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Vital Health Workers Fired
From SA TB-AIDS Clinics
XDR-TB epidemic worsened by severe health worker
shortage in SAfrica, warns Doctors without Borders
By Adriana Stuijt
Exclusive to Rense.com
KHAYELITSHA, Cape Town -- Half the staff at the cutting-edge Khayelitsha hospital near Cape Town, which dispenses daily life- saving medicines to TB/Aids-patients under the strict regimen required to prevent Extremely-Drug-Resistant Tuberculosis (XDR-TB) from developing, have now been fired by the ANC-regime. These dedicated, top-educated health workers denied in an urgent law suit filed in Cape Town High Court yesterday that they had willingly participated in the civil servants' strike, now in its third week.
Many of the fired health workers had been intimidated by striking mobs when they tried to treat patients and had been threatened and attacked, even at home, the court heard. The ongoing violence- driven strike has disrupted SA health- and educational institutions countrywide since June 1. The High Court will make its judgment known on Tuesday, June 26.
http://www.mg.co.za/articlepage.aspx?area=/breaking_news/ breaking_news__national/&articleid=312011
"Irreparable harm has been caused" by dismissing the health workers in Khayelitsha clinics said Dr Eric Goemaere, head of Médecins sans Frontières in South Africa. He told the Cape High Court that patients whose treatment had been interrupted could become ill and die.
Khayelitsha's research-driven clinic is unique on the African continent: run by the Nobel Peace Prize-winning aid organisation Doctors without Borders, the role of their trained health workers is vital: the clinic also treats many patients who are co-infected with Tuberculosis and the Aids-virus. The research at this clinic is focused on finding much faster, more accurate diagnostic tests and drug-resistance testing to detect XDR-TB is also carried out there. The clinic's task has become much more urgent now that XDR- TB has become an epidemic in South Africa within just the past six months, with hundreds of patients dying countrywide and more than 1,250 people per 100,000 of the SA population (total 47-million) now infected with it according to the last statement made on the subject by the National Department of Health -- in March 2007.
At the moment, people often die long before their diagnosis can even be confirmed in the laboratory: a 120-year-old sputum test still remains the only diagnostic tool and with South Africa's eight understaffed laboratories, it can take up to 2 months before the results are known.
The law suit contends that these dismissals infringe the constitutional rights of patients to health services and to life and dignity.
LINKS to Treatment Action Campaign:
These summary dismissals of half their health-care staff by the country's health minister is a particularly bitter blow to Dr Goemaere who heads the Doctors without Borders international health- care organisation's South African office. Six months ago he had already issued an urgent call for more health workers worldwide to sign up for jobs at these unique clinics, which treat and diagnose co-infected TB+Aids patients. SouthAfrica has 3,6-million people who are co-infected with TB and the Aids virus. Dr Goemaere issued an urgent call for foreign medically-trained workers to sign up for these southern African clinics, including at Khayelitsha, in a broadcast on the Voice of America radio station. He warned that there was such a severe shortage of doctors and nurses that many of their patients had to forego their medicines.
Patients with the TB+HIV coinfection often develop XDR-TB once their drug-taking regimen is interrupted. Dr Goemaere also warned in his VOA broadcast that 'diagnosing new TB+HIV patients also is becoming problematic (in South Africa) because there aren't enough nurses to take in new patients."
Hear Dr Goemaere's his VOA broadcast on:
"We can try to control the damage that we see today from drug- resistant TB," said Dr. Goemaere this week. "But we are only seeing the tip of the iceberg". He spoke in reaction to the World Health Organisation's new $2-billion plan, unveiled on June 22, to contain drug-resistant Tuberculosis worldwide:
read The WHO Plan, June 22 2007:
In South Africa, patients with the unique local strain of XDR-TB called SA-1, which is a mutation of the tuberculosis bacillus and the human-immune-deficiency virus, are dying within 20 days according to local doctors:
Listen to NPR interviews about the struggle to contain this XDR-TB strain with South African doctors and patients at two TB-hospitals:
Treatment is very difficult for patients co-infected with HIV/AIDS. "These patients have to take between 13 and 16 pills a day. Also, there are interactions between AIDS and TB treatment which cause side effects like liver problems or allergies," highlights Dr. Gilles Van Cutsem, the young Belgian-born doctor who coordinates one of MSF's programs at Khayelitsha. He heads the clinic at Khayelitsha's "Site B" since September 2003.
He recently co-authored several published scientific reports on the field-testing methods being tried out at Khayelitsha to try and detect TB+HIV co-infection quicker and more efficiently. At the moment it takes up to 2 months for the sputum-test to diagnose the condition, and even longer for the drug-resistant tests. Many patients die before the test results come back to the clinic. In a June 2007 report entitled : "Clinical, Immunological and Epidemiological Importance of Antituberculosis T-Cell Responses in HIV-infected Africans" . Dr Van Cutsem noted that:"the human immunodeficiency virus (HIV)-associated tuberculosis was a major cause of mortality in Africa."
http://www.doctorswithoutborders.org/publications/reports/2007/ healthcare_worker_report_05-2007.pdf
South Africa's University of Stellenbosch tuberculosis expert Dr Nulda Beyers said the key to controlling drug-resistant strains of the disease was to treat ordinary cases properly, preventing the creation of more difficult ones. She said most of the new spending (announced by the World Health Organisation on June 22) should be devoted to more medical staff."If one just put all the money into labs and fancy drugs, that's not going to do the thing," she said. "We need to build human capacity. We need people to do the work."
South Africa has the largest number of people with Hiv-Aids in the world, with about six million people infected -- and 60% (3.6- million) of those people also are co-infected with TB+HIV - a condition which becomes progressively untreatable with any available drugs and ultimately leads to their death from Extremely- Drug-Resistant Tuberculosis (XDR-TB).
On June 22, 2007 during the introduction of their R2-billion TB- campaign, Dr Paul Nunn of the World Health Organisation also stressed the need for a massive increase in laboratory capacity in poorer countries to diagnose and treat patients. "There is no way that we can even begin to diagnose and treat the number of patients that need to be diagnosed and treated unless we have a huge scale- up in lab capacity," he said. He also noted that there are more such laboratories in South Africa alone than in all of sub-Saharan Africa. South Africa has eight laboratories countrywide capable of handling such tests and all are grossly undermanned and underfunded.
The WHO first became concerned about XDR-TB in March 2006, and a particularly deadly outbreak among Aids-patients in South Africa only confirmed their worst fears, Nunn said. "In a worst case scenario, the 8.8 million annual cases of treatable TB worldwide could be replaced by an equivalent number of XDR-TB cases," he warned, noting that each one case of TB infects between 10 to 15 other people each year."The possibility is that you could replace that epidemic with a drug-resistant epidemic, in other words you could have 8.8 million cases of drug-resistant TB wandering around -- and then you will be back to the pre-antibiotic era," Nunn said.
http://news.brisbanetimes.com.au:80/who-seeks-over-2-billion-us- dollars-to-tackle-drugresistant-tb/20071922-jx4.html
http://www.washingtonpost.com/wp-srv/content/article/tb_6-22.html? hpid=topnews
Doctors without Borders/Medicins Sans Frontieres media contact:
Email: michael_goldfarb@msf.org
Telephone Direct: USA (1) (212) 763-5783



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