Surviving Drug-Resistant TB in Swaziland

Sven Torfinn


Thirty-five-year-old Khanyi proudly holds her certificate, which reads “I got tested and cured of TB." A mother of two, Khanyi lives in Logoba, an overcrowded informal settlement in central Swaziland near the industrial town of Matsapha.

Three years ago, while taking care of her diabetic husband, who is also co-infected with HIV and tuberculosis (TB), Khanyi was herself diagnosed with TB.

Khanyi’s husband found it very difficult to stick to his treatment. If Khanyi was not there to insist that he took his medication, he would not take it. Anxious and distracted by caring for him, Khanyi often failed to take her drugs, too.

Eight months into her treatment for TB, Khanyi was found to have multidrug-resistant tuberculosis (MDR-TB), a strain of the disease that is resistant to the most common anti-TB drugs.

“I strongly believe that I brought MDR-TB upon myself, because I would sometimes miss my TB treatment,” says Khanyi. “When my husband became ill, I became worried with caring for him. I remember the time he was admitted to hospital. I rushed to hospital to be at his bedside, and in the confusion I totally forgot about my treatment. I believe this is when I developed resistance to the drugs.”

Following her diagnosis, Khanyi was enrolled at the Doctors Without Borders/Médecins Sans Frontières (MSF) clinic in Matsapha, five kilometers [about three miles] away from her home, which offers patients home-based care. “The good thing about receiving treatment at the MSF clinic is that I got my injections at home,” says Khanyi. “This was a relief because, by then, both my husband and I had stopped working due to sickness, and money was scarce. Getting treatment from home meant I could cut traveling costs.”

Still, Khanyi describes starting MDR-TB treatment as “devastating,” and will never forget the pain of eight months of injections. “I could not bear the injections,” she says. “The pain would spread to my knees and back—it was so bad I couldn’t even walk. My every movement was thoroughly contemplated before it was made.”

Alongside injections, Khanyi had to take a daily cocktail of pills, with unpleasant side effects that can include constant nausea, depression, deafness, and sometimes even psychosis. Some months into her treatment for MDR-TB, Khanyi’s husband died, and one of her two daughters was diagnosed with TB. She admits there were times when she was tempted to stop the treatment altogether. “The tablets were very exhausting,” she says. “Just the thought of taking them was depressing. I had moments when I was tempted to give up treatment. But when I had such thoughts, I would think of my children. Being a widow with both my parents dead, I couldn’t imagine dying and leaving my children orphaned.”

In spite of all the hardship she endured, Khanyi was able to overcome the emotional and psychological challenges to complete her treatment. She was helped in this by MSF’s medical teams and by the encouragement of members of the community who volunteer to support patients at home. Today, Khanyi lives a normal life with her two daughters. They survive on what Khanyi earns as a fruit vendor. Her only regret is having infected her daughter with TB, although her daughter has also now been cured of the disease.

“I was ecstatic when the doctor told me that I had been cured of MDR-TB,” says Khanyi, smiling. “I couldn’t believe it was possible and I had made it through. I’m still over the moon.”

Khanyi is not alone in celebrating: 63 other patients from Matsapha clinic and 35 patients from nearby Mankayane hospital can proudly show certificates from MSF that proclaim “I got tested and cured of TB.”

MSF has been working in Swaziland since 2007, running integrated HIV/TB projects in the Shiselweni and Manzini regions. Alongside the Ministry of Health, MSF has integrated HIV and TB services at clinics and in the community. MSF is also advocating for the introduction of shorter, more tolerable treatment regimens for drug-resistant TB and the promotion and implementation of outpatient care for people with the disease. 

MSF staff conducting TB screening. Swaziland, Matsapha industrial area. October 2013.
Sven Torfinn