Isabel Maria Francisco, 41, gets up at 4:30 in the morning, eats a light breakfast and takes a minibus taxi to Chamanculo Hospital on the outskirts of Mozambique's capital, Maputo, to start work as a patient-expert at 6:00 a.m.
Despite her shyness when talking to IRIN/PlusNews, a transformation takes place as she tells hundreds of patients in seminars at the hospital and in communities about the importance of adhering to their tuberculosis (TB) and HIV drug regimens, and motivates them never to miss a dose of their medicine. She managed to cure her TB infection after eight months of treatment in 2004, and started taking antiretroviral (ARV) medication in 2008.
Like Francisco, other activists supported by provincial and district health facilities visit remote areas looking for people with symptoms of TB - a cough that has persisted for more than three weeks, phlegm, breathlessness and chest pains - and refer them to the closest health centre, or collect samples and take them to testing centres by bicycle.
"It's also common to see TB patients sitting in the shade of a tree in rural districts, taking their medication together under the watch of a volunteer," said Paula Samo Gudo, head of the National Tuberculosis Control Programme.
In search of the perfect treatment
Mozambique is 18th on the World Health Organization (WHO) list of the 22 countries most affected by TB. The government estimates that 20,000 cases are diagnosed every year, but these figures probably represent half the actual number of cases, since up to 50 percent are never diagnosed.
With the support of health activists and other groups, such as traditional doctors and faith-based organizations, who work directly in the community, the Health Ministry has recorded an improvement in detecting TB: 35,672 new cases were registered in 2006, but this rose to 38,044 in 2007.
There is growing concern over keeping people on treatment, and Gudo said the Ministry of Health would conduct a survey to determine the scale of treatment defaulting.
A major reason for treatment interruption is the movement of Mozambican workers to mines in neighbouring South Africa. Many come to their native country for treatment but go back across the border as soon as they show improvement. Myths that TB does not exist, or is the result of witchcraft, also contribute to people stopping therapy.
Interrupting treatment for TB or HIV can lead to the development of strains of TB that are resistant to first-line drugs and are much more difficult to diagnose and treat, which are becoming increasingly common among migrant mine workers and their families.
Multidrug-resistant TB (MDR-TB), the most highly transmissible form of TB, represents an estimated 3.4 percent of all new cases of the disease in Mozambique.
The country does not yet have the capacity to diagnose extensively drug-resistant TB (XDR-TB), so when a patient is suspected of having XDR-TB, samples are sent to be tested in South Africa. So far, only one confirmed case has been registered in Mozambique, in 2006, and the patient passed away in the same year.
Médecins Sans Frontières-Switzerland, an international medical aid organization, provides technical support to the Ministry of Health to treat TB in Maputo. Gbamou George Tonamou, a physician with the organization, told IRIN/PlusNews that he worked with TB patients showing resistance to treatment and those who were HIV-positive.
"These are actually the hardest patients to treat," he commented. "We have to be very careful, as, since they have failed to react well to initial treatment and many of them have AIDS, a simple slip-up could be fatal."
Official Health Ministry figures indicate that some 60 percent of TB patients are co-infected with HIV, and all the units providing TB treatment now also offer HIV counselling and testing.
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Despite her shyness when talking to IRIN/PlusNews, a transformation takes place as she tells hundreds of patients in seminars at the hospital and in communities about the importance of adhering to their tuberculosis (TB) and HIV drug regimens, and motivates them never to miss a dose of their medicine. She managed to cure her TB infection after eight months of treatment in 2004, and started taking antiretroviral (ARV) medication in 2008.
Like Francisco, other activists supported by provincial and district health facilities visit remote areas looking for people with symptoms of TB - a cough that has persisted for more than three weeks, phlegm, breathlessness and chest pains - and refer them to the closest health centre, or collect samples and take them to testing centres by bicycle.
"It's also common to see TB patients sitting in the shade of a tree in rural districts, taking their medication together under the watch of a volunteer," said Paula Samo Gudo, head of the National Tuberculosis Control Programme.
In search of the perfect treatment
Photo: Lucas Bonanno/PlusNews  |
| There is growing concern over keeping people on treatment |
With the support of health activists and other groups, such as traditional doctors and faith-based organizations, who work directly in the community, the Health Ministry has recorded an improvement in detecting TB: 35,672 new cases were registered in 2006, but this rose to 38,044 in 2007.
There is growing concern over keeping people on treatment, and Gudo said the Ministry of Health would conduct a survey to determine the scale of treatment defaulting.
A major reason for treatment interruption is the movement of Mozambican workers to mines in neighbouring South Africa. Many come to their native country for treatment but go back across the border as soon as they show improvement. Myths that TB does not exist, or is the result of witchcraft, also contribute to people stopping therapy.
Interrupting treatment for TB or HIV can lead to the development of strains of TB that are resistant to first-line drugs and are much more difficult to diagnose and treat, which are becoming increasingly common among migrant mine workers and their families.
Multidrug-resistant TB (MDR-TB), the most highly transmissible form of TB, represents an estimated 3.4 percent of all new cases of the disease in Mozambique.
The country does not yet have the capacity to diagnose extensively drug-resistant TB (XDR-TB), so when a patient is suspected of having XDR-TB, samples are sent to be tested in South Africa. So far, only one confirmed case has been registered in Mozambique, in 2006, and the patient passed away in the same year.
Médecins Sans Frontières-Switzerland, an international medical aid organization, provides technical support to the Ministry of Health to treat TB in Maputo. Gbamou George Tonamou, a physician with the organization, told IRIN/PlusNews that he worked with TB patients showing resistance to treatment and those who were HIV-positive.
"These are actually the hardest patients to treat," he commented. "We have to be very careful, as, since they have failed to react well to initial treatment and many of them have AIDS, a simple slip-up could be fatal."
Official Health Ministry figures indicate that some 60 percent of TB patients are co-infected with HIV, and all the units providing TB treatment now also offer HIV counselling and testing.
lb/jh/kn/he
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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