Tuberculosis until a few years ago was off the informal list of priority diseases because it could be prevented and it could be cured. Now, as the world marks Tuberculosis Day, the disease is causing alarm because of the rising numbers of cases and the emergence of strains of TB that are resistant to almost all known drugs. Correspondent Scott Bobb in Johannesburg visited Sizwe Hospital, one of South Africa's largest facilities for people with drug-resistant TB, and has this report.
Sizwe Tropical Diseases Hospital is a rambling group of one-story buildings lying on the outskirts of Johannesburg.
The pastoral site, which is also home to monkeys and wild birds, is an ideal location for the 260-bed facility which now cares exclusively for South Africa's growing population of people with drug-resistant Tuberculosis.
People with multiple drug-resistant TB have only a 50 percent chance of being cured. Three thousand new cases of MDR-TB were identified last year alone. And few people survive a new strain, called Extreme-Drug-Resistant TB, or XDR-TB, which is resistant to virtually every drug known to science.
Chief Medical Officer, Alicja Dziewiecki, says people develop drug-resistant TB when they abandon treatment before they are cured or when they receive incorrect doses of medicine.
"Multi-Drug Resistant TB, it is TB which is a man-made disease," said Dziewiecki. "This is our fault, patients' fault. All together we made this disease."
Patients take one painful injection and as many as two-dozen pills each day.
Treatment can take up to two years and the drugs have debilitating side-effects.
In Africa, more than three million people are living with TB. And half-a-million die each year from the microscopic (TB) bacteria which are spread through the air, usually by the cough of an infected person.
The number of TB victims is rising rapidly in Africa, due in large part to HIV/AIDS which weakens the person's ability to fight disease.
Children, too, are victims of drug-resistant TB. Most of the two dozen children at Sizwe Hospital are also HIV positive and most are orphans. Some have families but have been rejected by them. If they are cured of TB, they will be placed in special homes.
Johannesburg's National Health Laboratory is located in an old but immaculate building in the center of town. It is one of the few public institutions that tests for drug-resistant TB.
Technicians here each day test 500 specimens from all over southern Africa. Because the TB bacterium is elusive the specimens must be tested in several ways using smears and cultures which are incubated for weeks.
Nearly one-fourth turn out to be drug-resistant and require even more testing to find out which drugs they resist.
Lab director, Dr. Xoliswa Poswa, says during this time the victim may be infecting others.
"Waiting for two weeks, even more than two weeks in certain cases, is too long for someone who is quite ill," she said. "So for laboratorians it [the challenge] is coming up with diagnostic measures that are going to give them [doctors] a diagnosis upon which they can act quickly and save lives."
The laboratory is now experimenting with DNA tests which identify drug-resistance within two days.
Patients under treatment are separated from their families, sometimes for years. This causes economic and social problems for the patient and the family and requires extensive counseling for all.
Some health workers believe people with drug-resistant TB should be quarantined, even against their will if necessary, in order to protect their communities. But human rights activists say this would be a violation of their rights.
In South Africa, where memories of the abuses of the apartheid era are still fresh, the debate evokes strong emotions.
Sizwe's Head Doctor, Xavier Padanilam, notes that such issues are still unresolved because drug-resistant TB is so new.
"Regarding the moral, ethical issues, I would say we are still working on it," said Padanilam. "We haven't reached clear cut guidelines regarding forced isolation of the XDR patient, how we can discharge those patients back to the community, those issues have to be worked out."
But he notes that most patients after counseling accept treatment and quarantine.
"Early on we treated the sensitive TB, and I used to meet patients in the townships, the cured patients," said nurse Alma Joyce Kutwane, who has been working with TB patients for 34 years. "But today the patients that I see that I cured are very few. I don't know whether it is because of the Multi-Drug Resistance or because of the HIV, I don't know. It really hurts. I feel like crying."
It has been more than 20 years since a new TB drug was developed. Some new drugs are now undergoing preliminary human trials but it will be years before they become available.
In the meantime, TB care givers say the most important way to confront the disease is to help the patient complete the treatment and deal with the months of separation from family and friends. For some with drug-resistant TB the separation will last the rest of their lives.