professionals to adhere to these protocols.
“Dr Pather was an unfortunate incident and is not attributable to such a process. Any health-care professional working within our institutions is at risk of infection from those who come to our institution needing help. And by the time doctors see them, they have not yet been diagnosed as having MDR or XDR-TB.”