Health-e (Cape Town)

24 March 2011

South Africa: TB Diagnosis Dire for Children

analysis

TB can hold serious physical and psychological consequences for those who are infected, and for children the diagnosis is often even bleaker. Dipuo Sedibe of Health-e News Service spent a day with a group of youngsters and their carers at Brooklyn Chest Hospital in Cape Town.

Entering Brooklyn Chest Hospital visitors are greeted by the sight of lethargic adults sitting aimlessly outside, basking in the sun waiting to be cured of TB or in some cases to die.

The face and voice of TB is overwhelmingly that of adults, however this picture changes upon entering the hospital's Ward B, a paediatric section for children diagnosed with TB.

The entrance to Ward B is no different from any hospital ward. The wooden sliding door with see through glass allows a peep before deciding whether you want to enter. Posters listing the signs and symptoms of TB are pasted on the walls. Inside, metal cots are lined up along the walls with just enough space to stop physical contact among the little patients. The only other furniture is tiny individual cupboards containing the children's meagre belongings. Nurses bustle around the ward with the cries and squeaks of babies filling the space. Some of the tiny patients simply stare into space too weak and ill to even cry. Some wear masks while others are in isolation because they have drug-resistant TB.

A couple of paces down the passage from this ward, the mood changes as does the sounds.

Inside the "Educare Centre", a brightly decorated spacious two-room crèche is filled with the laughter and happy voices of children. Colourful pictures and cartoon characters line the walls. There is a sense of normalcy here, and children are just that, children.

Nomntu Ncapayi, the educare teacher employed by the TB/HIV Care Association, looks after 40 children, and it is her enthusiasm that allows the children to play and forget about the TB.

There are also no nurses or doctors to remind them of the reason they are at Brooklyn. It's just them and their toys.

The room is noisy with singing, dancing, and clapping and the intermittent sounds of squeaky toys.

There is the usual infighting among the toddlers. Ncapayi shouts: "No don't do that, give it back."

Ncapayi has been working at the Educare Centre for the past 18 months. This is not her first experience working with TB, she used to be a Community Health Care Worker and TB treatment supporter.

Although some of the children are clearly frail, Ncapayi manages to enthuse them enough to jump up and down, scream and just be children. Some of the children have obvious deformities and delayed growth, but here they defy the odds.

Ncapayi is well aware of the importance of stimulating them. She hugs, cuddles and tickles the children and gives them the warmth of a parent.

The TB/HIV Care Association also assists parents with travel fare allowing them to visit the children every day. According to Ncapayi, not all parents visit their children while in hospital. "Some families never visit their children, they just come to collect them after they have been discharged," she says.

"I love these kids as if they are my own," says Ncapayi. She says she is humbled by the reaction of the children when they see her: "They jump and become happy when they see me and I can't just disappear from their lives," she laughs. "I will stay here for as long as possible."

"The crèche definitely has a positive psychological impact on the children. It is part of nursing them holistically," says the sister in charge of the ward, who did not want to be identified. "Having the crèche is also helpful as the teacher sometimes picks up things that we might miss as professionals," she says.

Ncapayi also often helps with extra duties in the ward - making the beds or feeding the children. "You see, the kids eat healthy food," she says pointing to a plate of butternut, rice, mixed vegetables and meat.

"Roly-poly, roly-poly, up-up-up-clap-clap" shout the children at Ncapayi instructions.

The most common source of TB infection in children is exposure to an adult who is infected with TB.

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