What if I told you that a third of the world’s population is latently infected with a deadly disease? And that the disease has mutated into a more deadly form that can’t be treated with normal drugs? And that, in some places, the disease is completely untreatable? Oh, and that the disease is airborne – just sitting next to someone who has it could be enough to catch it? And although fifty million people worldwide are infected with the mutant form, the only drugs that treat it can make you vomit, lose your hearing or become psychotic?
Well, TB is back and bigger than ever. It's the world’s second most common adult infectious disease after AIDS. And the drugs don’t work.
In the kingdom of Swaziland, one of Africa’s smallest countries, the TB rate is highest in the world. It also has the world’s highest HIV/AIDS rate, with over 26 percent of the adult population infected. Put those two statistics together, and you have the very real problem of an average life expectancy of just 49, which is lower than Somalia or Afghanistan.
But Swaziland isn’t a basket case – the water is clean, the roads are tarmacked and everyone goes to secondary school. Arriving at Manzini International Airport and driving into town, the scenery is reminiscent of Napa Valley, except the fields are abundant with pineapple crops and sugar cane rather than grapevines and illegal Mexican workers.
The hospitals and health clinics are where it hits you. Instead of seeing sickly old people and infants, it’s the grannies and kids who look healthy and the young adults who are barely able to walk. Plenty of HIV positive people look healthy – HIV/AIDS is now a chronic disease, so if you take your pills every day there’s no reason not to live a long life (or at least one that's longer than if you ate shitty fast food three times a day). In Swaziland, it’s the TB cases who look really bad.
Visiting the TB ward, infection control is rigorous. You’re instructed on how to put your mask on, pinching the top part to ensure that no air can get through, and even though most of the TB patients also have HIV/AIDS, there’s a small risk of catching TB even if you’re HIV negative.
The problem is, in Swaziland one percent of the population has TB. And if you have the mutant form, called Multidrug resistant TB (MDR-TB), your treatment will take around two years. The Swazi government has a slightly more touchy-feely approach than Kenya, where people who don’t take their drugs properly are locked up for eight months. But the treatment is hard going – many people give up.
The Swazi government soon realised that they just couldn’t cope with the epidemic in 2007. Not only did they have a huge number of patients to treat, but many of their most talented healthcare workers had succumbed to AIDS, while foreign wages continue to tempt the remainder overseas. The result is a severely depleted workforce.
Eventually, Medecins Sans Frontieres, also known as Doctors without Borders (MSF) was asked to intervene. The international medical aid agency – usually seen in warzones and earthquakes– started working in hospitals which were very different from those in Haiti or Somali: in Swaziland they’re not routinely covered in shit, blood and body parts and they're reasonably well-equipped.
But treatment is tough. If you're an MDR-TB patient, you're gonna require daily injections for the first six months of treatment. If you live 15 miles from the nearest clinic, and you can’t work because of the side-effects, this is a big problem. And if you need to take your tablets on a full stomach, but you can’t because you haven’t got enough money for food, well, that's another big problem. Finally, if this is going to continue for the next two years, you’re probably going to think that it simply isn’t worth it.
Ngetie, a woman with HIV and a family who I met in Swaziland, thought like that sometimes. When she was diagnosed with MDR-TB in 2007 she sometimes felt like giving up. But her family was relying on her to get through. Close to the end of her treatment, she realised she was pregnant. Riddled with guilt, knowing that the potent drugs could affect her unborn child, she told her family.
Sinetsemba Nkambule was born three months later. A girl weighing 3.5 kilos, the baby was HIV negative and had no health problems. Ngetie went on to complete her treatment and now is a social worker for MSF.
“I help to motivate the patients, so that they take their treatment correctly, and I encourage them. When I tell them my story and they understand that I’ve been there and that they can get through it, it gives them hope,” she says.
Ngetie and her team provide practical and psychological support to the patients, as well as practical support, including bus fares and food vouchers. If people are sleeping in the same room as others, MSF will build an extra room to ensure that other family members don't get infected too.
Another person I met, Benson, lives with his wife Florence and their three kids. Benson has AIDS and caught drug-resistant TB when he was working in a mine. When he was first diagnosed he had to trek five miles each day to have his injections. When he didn’t have money for the bus fare he had to walk, which was not exactly easy as the medication made his legs swell up like balloon animals.
“I felt like I was lifeless when I first started taking the medication. I felt as if I had already died. When the people from MSF came to speak to me, to give me counselling, I felt like my life had meaning and that I had the strength to carry on."
The family is not rich and the food packages make an enormous difference. “Even if we don’t have much food, I don’t feel nearly as stressed about it, because I know that we’ll get food packages and that we’ll be okay,” says Florence. “Taking care of my husband is so much easier because people come to visit us regularly. I feel sure that Benson is going to be cured now.”
The only way to beat drug-resistant TB is with a long and arduous treatment. Better drugs and a shorter treatment course are desperately needed. But relatively cheap and simple measures can make all the difference to those people who are managing to stick to their treatment. People like Benson and Ngetie, for whom it's no exaggeration to say that the situation is literally one of life or death.