Swaziland: A new ward to treat patients with drug resistant tuberculosis

Last week, the first patients infected with drug resistant tuberculosis (DR-TB) were admitted in a new wing at Nhlangano Health Centre, in the Shiselweni region of southern Swaziland. The facility was constructed by MSF through private donations. The Ministry of Health and MSF teams will be jointly running this new facility.

The new DR-TB wing can attend to a maximum of 30 patients. International standards for infection control were integrated with the use of natural ventilation. The ward also includes a laboratory with state-of-the-art technology. Amongst the features MSF is proud to introduce is the molecular analyser, which detects specific drug resistance in less than two hours, allowing clinicians to quickly initiate patients on adequate treatment.

The ward was officially opened on the September 20, 2011. The inauguration was attended by the King of Swaziland Mswati III, members of his government and his cabinet, as well as representatives of World Health Organization and NGO partners. The event took place before a large crowd of Swazis gathered behind the newly erected building.

While commending Swaziland efforts in its fight against TB and particularly the recent decision of the government to declare the epidemic as an emergency, the president of MSF’s Swiss association, Dr Abiy Tamrat, warned King Mswati III against the consequences of the financial crisis affecting Swaziland.

“We wish to appeal to you to ensure that all measures are taken by your government for the timely procurement, supply and distribution of drugs and lab supplies to health facilities and patients. Defaulting on this commitment would directly impact on the lives of many and on our chances to successfully curb the dual HIV-TB epidemic affecting the Kingdom,” said Abyi Tamrat.

The management of DR-TB is a growing challenge in Swaziland. Almost 8% of new TB cases are infected with a drug resistant form of TB and 20% of TB cases in Swaziland are DR-TB cases. There are currently more than 800 cases of DR-TB treated in the country and 172 alone in the region of Shiselweni, where MSF has been working since 2007.

DR-TB treatment is very taxing for patients. They must receive daily injections for at least six months and take up to 18 pills a day. Adverse effects are many and require even more medicines.

Because it is humanely and practically impossible to keep patients in hospital for months, the new DR-TB ward comes as a complement to a community based approach. “For the majority of our very sick patients, this is the only opportunity to access good quality of care, close to home, in case they need hospitalisation,” explains Dr. Natalia Tamayo Antabak, the medical head of the new DR-TB ward.

Since 2007, MSF teams have been focusing their efforts on facilitating the free access to integrated HIV and TB services at the lowest point of care, the Primary Health Care clinic. Today, there are 22 rural clinics in the Shiselweni region that offer decentralised TB care and treatment to more than 2,000 patients every year. In the Manzini region, five clinics offer decentralised care for drug sensitive and drug resistant TB.