22 November 2012

Zimbabwe: First Patient Cured of MDR-TB

After two gruelling years of treatment, Chipo Mhlanga (not real name) is the first patient in Zimbabwe to beat multidrug-resistant tuberculosis (MDR-TB). While this is great news, there is still an urgent need for better treatment that cures people in less time and with fewer side effects.

In her home, on the outskirts of Zimbabwe's capital city, 48-year-old Chipo says that, although she has conquered MDR-TB, she now faces another challenge: "I have my appetite back and now I am eating everything in sight."

Chipo's ability to joke has finally been restored following two gruelling years of medical treatment for MDR-TB which included daily injections and a cocktail of highly toxic pills that made her vomit, lose her appetite and hallucinate.

"I felt like I had bugs crawling on the inside of my head," she says.

First signs of TB

Chipo first showed the symptoms of tuberculosis (TB) in 2006, after caring for four members of her family who had the disease.

Chipo reported that after eight months of treatment, and without screening her to confirm whether it had been successful, she was taken off TB medication by her doctor who declared she "looked much better".

Over the following months, Chipo was in and out of hospital with fever and a dry cough that would not shift.

She grew thinner and thinner, her condition got worse and -- having already lost half her body weight -- she took the advice of a neighbour and went to a clinic where Médecins Sans Frontières (MSF) was treating patients with TB.

She was diagnosed with a strain of TB resistant to the usual drugs. At that time, treatment for drug-resistant TB in Zimbabwe was limited and centralised, but when MSF launched its MDR-TB project in Epworth, near Harare, in December 2010, Chipo became its very first patient.

For Chipo, the treatment came just in time.

"Just two days before the MSF doctors came to tell us the good news -- that she would go on a new course of drugs -- my mother had coughed up half a bucket of blood. It was terrible, I thought she was going to die," says Chipo's 24-year-old daughter, Judith.

Zimbabwe's TB stigma

In Zimbabwe, there is massive stigma around TB, and many people wrongly believe that the disease is incurable.

Chipo says, "Most of my family deserted me for two years while I was on MDR-TB treatment. My own relatives didn't come to visit me when I was on death's doorstep. The only family I had left was MSF and my two children."

It was a horribly difficult time: "I had to pass through hell to get to heaven," says Chipo, but she was able to see the treatment through to its end with the support of MSF staff, who also shared their knowledge with government doctors throughout Zimbabwe, most of whom had no previous experience of treating the disease.

"It's extremely difficult to watch your patients try to cope with the horrendous side effects caused by this arduous two-year treatment. We urgently need treatment for DR-TB that can cure people in less time and with fewer side effects," says Rumbidzai Vundla, MSF TB Nurse in Zimbabwe.

Growing number of patient

In those two years since Chipo became Epworth's first MDR-TB patient, the numbers on treatment have grown.

Currently, MSF is treating 40 MDR-TB patients across the country, helped by the introduction of a new test for TB drug-resistance, known as GeneXpert, which has cut the diagnosis time from 42 days to just two hours -- which is more than 500 times faster.

Now Chipo is cured, she is energetic and sociable again, and an inspiration for the other patients at Epworth.

For them, she is living proof that the treatment works.

"The MDR-TB treatment was a miracle," says Chipo. "MSF lifted me up from my deathbed and gave me back my life."

In Mashonaland East Province, there are currently 14 patients on DR- TB treatment, according to Ministry of Health and Child Welfare.

"All the 14 DR TB patients in the province are on treatment. We are in the process of strengthening our laboratory capacity and the Ministry has since procured Gene Expert machines for all provincial and central hospitals.

This will enhance our capacity to detect DR TB and ensure that patients are put on treatment early," said Dr Simukai Zizhou, the Provincial Medical Director for Mashonaland East Province.

Dr Zizhou added that statistics show that less people are being diagnosed with TB due to the early seeking treatment behaviour for opportunistic infections. -- MSF.

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