Swaziland: Surviving drug-resistant TB: “I’m still over the moon”
Proudly holding her certificate, which reads “I got tested and cured of TB”, is Khanyi. Thirty-five years old and a mother of two, Khanyi lives in Logoba, an overcrowded informal settlement in central Swaziland, most of whose residents came to the industrial town of Matsapha in search of job opportunities.
Difficult to stick to treatment
Three years ago, while taking care of her diabetic husband, who was also co-infected with HIV and TB, Khanyi was herself diagnosed with TB. Khanyi’s husband found it very difficult to stick to his treatment. If Khanyi was not there to insist that he took his medication, he would not take it. Anxious and distracted by caring for him, Khanyi often failed to take her drugs too.
Eight months into her treatment for TB, Khanyi was found to have multidrug-resistant tuberculosis (MDR-TB), a strain of the disease that is resistant to the most common anti-TB drugs. “I strongly believe that I brought MDR-TB upon myself, because I would sometimes miss my TB treatment,” says Khanyi. “When my husband became ill, I became worried with caring for him. I remember the time he was admitted to hospital. I rushed to hospital to be at his bedside, and in the confusion I totally forgot about my treatment. I believe this is when I developed resistance to the drugs.”
Following her diagnosis, Khanyi was enrolled at MSF’s clinic in Matsapha, five km away, which offers patients home-based care. “The good thing about receiving treatment at the MSF clinic is that I got my injections at home,” says Khanyi. “This was a relief because, by then, both my husband and I had stopped working due to sickness, and money was scarce. Getting treatment from home meant I could cut on travelling costs.”
Still, Khanyi describes starting MDR-TB treatment as “devastating”, and will never forget the pain of eight months of injections. “I could not bear the injections,” she says. “The pain would spread to my knees and back – it was so bad I couldn’t even walk. My every movement was thoroughly contemplated before it was made.”
The tablets were very exhausting
Alongside injections, Khanyi had to take a daily cocktail of pills, with unpleasant side effects which can include constant nausea, depression, deafness and sometimes even psychosis. She admits there were times when she was tempted to stop the treatment altogether. “The tablets were very exhausting,” she says. “Just the thought of taking them was depressing. I had moments when I was tempted to give up treatment. But when I had such thoughts, I would think of my children. Being a widow with both my parents dead, I couldn’t imagine dying and leaving my children orphaned.”
Some months into her treatment for MDR-TB, Khanyi’s husband died, and one of her two daughters was diagnosed with TB. But, in spite of everything, Khanyi was able to overcome the emotional and psychological challenges to complete her treatment. She was helped in this by MSF’s medical teams as well as by the encouragement of members of the community who volunteer to support patients at home.
Today Khanyi lives a normal life with her two daughters. They survive on what Khanyi earns as a fruit vendor. Her only regret is having infected her daughter with TB, although her daughter too is now cured of the disease. So Khanyi’s joy is double, even if she cannot share it with her husband.
“I was ecstatic when the doctor told me that I had been cured of MDR-TB,” says a smiling Khanyi. “I couldn’t believe it was possible and I had made it through. I’m still over the moon.”
Khanyi is not alone in celebrating: 63 other patients from Matsapha clinic and 35 patients from Mankayane hospital, some 45 km away, can proudly show certificates from MSF which proclaim, “I got tested and cured of TB”.
MSF has been working in Swaziland since 2007, running integrated HIV/TB projects in the Shiselweni and Manzini regions. Alongside the Ministry of Health, MSF has integrated HIV and TB services at clinics and in the community. MSF is also advocating for the introduction of shorter, more tolerable treatment regimens for drug-resistant TB and the promotion and implementation of outpatient care for people with the disease.