Using New Weapons to Fight the TB War

Today, as the sun rises over the rural villages of South Africa's Eastern Cape Province, community members witness what is becoming a common sight. A motorbike speeds by and its driver readily waves; today he does not stop to chat. He is Mtiteto Mfikile and he has work to do. Meanwhile, a village nurse hears the beep of her cell phone and she too gets to work - an SMS message from a nearby laboratory gives her TB smear results of a patient. She can start appropriate treatment now. It is their dedication - coupled with a novel concept in health delivery - that is making the days in these poor, remote villages brimmer with a renewed sense of hope for a healthier future.

South Africa has one of the worst TB epidemics in the world. In the rural areas of the Eastern Cape Province, this fact is hard to miss. Various factors - poverty, HIV/AIDS, and lack of infrastructure - all contribute to rising TB rates, particularly in remote areas difficult to reach by standard vehicles and located a considerable distance from health facilities. Less than two years ago in the remote communities near Port St. John's, residents were succumbing in record numbers to TB as transport problems prevented timely movement of TB sputa to and from rural clinics. Despite the fact that clinics in these outlying areas were collecting and transporting sputa samples, they had to wait from weeks to months to receive laboratory results. By then, most of those tested and suspected of having TB were unaccounted for. Nondyebo Mazwi, lab technician at the Port St. John's clinic, was one of many worried and frustrated health staff:

"Before, we were using government vehicles - which are scarce - to transport lab results to the rural areas. Since the roads are bad, these vehicles often broke down. Also, no one was responsible. Results were lost and the rate of TB continued to increase."

Monday through Friday, Mfikile travels to areas virtually impossible to reach by vehicles - and therefore neglected by health authorities - to collect TB sputa covering a population of 18 000 rural residents. He then delivers the sputa to the Port St. John's clinic and Nondyebo, the lab technician, analyses the samples, enters results into a computer, and immediately sends her findings to the rural clinics via SMS. This process, Nondyebo is proud to say, now takes 12-24 hours - compared to the months it took prior to the Zanempilo Project. Nondyebo shakes her head, recalling the past: "Before this project we were not using the TB register. There was no system we have started keeping records of every laboratory result and every patient that is on DOTS." Working closely with village health workers, the TB Coordinator, Pindiwe Duze, smiles as she says: "There are a limited number of defaulters now. Since the project began, things are different because now the patients improve. Before, there were a lot of defaulters. Now we start treatment right away and do health education every day. We've seen a big different in cure rates."

Through a comprehensive approach to tackling TB, project partners conducted training in effective identification and treatment, improved the use of TB registers, and linked laboratory service with rural clinics via a motorbike and a cell phone. Today, everyone is seeing results. Rural communities are now getting treatment close to home, under the supervision of village health workers. Defaulters have decreased and cure rates continue to climb. Most importantly, the Zanempilo Project has instilled a renewed sense of hope at all levels - from government officials and clinic staff to village health workers and TB patients. For a low cost, there is hope for healthier communities, who are now motivated to influence positive change themselves. Thanks to effective collaboration among all players, the Zanempilo Project proves not only that community mobilization to combat health problems is possible, but that it is crucial to sustaining health improvements in under-resourced areas. Working together, it is the community voices and spirit that ring loud and clear. They will not stop until TB does:

"Our patients are getting better and the community has changed. We are making sure that Zanempilo will never fail. We are helping people...saving the lives of our communities. This is what motivates us...and has given us even more spirit to continue - this is for all of us, it is our achievement."

Mtiteto Mfikile,
Motorbike Driver, Zanempilo Project