State is 'Turning Tide' on TB. 3/4/11

South Africa introduces airy new wards, faster diagnosis and more testing thrown into attack

Times Live

Airy new wards, faster diagnosis and more testing thrown into attack

Adisease that kills tens of thousands of South Africans every year is being smashed with the help of expensive gadgets, home visits by health officials and specially designed hospital wards.

The government's war on TB was spelt out this week by the Minister of Health, Aaron Motsoaledi, in an address to Harvard University experts in Boston in the US.

Instead of merely treating patients who have the drug-resistant illness, community healthcare workers now travel to the homes of all known TB sufferers. The patient's relatives are all tested to find out whether they are infected as well - and so far more than 60000 people have been checked since the programme began six weeks ago.

The government has also received the world's largest order of TB-diagnostic machines. Thanks to the roll-out of 24 "GeneXpert" machines, South African authorities can now diagnose patients in two hours instead of the minimum six weeks it usually takes. In the past, thousands of patients died of TB while waiting to find out if they were infected.

Nine prototype TB hospital wards - one for each province - have been designed by the Council for Scientific and Industrial Research (CSIR) with help from Harvard.

A 40-bed wing of the new type of ward was opened in Klerksdorp in North West last week, and the Catherine Booth hospital in Empangeni opens its facility next week.

Designers have concentrated on providing natural ventilation, so the TB bacillus is dispersed - rather than infecting or re-infecting other patients.

The wards, which are reminiscent of airy safari lodges, have private rooms with high ceilings, open corridors, a special system of air vents, and huge windows overlooking landscaped courtyards.

David Mametja, the head of TB control for the Department of Health, said that, during interviews, the minister "is presenting the line that we are finally turning the tide against TB".

Mametja, who accompanied Motsoaledi to the US, said the Global Fund to Fight Tuberculosis had helped to finance the R100-million wards project, with 400 new beds.

US Aid helped sponsor the largest of the GeneXpert machines - the R2.5-million unit now at Prince Mshiyeni Hospital in Umlazi, KwaZulu-Natal.

Mametja said "a combination of government resources" had funded other machines, operator training and community health workers.

Some 13% of all South Africans who died each year had TB at the time of death, Mametja said.

"Thousands of lives (will now be saved). It is historic. We no longer wait for patients and, because of these machines, patients no longer wait for us.

"About 410000 individuals contracted TB in 2010 and the commitment we've made is that, by March next year, we should have visited at least half of their homes for screening and counselling. That's 200000 families."

Mametja admitted that many patients had died needlessly - because of their treatment in hospital.

"The problem we have with some of our health facilities is they are old and inadequately designed. And, you actually are more likely to get infected with a disease when you are in that institution than when you are out of it," Mametja said.

Geoff Abbott, project co-ordinator with the CSIR's Building, Science and Technology Unit, said natural ventilation changed the air up to 15 times an hour in the new wards.

And it was hoped the trees and bomas in the courtyards would encourage TB patients to spend as much time outside as possible.

Kathy Wiebe-Randaree, CEO of Tshepong Hospital in Klerksdorp, said her hospital now had both a CSIR-designed 40-bed drug-resistant TB wing and a mid-sized version of the GeneXpert diagnostic machine.

"These will make a tremendous difference. Previously you could have a patient with TB in a normal medical ward with other patients and you wouldn't know it."

Pamela Richards, deputy director of the government's drug-resistant TB programme, said the new machines were "absolute life-savers".

In 2005 she visited at the Church of Scotland Hospital in KwaZulu-Natal when 52 people died in the world's worst outbreak of drug-resistant TB.

Richards said: "I remember walking into that ward. I was never upset like that in my life. Everybody was busy dying. These outbreaks shouldn't happen with the new designs."