A month or so ago we had a visitor who has a long history with Cabrini Ministries in Swaziland. His name is Dr. Mario Raviglione, and he is currently the Director of the Stop TB program for the World Health Organization, stationed in Geneva. He’s Italian, and about 20 years ago, he was in the US doing his residency in infectious diseases at Cabrini Medical Center in New York. During that time, he came for three weeks to work in the clinic here at St. Philip’s Mission in Swaziland with our sisters. One of the sisters, who I believe was Sr. Raphael, said to Mario- “Now don’t go back to Italy and be a doctor and get rich, but do something good for other people with your medicine.” He shared with us that Sr. Raphael was one of his inspirations to go into public health service.
About 6 months ago, he decided that he wanted to return to Swaziland to come back and see it, and wanted to bring his family with him, because he now has children that are between 15 and 22. So he got in touch with our superior in Italy and asked if Sr. Raphael was still there at St. Philip’s. She said, “No, I’m sorry to tell you that she has died, but you can still go there and visit.” So he came to see us, and we took him out to see patients, such as one woman who we care for who needs daily injections of antibiotics to treat her TB, and he was very interested to see our responses to the challenges of increasing TB incidence in our area.
[World TB incidence. Cases per 100,000; Red = >300, orange = 200-300; yellow = 100-200; green 50-100 and grey <50. Data from World Health Organization, 2006. (Source: Wikipedia, "Tuberculosis," http://en.wikipedia.org/wiki/Tuberculosis)]
In particular, there is a growing problem here with drug-resistant TB. There are something like eight different classes of antibiotics for TB, so you start out with the lowest class. If the patient doesn’t respond, then you move up a level. Once you’re onto the 3rd or 4th levels, that is what is called “multi-drug resistant TB” (MDR-TB). There are some cases that aren’t responding to any level of drugs at all- called “extreme drug-resistant TB” (XDR-TB).
Diseases become able to combat medicines when there are mutations of the original disease, or if there are problems with compliance (taking the drug regularly as directed and with no interruptions). The same thing is happening with the HIV virus, and most people in our area with TB have HIV and vice versa. You can imagine how drug compliance problems are rampant in places like Swaziland that are battling with extreme poverty, lack of food and water, and multiple, complicated diseases requiring complicated treatments. So this is how you get your first-line medications, your second-line meds, etc… (these are terms used to describe HIV drugs). Only TB right now is up to 8 lines of treatment. And unfortunately, as you go up the levels, the drugs are more expensive and harder to obtain.
(photo: Mike Hutchings/Reuters)
[Read more about TB in Swaziland in another post on the blog: “The Tuberculosis Epidemic- Impacts the People & Places Struggling with HIV”]
It was good to have Dr. Mario and Dr. Rudolfo Russo here with their families. They have been great supporters of our work and are helping us draw up new ways to improve our TB screening and treatment procedures. And I think it’s great how he was sort of able to come full circle with the Cabrini sisters in Swaziland.
I feel that right now, TB is a much more immediate threat to the health of all of us than HIV is (though of course they go hand in hand), because of the way it’s spread- if you’re talking with someone within two feet of them, saliva molecules can be passed- and because it’s becoming so drug-resistant. Dr. Samson Haumba, the HIV-TB coordinator in Swaziland, and Elijah Dlamini, a long-time TB nurse from Good Shepherd Hospital, have both given our staff presentations on protecting ourselves while dealing with TB. We are scrambling to meet all the challenges and are in great need of protective measures like masks. There are no isolation rooms anywhere in the country and the hospitals are overwhelmed, so this woman who we care for, who is lying under a tree and can’t even sit up to feed herself, cannot be in a hospital because she will infect other people. Homestead visits like what we are doing with our home-based care program are the best solution, but it is still a lot to ask of community health providers to manage multiple, complicated diseases like HIV and TB.
Still, we do manage to care for at least 10 new patients each month, and we are able to provide complete care for those people thanks to our worldwide support. The heartache of such sickness can be soothed, and to see our patients get a second life thanks to receiving the healthcare they need renews my spirit and I hope the spirit of the world.
Blessings and love to all,