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Sunday, October 25, 1998 Published at 12:34 GMT

World: Africa

South Africa's war on TB epidemic

South Africa is suffering from a TB epidemic

By Southern Africa Correspondent Jeremy Vine

In South Africa's rural hospitals a wracking cough is a sure sign of tuberculosis. Without treatment the disease is invariably fatal.

Now, a Northern Province hospital has slashed the death rate for TB with a simple but effective treatment that has raised the cure rate from 40% to 80%.

[ image: This shopkeeper makes sure the patient takes their medicine]
This shopkeeper makes sure the patient takes their medicine
Millions of poor, mainly black South Africans are infected with TB and the health ministry acknowledges the illness has reached epidemic level.

The remedy is a six month course of tablets - but there is a hitch: patients can't stay in hospital all that time and the nurses know that many will go home, feel a bit better, and then stop taking their pills.

BBC Southern Africa Correspondent Jeremy Vine examines the successes of Directly Observed Therapy
But at the Jane Furse Hospital, staff believe they are winning the battle, with a method of treatment called DOTS that is staggeringly simple.

DOTS stands for directly observed therapy, short course: and it is proving highly effective.

Community care

[ image: Bad sanitation is one cause of the disease]
Bad sanitation is one cause of the disease
In one village the nurses have recruited a shopkeeper near the home of one patient who is willing to make sure she takes her TB pills.

The shopkeeper is given a checklist and the tablets - if the patient doesn't turn up to take them the shopkeeper will ring the hospital.

Nurse Emily Mafri says this is being repeated across the region and is saving many lives.

"A patient can see that she is being supported by the community and the shopkeeper and she can see that it's very important for her to complete the course of treatment," she says.

A disease of poverty

[ image: Diagnosis from a bag of bones]
Diagnosis from a bag of bones
TB spreads like wildfire through these poor rural areas because of bad sanitation and cramped living conditions.

But traditional healers are being blamed as well.

The people who used to be called witch doctors still do a roaring and lucrative trade.

One local healer uses a bag of bones and other odds and ends to diagnose his patient's condition. The way the bones fall onto the ground will say what's wrong with them.

Traditional medicine

[ image: Traditional cures have proved ineffective]
Traditional cures have proved ineffective
Whatever the diagnosis, the healer has a whole cabinet of traditional medicines, including some that he says will combat TB. Most of them are in old vodka bottles.

"This one has dust inside" he explains. "You put it in boiling water and then the patient drinks it."

Johannes Maisane drank quite a lot of 'dust' until realising he was about to die of TB and went to hospital instead. The doctors put him on a DOTS course which means a daily walk to the local grocer to collect his tablets.

One cured many more to go

[ image: Johannes Maisane takes a daily walks to collect his pills]
Johannes Maisane takes a daily walks to collect his pills
"I'm very grateful" he says. "I now feel much better and can walk 15 miles without a problem."

His life has been saved - two more weeks and he will be completely clear of TB.

But the man behind DOTS, Dr John Millard, is not celebrating yet because there is still an enormous TB epidemic.

"It's going to put an enormous strain on the health service, on the doctors, on beds, on nurses and the supply of drugs," he says

"It's a very serious problem which could affect the economy of the whole country."

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