Fighting stigma and strengthening TB treatment in Ehlanzeni district, Mpumalanga
By: Palesa Chidi
Tuberculosis (TB) remains a formidable public health challenge in South Africa, particularly in rural districts like Ehlanzeni in Mpumalanga. Despite TB being treatable, the disease continues to claim lives at an alarming rate. Ernest Nkanyana, a dedicated health worker from Obrigado Home-based Care, and the Chairperson of Civil Society Forum Bushbuckridge Local Municipality, Ehlanzeni District provides critical insights into the challenges and potential solutions for combating TB in the region.
According to Nkanyana, TB is a major concern in Ehlanzeni. “There is a high mortality rate, and when patients are initiated on treatment, they die after two weeks,” he explains. “It is mostly older people who die, mainly due to the poor quality of screening.”
One of the key issues is that some patients are asymptomatic, making diagnosis even more difficult. “In most instances, sputum needs to be taken, but some patients do not show symptoms, so they end up not being properly screened,” Nkanyana adds. This inefficient screening process leads to delayed diagnoses, with many patients starting treatment too late. By the time they receive care, their condition has often deteriorated beyond recovery.
The rural setting of Ehlanzeni presents multiple obstacles for TB patients. Firstly, distance is a major deterrent. “Travelling to the health facility is challenging because the distance is long,” says Nkanyana. “Many patients only test for TB but do not return for their results, which take two to three weeks to be processed. This discourages them from making the journey again.” The delay in diagnosis leads to a dangerous gap in treatment initiation.
TB is deeply misunderstood in rural communities. Many see it as a spiritual or traditional affliction rather than a medical condition. “When someone has a cough, they are often told they did not perform a certain ceremony for the dead or themselves,” Nkanyana explains. “They are also seen as people who bring bad omens to their homes and communities.” This misconception fosters stigma, discouraging individuals, especially men, from seeking medical help. Instead, they turn to traditional healers, delaying proper treatment and allowing the disease to spread further.
Surprisingly, TB carries a greater stigma than HIV. “People have come to accept HIV more than TB,” Nkanyana says. “When one is infected with HIV, they are not afraid to disclose or seek treatment, compared to when they have TB. This is mainly because of the treatment process. With HIV, testing and treatment start on the same day, but for TB, one has to wait weeks for results.”
Beyond stigma, poverty and lifestyle choices also play a role in TB’s prevalence. “Many people in rural areas do not have access to healthy and nutritious food because it is unaffordable,” Nkanyana points out. “This is challenging for those on treatment because they need good nutrition to recover properly.”
Alcohol consumption is another factor. “Most men sit together when they drink and tend to share their alcohol, spreading the disease further,” says Nkanyana. “This is the same for smoking. It becomes a social habit that unintentionally contributes to the spread of TB.”
Addressing TB in Ehlanzeni requires innovative and community-driven approaches. Advocacy programs must directly engage with affected populations, meeting people where they are rather than expecting them to come forward voluntarily.
Nkanyana suggests that community gatherings, such as imbizos and dialogues, can help educate residents on TB. A targeted approach for men is particularly crucial. “We need to go to where men are, like taverns and drinking places, and provide them with traditional food, such as beef head,” he explains. “This can bring them together and give us the opportunity to discuss TB, its treatment, and its impact.” Similarly, organising soccer tournaments would draw men together, providing an opportunity for on-the-ground screening and education.
Another critical intervention is the introduction of male-friendly health services. “We could try to provide men with male nurses,” Ernest suggests. “This could help male patients feel more comfortable opening up about their condition and change their attitude towards TB treatment.”
The reintroduction of Directly Observed Treatment (DOT) supporters could also make a significant difference. “These health workers used to go out to communities and screen patients at their homes,” Nkanyana explains. “As an advantage, if that person has TB, the whole family would be screened. This is one strategy that can be used to bring services to the community.”
TB programs are severely underfunded, with only five percent of the health budget allocated to combating the disease. “Funding is needed for TB support programmes,” Ernest stresses. “Without adequate resources, we cannot implement these strategies effectively.”
The battle against TB in Ehlanzeni is far from over, but solutions are within reach. By improving screening protocols, addressing stigma, and tailoring outreach efforts to community needs, significant progress can be made. As Nkanyana and other health workers continue their fight against TB, it is clear that greater awareness, community engagement, and increased funding will be key in turning the tide against this deadly disease.