MSF-USA: Swaziland: Children Suffer the Consequences of Poor TB Infection Control

March 23, 2010
Swaziland: Children Suffer the Consequences of Poor TB Infection Control

Her smile is so sweet and her disposition is so sparkling that you would never believe what she has been through in her short life. Yet there was a time not long ago when six-year-old Lindokuhle Mamba couldn't smile because she was in constant pain. Young as she is, she has already come close to dying at the hands of one of the deadliest diseases, tuberculosis (TB).

Not only does Lindokuhle have TB, but she suffers from multi-drug resistant (MDR) TB which means that she has a strain of the TB bacteria that is resistant to a number of treatment drugs. This makes the disease that much harder to treat. It is even more difficult for a young child to swallow four to seven tablets twice a day, for an extended period of time.

Lindo, as she is affectionately known to her loving grandmother, mother and fellow MDR TB patients, has had to endure daily injections of one of the MDR TB treatment drugs for the past four months and likely will continue to do so for another two to four months. That will not be the end of it, though, because she will then have to continue taking second-line TB tablets for the an additional18 to 24 months.

By the time Lindo was three years old, she had developed a constant cough and breathing problems and was too weak to walk. Lindo’s mother, who worked in a dairy farm just outside the town of Nhlangano in Swaziland’s Shiselweni Region, had taken her daughter to private doctors and pharmacists, but nothing had helped. For brief spells, she would appear to get better, but then the throwing up and diarrhea would start all over again.

When Lindo and her mother visited Lindo’s grandmother, Thab’sile Macu, at her home in the village of Machobeni in Shiselweni, close to the border with South Africa’s KwaZulu Natal province, the grandmother was very concerned about the child’s health.

“I asked my daughter to leave the child with me for a short while because my biggest concern was that, maybe, she was not being fed well,” explains Thab’sile. The short stay turned into a long one, however, because Thab’sile soon realized that Lindo’s problem was much more serious than just malnutrition. She decided to take the little girl to Nhlangano Health Center. After several tests and scans, Lindo was diagnosed with TB and started on treatment. When her condition did not improve after a few months, further screening was conducted and Lindo was diagnosed with MDR TB.

This meant she would be on a long and difficult treatment. Joyce Sibanda, a Doctors Without Borders/Médecins Sans Frontières (MSF) nurse at the Nhlangano Health Center, recalls, “I had to pray to God to help me because I didn’t know how I was going to bear the task of giving the painful injections to such a little child every single day.”

Lindo did not get drug-resistant TB because she had defaulted on previous TB treatment, but because she was exposed to an adult with MDR TB—an older man, it seems, who did not practice proper cough hygiene and, as a result, infected a child he was actually very fond of and would never intentionally harm. “I believe more needs to be done to educate people about TB infection control in this country because many have died or suffered because people do not know what to do to protect others, like covering their mouths and noses when they cough or sneeze,” says Lindo’s grandmother.

In the meantime, little Lindo has come to appreciate the fact that the injections are being administered to make her feel better. She does not even cry any more, which makes the nurses’ job easier. With her grandmother’s nurturing love, Lindo is well on her way to recovery, as evidenced by her weight gain--and her ever sparkling personality.