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Taking multi-drug resistant tuberculosis fight to rural areas

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AT WORK— A medical worker uses a microscope to come up with the correct diagnosis

Eliza Namvenya had, for the better part of her 39 years of existence, been a woman full of life. Not once did she think that sickness would one day stand between herself and her dreams.

But this is what happened to her in 2015, which marked a turning point for Namvenya, a subject of Village Headman Mkaka, Traditional Authority (T/A) Nchiramwera, in Thyolo District.

The turning point was not marked by earthquakes, or any visible sign to Mkaka’s other subjects; Namvenya simply lost appetite.

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Before long, Namvenya, who gave birth when she was 20 years old, started losing sleep. When she realised that she had also started sweating profusely, nursing swollen feet and coughing around the clock, she sensed danger.

There was danger in the air, her clothes, her chest, her skin. There was danger everywhere.

Her first reaction was to get medication from local shops in her attempt to buy temporary relief, especially at night— which, all of a sudden, became a pinnacle of all her miseries.

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But the pain persisted, to the extent that she had no choice but to visit Thyolo District Hospital.

Namvenya was diagnosed with tuberculosis (TB) and was put on treatment for a period of six months. She was put on an intensive phase of two months followed by another phase of four months.

However, Namvenya, an ever-smiling woman, did not get better.

“I felt like I was getting better but, frankly speaking, I was feeling unwell. My husband encouraged me to go back to the hospital for further treatment and I did not object. We went back,” she says.

The World Health Organisation (WHO) indicates that it is possible for a patient not to respond positively to treatment. It says some of the factors that can stop a patient from responding positively to TB treatment include patients stopping taking drugs too soon, failure to take drugs correctly, or when TB bacteria that are still alive become resistant to drugs.

According to WHO, TB that is resistant to drugs (MDR) is harder and more expensive to treat.

In its 2017 Global Tuberculosis Report, WHO says: “Most people with TB are cured by a strictly followed, six-month drug regimen that is provided to patients with support and supervision.”

However, Namvenya denied not following the TB drug regimen to the book.

She went back to the hospital.

And, again, she did not get better.

By now, it had become common knowledge. TB bacteria had developed resistance to the antimicrobial drug, rifampicin— one of the two most powerful anti-TB drug.

Mind-blowing

Her life changed, physically, psychologically, socially and spiritually.

She lost weight, from about 60 kilogrammes (kg) to 42kg and lost almost all her friends.

In the first days of MDR-TB, people are encouraged to keep their distance from patients. Otherwise, they are encouraged to put on protective gear.

“This meant all my friends no longer visited me and I could not visit them. I can no longer attend a church service or any other social gathering. I was advised to keep a distance from others to avoid infecting them. I used to do business— I was selling dry fish and tomatoes — and I stopped way back. My life became more miserable than ever before,” she said.

Her husband, Steven Masula, who has been married to her for 15 years, also felt the pinch. He also nearly lost all his friends.

“My friends also felt I had contracted the T B bacteria and that I would infect them. But I know that everybody has time to get sick and time to get better. I believe that love has no limitations. With that in mind, I keep on going. My job every day is to encourage her to take medication and, together, she does not miss her dosage,” he said.

Namvenya takes nine pills every day.

The jovial Namvenya is set to finish the two-year TB regimen in October this year. She is optimistic that, this time, she will get better.

Masula also says, after his wife was diagnosed with TB, he was advised to ensure that ventilation was top notch in his house and, of course, family members were, during the first days, being given masks whenever they were in close contact with the wife.

Interventions

Currently, Development Aid from People to People (Dapp) Malawi is working in Thyolo District in all its 14 traditional authorities in a programme called Integrated HIV/TB Project being financed by Comic Relief though TB Alert-United Kingdom.

The three-year project, which started in 2015, seeks to raise awareness on the TB disease; hence, persuade people to have early diagnosis. The awareness is done door-door with help of about 750 volunteers deployed to do to work.

Dapp Programmes Manager, Frank Pachanya, says 75 sputum collection centres were established and, so far, 172, 000 people have been reached with HIV/TB information during the door-to-door campaign— beating the 140, 000 target set to be met by the end of the programme next year.

“We also managed to donate six microscopes to various community hospitals, one of which was given to Mikolongwe Community Hospital, which has a catchment of 32 villages. We have managed to identify several TB cases, including in hard-to-reach areas such as Mtambanyama through the door-to-door initiative,” he said.

One of the officials at Mikolongwe Community Hospital, Expert Kennedy, said they started using the facility in January 2017.

“Since we started using the facility, 245 people were diagnosed and 13 people tested positive and are on TB treatment,” he said.

Pachanya added that under-privileged patients who were diagnosed with MDR TB are given 100 kg of maize, four litres of cooking oil, 16 packets of soya pieces, two bottles of peanut butter, Sibusiso and two kg of Likuni Phala every two months until they finish treatment.

MDR status in Malawi

Thyolo alone has six patients with MDR-TB – two patients in T/A Nchiramwera, two in T/A Bvumbwe, one in T/A Kapichi and Mphuka.

Ministry of Health spokesperson, Joshua Malango, says Malawi registers about 50 patients with MDR TB yearly but about 70 percent of them are treated successfully.

The WHO 2017 Global Tuberculosis Report indicates that an estimated 490, 000 people worldwide developed MDR-TB, and an additional 110 000 people with rifampicin-resistant TB were also eligible for MDR-TB treatment.

Among new TB cases, which account for most of the global TB burden, an estimated 4.1 percent have MDR or rifampicin-resistant TB. The proportion is higher among people previously treated for TB, at 19 percent.

While these levels have remained fairly stable over time, some countries do have serious epidemics, particularly in Eastern Europe and Central Asia.

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