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SA’s healthcare workers hard hit by TB infections

Exposure to infectious patients, high HIV rates and a lack of ventilation in facilities are some of the reasons healthcare workers in South Africa have the one of the highest tuberculosis (TB) infection rates in the world.

When x-rays show complicated and massive fractures, all you want is an orthopod but in a rural hospital, sometimes a girl's got to go it alone.

When x-rays show complicated and massive fractures, all you want is an orthopod but in a rural hospital, sometimes a girl’s got to go it alone.

According to the findings published last week in the World Health Organisation’s Global Tuberculosis Report 2016, last year almost 10 000 healthcare workers were reported to have contracted TB around the world: 30 percent of these were from China, with South Africa accounting for the second-highest proportion: 21 percent.

Dr Nazir Ismail from the National Institute for Communicable Diseases, said TB is a “major problem” in South Africa and efforts to identify the disease in healthcare workers have been ramped up in recent years.

“South Africa has one of the highest incidence of TB globally and this is reflected in the ratio in health-care workers for two reasons: occupational exposure to infectious and untreated patients on a regular basis puts them at risk and is common in SA. Second, most healthcare workers are usually between the ages of 25- 44 which is the age group with the highest incidence of HIV an important factor for TB,” he said.

Survivor speaks

But TB survivor Dr Dalene von Delft, who heads up the local organisation TB Proof, said not enough is being done to protect the health workforce.

“While generally health workers are at a three times higher risk of contracting TB than the general population, some recent research has indicated that health workers in KwaZulu-Natal are up to seven times more likely to contract dangerous drug-resistant TB (DR-TB) strains” she said.

While generally health workers are at a three times higher risk of contracting TB than the general population, some recent research has indicated that health workers in KwaZulu-Natal are up to seven times more likely to contract contract dangerous drug-resistant TB (DR-TB) strains.

Treatment losses

“We’re losing professionals to DR-TB: the drugs are toxic, treatment is long and often ineffective – up to 30 percent of healthcare workers who get DR-TB die,” she said.

And even if one survives the almost two years of toxic treatment, and is cured of TB, one may be left with debilitating side-effects.

Von Delft, who contracted DR-TB in 2010, started to lose her hearing – one of the most common side effects of DR-TB drugs.

“I was very fortunate and was able to get onto a special access programme and received a very new drug bedaquiline to replace the drugs which were causing hearing loss. I could have lost my ability to hear. I could have lost my career as a doctor. I would not have been able to do something as simple as listen to a stethoscope or communicate with patients,” she said.

Long term disabilities

According to Von Delft, many of her colleagues haven’t been as lucky and are living with long-term disabilities as a result of DR-TB treatment like deafness, blindness and debilitating nerve damage.

Dr Maxime Molisho, Clinical Advisor for the TB/HIV Care organisation, said: “More resources, in terms of masks and better-ventilated facilities, are always welcome. However, a critical element to consider is ensuring that health-care workers are empowered with knowledge of how they are at risk, and the steps they can take to protect themselves. After all, having an N95 mask [a special anti-TB face-mask] available won’t help if you don’t wear it.”

This is an issue TB Proof hopes will be highlighted at the 47th Union World Conference on Lung Health taking place in Liverpool in the United Kingdom this week.

Said Von Delft: “Healthcare workers are a precious and scarce resource and we are losing them to something that can be largely prevented.”

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