Somewhere between walking out her front door in Cape Town, taking a taxi to college and hanging out with friends, Phumeza Tisile caught tuberculosis.
It was during her first semester as a student at the Cape Peninsula University of Technology that Tisile began to cough and lose weight. She was soon so weak she could barely walk. She went to a private doctor who treated her for pneumonia and then sent her to a government health clinic where she tested positive for TB.
That was in May 2010, just months before South Africa hosted the football World Cup, the first time the finals had been held on African soil. While the rest of the country was celebrating, Tisile became increasingly ill. She was taking her TB medication as prescribed, but she was not getting better.
“I’m not a soccer fan, but I remember that time clearly,” she says, “I was in Karl Bremer Hospital, but then they had to transfer me to the Brooklyn Chest hospital. I was too weak, but at least I was able to walk. The other patients were enjoying [the World Cup], they even had the energy to blow vuvuzelas. I couldn’t care less, but it was nice to have people around, unlike Karl Bremer where you live in a closed room alone.”
Tisile’s admission to hospital followed her body’s failure to respond to standard TB treatment. By this time she was desperately ill with TB in her brain and chest and required a major operation and long-term chest drain.
TB is so widespread in South Africa that simply breathing carries a risk. According to the World Health Organisation’s 2012 Global TB Report there are half a million new cases of TB in South Africa each year, and the South African National Aids Council reports a 400 percent rise in TB over the past 15 years.
In most patients, a dose of two to three tablets a day for a minimum of six months cures drug-sensitive TB. In Tisile’s case, further tests found that even though she was HIV-negative and had never had TB before, she was diagnosed with multi-drug-resistant TB (MDR-TB) – or so she thought.
Until 2011, South African health guidelines required that patients with multi-drug resistant-TB (also referred to as drug-resistant or DR-TB) receive their treatment as in-patients in one of the country’s handful of dedicated TB hospitals. However, with new cases of DR-TB outstripping the bed capacity, the government has been forced to re-think.
At the South African TB conference in June 2012, the director of TB, DR-TB and HIV in the national health department, Dr. Norbert Ndjeka, acknowledged the need to change.
“We will never have enough beds in our lifetime to admit all the MDR-TB cases and we can’t keep building more hospitals,” Ndjeka told a United Nations news agency. “The first success has been getting the right policies in place. The next success will be when we declare that there are no more waiting lists.”
The lack of beds in dedicated TB hospitals meant that not only were people in need of treatment being turned away and left to die in the community, but without treatment they were still infectious and liable to spread MDR-TB to anyone with whom they came in contact.
In 2012, almost 7,400 DR-TB cases were diagnosed in South Africa, but health officials recognise that it is likely that many more cases go undetected.
A small prevalence survey carried out by the international medical humanitarian organization, Médecins Sans Frontières (Doctors Without Borders) in the sub-district of Khayelitsha in 2008 estimated that there were more than 400 DR-TB cases each year in Khayelitsha alone.