Hospitals are not protecting their workers from tuberculosis (TB) infection, say nurses in Swaziland, who recently staged a rare public demonstration to draw attention to how vulnerable they are to this highly infectious disease.
Nurses attached to the National TB Hospital in Swaziland's commercial hub, Manzini, are blaming inadequate infection measures at the hospital for the risk they face. TB is one of the primary killers and the main opportunistic disease in people living with HIV and AIDS. In a country with the world's highest HIV prevalence, 80 percent of HIV-positive people are co-infected with TB.
A study conducted in neighbouring South Africa's KwaZulu-Natal (KZN) Province has found that the incidence of extensively drug-resistant (XDR-TB) and multidrug-resistant (MDR) TB is six to seven times higher among health care workers than among non-health care worker patients. There are no official figures for health care workers infected with TB in Swaziland.
Health personnel warn that government's inaction could make things worse. "Government is killing us with its negligence. We just buried one of our sisters [another nurse] who died of TB. She contracted TB at the hospital where she worked," Abigale Dube, a nurse and member of the Swaziland Democratic Nurses Union (SDNU), told IRIN/PlusNews.
There are no national guidelines on TB infection control measures in the country's health care facilities, and nurses say this makes matters worse.
"What we gathered is that in the other hospitals, nurses have contracted multidrug-resistant TB because they are exposed to the disease on a daily basis. This can only mean their working environment is unsafe," said Nurses' Union General Secretary Nathi Kunene.
A nationwide strike attended by all nurses would ensue if issues like poor ventilation, unhygienic conditions and a lack of protective gear were not addressed, Kunene said.
Swaziland has the world's highest TB infection level, and a 2010 survey found that 7.7 percent of all TB cases involved multidrug-resistant TB, putting it among the countries with the highest rates of this variant of the disease.
According to a recent report on MDR-TB in Swaziland, "the high prevalence of drug resistance in a country already facing a huge epidemic of TB and HIV shows an urgent need for major interventions in terms of detection, treatment, and infection control".
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Health services are being overwhelmed by the number of patients. "There is a shortage of nurses in Swaziland. The country does not pay well compared to other countries, and we have nurses trained here who are doing quite well in Europe, where they are in demand,” said Nurse Dube
“The reason they don't stay here is the same reason that the remaining nurses are in danger - no money to make the hospitals safe places to work, so there will be fewer nurses as they grow sick and die."
The Ministry of Health has responded to rising TB rates by "decentralizing" TB care from Mbabane, the capital, and Manzini to some regional health facilities, so that patients do not have to take long bus trips to receive treatment.
Even with 15 clinics nationwide now offering free TB testing, the number is still inadequate, and transport costs and user fees at health facilities are still a major hurdle for patients.
The National TB Programme announced this week that Swaziland's TB response has received a US$19.4 million boost from the Global Fund to fight Tuberculosis AIDS and Malaria. One of the areas that will be strengthened is infection control measures at healthcare facilities.
"Following the declaration of TB as an emergency, the country has already geared to working in an emergency mode in the fight against the epidemic,” it said in a statement. “The funding will go a long way in addressing TB challenges."