Visiting an MDR-TB Patient in Lesotho

Lesotho, surrounded by South Africa and with a population of just under 2 million, is known as the “Mountain Kingdom.” While the very mountainous terrain makes for lovely pictures, it presents a major obstacle to providing and accessing even basic health care services — not to mention education. Many areas can only be accessed by a small prop plane — in fact, some towns have never seen a car — or on horseback. During rainy season, the obstacles are even greater. It has very little arable land, the unemployment rate is 50 percent, and its only major economic assets are water exportation to South Africa and its people.

Thus, it is devastating that the TB-HIV prevalence rate is about 85 percent, which is even higher than in Zambia (see previous blog post), and the HIV prevalence rate hovers between 25 and 29 percent, one of the worst in the world. Many men travel to South Africa to work in the mines, where they are infected with HIV and TB, which they bring home to their families.

The country has recently started to implement more aggressive policies to ensure cross-testing and treatment of TB patients for HIV and vice versa. Lesotho receives PEPFAR and Global Fund support for TB and HIV/AIDS, and it is the first country to identify health as a major obstacle to development and thus incorporate a request for health infrastructure support as part of its grant from the Millennium Challenge Corporation (MCC), a U.S. government aid program.

Partners in Health (PIH) is also in Lesotho helping to build the government’s capacity to provide TB and TB-HIV services. PIH also runs a cutting-edge multi-drug resistant (MDR) TB lab and hospital that is helping to create international recommendations on how to diagnosis and treat MDR-TB. MDR-TB treatment takes 24 months and you can be infectious for up to 12 months even on treatment. In contrast, it takes 6–8 months (still too long) to treat standard TB, and you are only infectious for about 2 weeks after starting your drugs.

With PIH and the government’s TB program manager, we visited an MDR-TB patient at her home. She is finishing her 2 year treatment program, the first 12 month of which include the daily injection of highly-toxic drugs, which caused her to permanently lose her hearing and have temporary mental psychosis. She was a schoolteacher, like her husband. With the help of PIH, she will hopefully soon be trained in sign language and then teach it to others.