What has gone wrong? Experts point to the following :
Poor patient compliance
Cornelia Muller, 54, a cleaner from Ravensmead, Cape Town, first developed Tb in 1986. Although her clinic put her on a six-month regimen of drugs, she stopped the treatment when she felt better after six weeks. The Tb came back again and again, but she never completed the full treatment which could have effected a cure. One day in 1995 she coughed up half a cup of blood. By now resistant to all standard drugs, she was hospitalized for six months before the infection cleared up. Doctors are sceptical that she will take the medication necessary for a cure.
The biggest problem in controlling Tb is that one in five people stop taking the drugs as soon as they feel better, generally after two months. Unfortunatey, the first phase of treatment kills only the active bacilli. In normal circumstance, it takes another four months to cure the disease. Half-completed treatments kill off the weaker strains of the germ, leaving behind tougher, mutant strians which then enter the infectious pool and require treatment that is 20 times more expensive, lasts four times longer ---- and often fails.
Indadequte state health facilities
According to the World Health Organization(WHO), the most effective way of diagnosing pulmonary Tb is through a sputum test, where Tb bacilli are identified under a microscope. This method has been adopted at government hospitals and clinics throughout South Africa, but poorly trained staff and a shortage of clinics and laboratories in rural areas make it all but impossible to implement an effective screening programme.
All in all, health authorities have shown an apalling inability to administer a control programme. Too few cases have been identified and too few contacts traced, drug compliance has not been monitored, and records of treatment have often been non-existent.
At 14 months, Phiwayinkosi Zuma of KwaMashu in Kwa-Zulu Natal was a boisterous toddler. When he became listless and refused to eat, doctors blamed teething or flu. But Phiwayinkosi continued to deteriorate until his eyes became unfocused and he couldn't sit up. Finally diagnosed with tuberculosis meningitis, Phiwayinkosi spent seven months in hospital. Although cured of the disease, he is permanently blind.
The frightening thing is that Phiwayinkosi was vaccinated against Tb, a compulsory requirement introduced in 1973 for all newborn South Africans. Further more a study found that eight out of ten children admitted to the Tygerberg Hospital in the Western Cape between 1985 and 1992 for Tb meningitis ---- the incidence of which is particuluarly high in South Africa ---- had received the Bacillus Calmette-Guerin (BCG) vaccination.
" The protective effect of the vaccination varies from country to country, ranging from 85 per cent to a mere 15 per cent, " says Dr Fourie , Head of the Medical Research Council of South Africa. " From the little we know about its efficacy in South Africa, we can assume that it provides 60 per cent protection in preventing serious forms of Tb in children under the age of five".
What is also known is that the method of administering the vaccine is highly suspect. A report in the South African Medical Journal in October 1995 on a study of 125 vaccinated infants in two Cape Town maternity hospitals revealed that 91 of them showed no skin puncture marks. They should have shown 18, since the nine-needle Japanese tool is depressed twice to push the vaccine into the skin. " The tool and the method of applying it require urgent reappraisal, " says Emeritus Professor Maurice Kibel, former head of child health at the University of Cape Town who lead the study.
HIV : a sinister partner
Once inhaled, Tb bacilli may lie dormant in the body for decades, shielded by a thick waxy cell wall. According to the National Tuberculosis Research Programme, a third of all South Africans harbour dormant Tb, kept in check by their body's defences. If the immune system is lowered, however, the germ leaps into action.
Enter the Aids virus.
It's estimated that Tb will be the main killer of HIV- positive patients
by the year 2000. HIV and Tb make bad partners. HIV allows
dormant Tb bacilli to become activated while Tb turns HIV into Aids.
Statistics show that people with HIV are ten times more likely to develop
reactivated Tb than the average person harbouring the dormant germ.
At present 1,8 million South Africans are HIV positive, according to the
Department of Health, a number that has doubled in the past 15 months.
This means that the pool of people passing on Tb could swell to an ocean
in a few short years.