Are Healthcare workers Tuberculosis Proof?
by Alice Tembe
August 30, 2013
‘I had to choose between being deaf and being dead’, this is what Dalene von Delft, a Medical Doctor from Stellenbosch
University in South Africa, said in her testimony at a two-day Southern Africa meeting held recently to strengthen and
scale up TB /HIV responses in the workplace. The meet was supported under the TB Care II program by University Research
Company in collaboration with USAID. In the meeting, Swaziland, Namibia, and South Africa were represented by their
government, workers and employers’ organizations working in the field of TB.
Dr Delft is one of the few doctors who work in high risk healthcare facilities and thus are constantly exposed to TB.
She contracted the disease from her workplace and was diagnosed with Multiple Drug Resistant Tuberculosis (MDR-TB).
Despite being a doctor, she was unfortunate enough to be burdened by an irreparable side effects of MDR-TB
treatment—deafness. She noted that tuberculosis needs to be considered seriously as an occupational health concern and
more importantly as a preventable risk.
In the same meeting a presentation by Dr. Babatunde from the United Nation Population Fund (UNFPA) indicated that an
employee with TB loses 3-4 months of work in a year, amounting to 30%-40% of annual household income. His presentation
highlighted the magnitude of TB in the countries present at the meeting, where HIV prevalence has prepared a fertile
ground for MDR-TB. TB is indeed affecting productivity in the workplace as well as the quality of life in the extended
community through the affected families. As Dr Paula Fujiwara, a Scientific Director at the International Union Against
Tuberculosis and Lung Disease (The Union) said to Citizen News Service – CNS: “In countries with resources, people are
often given a tuberculin skin test and a Chest X-ray (CXR). If the skin test is positive and the CXR is negative, they
can be placed on preventive therapy. However, people with HIV may have a negative skin test and/or a negative CXR, even
though they have ACTIVE TB."
Dr Babatunde noted that workplaces have to scale up and strengthen their infection control methods and TB responses. He
explained that in workplaces there is already an easy access to a large number of people who can be a ready audience for
communication. There are also existing structures and systems to build in TB-HIV support systems that can manage stigma
and discrimination. The Swaziland Business Coalition on HIV-AIDS (SWABCHA), an employer established institution, has
introduced TB-HIV awareness dialogues and adopted the national basic screening tools through a mobile wellness clinic
for most at risk populations, like migrant workers who live in congested environments and have long labour intensive
working hours in textile factories, construction sector and as cane cutters in agriculture sector. In particular for
healthcare workers, Swaziland has established a Wellness Center, and provides TB-HIV screening services for them at
their workplace itself. Further, the wellness center is equipped to provide HIV counseling and testing, antiretroviral
treatment (ART) for HIV, as well as Directly Observed Treatment Short course (DOTS) for TB. This has helped to minimize
healthcare workers fear of queuing up at the same healthcare centre with their own patients. It has also helped them in
forming support system groups with other health care workers managing the same disease and, in some cases, both HIV and
National TB programmes still face many challenges, which include limited funding for the workplace since TB-HIV are
still not highly rated as an occupational hazard; stigma and discrimination associated with TB-HIV resulting in poor
access to services and non- completion of treatment which further fuels MDR-TB—the latter making it more difficult to
treat and reduce mortality rates due to TB. The high burden of HIV in majority of Southern African countries has
prepared a fertile ground for easy spread of both drug susceptible and drug resistant TB that is difficult to diagnose
as well as to treat as expressed by Dr.Fujiwara from The Union. Then again, there are most at risk populations, who work
long labour intensive hours and they are a highly mobile and migrant workforce working in factories, and as agricultural
seasonal workers and construction workers.
In the light of the challenges noted above, SWABCHA has proposed possible future responses for TB-HIV in the workplace.
Firstly there is a need to expand the use of Gene Xpert for point of care diagnosis of basic TB and MDR-TB. Secondly, we
will have to intensify infection control in congested workplaces and focus on geographic targeting of hot spots of TB,
with a view to maximize programme investments. Thirdly, there is need to strengthen partnerships and multi-sectoral
responses, addressing TB as not only a medical challenge but also as a social and economic threat. And lastly,
establishing mobile data collection and management to increase efficiency in patient tracking and strengthening data
collection for continuous research on TB drugs especially drug resistant TB is also necessary. SWABCHA will be launching
a mobile phone data collection, linked to an electronic data base this August 2013.
TB is a preventable and, most importantly, a curable disease and there should be no deaths as a result of poor diagnosis
(or no diagnosis at all) and/or lack of access to quality treatment.