D Peters: World TB Day

24 March 2007

Members of the Executive Council,
Mayors and councillors
Community Health Workers,
Non-governmental organisations (NGOs),
Representatives from the private sector,
Religious leaders,
Officials from various government departments,
Ladies and gentlemen,
Boys and girls

Before commencing, I would like to take this opportunity to wish our Health
Minister, Dr Manto Tshabalala-Msimang, a speedy recovery after having undergone
a liver transplant in Johannesburg last week.

We know that if she was in good health, she would be addressing our nation
on the challenges of tuberculosis (TB), HIV and AIDS today. However, in her
absence from the public eye, we will continue to rally for support from our
communities on these very challenges and spread the messages of life and death.
Today is significant for us as a province because we are saying that TB
Anywhere is TB Everywhere. In other words, we are all affected, whether we have
TB or not, whether we know someone with TB or not.

So as we gather here today, I am officially sharing the responsibility of
this disease with you, the people of the Northern Cape. This is because
government is a strong believer that no single sector, ministry, department or
organisation can in isolation be responsible for addressing the many HIV, AIDS,
Sexually Transmitted Infection (STI) and TB challenges that we are faced with.
To put the magnitude of our situation into perspective, let me remind you that
the World Health Organisation declared TB as an emergency in Sub-Saharan Africa
in August 2005, after which South Africa followed suit. And on the 13th of June
last year, provincial government further declared Frances Baard and Siyanda as
crisis districts at the launch of the Northern Cape TB Crisis Management
Plan.

According to the Oxford Dictionary, a crisis is defined as a time of intense
difficulty or danger. As a province, we thus find ourselves in a danger zone.
We are also at the turning point of a disease whereby our actions will either
lead to recovery or to death. Our sparsely populated province currently has the
third highest TB incidence rate in the country, after Western Cape and
KwaZulu-Natal, with the figures for 2005 indicating a rate of 846.0 per 100 000
people. Perhaps these numbers don't mean much to you, but if I tell you that in
the past financial year, a total of 266 people died of TB, what would you
say?

Is this really acceptable for a disease that is 100% curable? Before I
continue, let me tell you a bit more about TB. TB has become very much a
lifestyle disease, in that it is predominantly found in overcrowded households,
where ventilation is poor and living conditions are cramped. This is because TB
is a disease caused by bacteria that is spread by droplets when infected people
cough or sneeze.

In fact, three of the province's nine cases of Extreme Drug Resistant TB all
stem from one of our Correctional Services facilities. This in turn goes to
show that living in close proximity of people infected with TB is a risk if the
TB patients are not on treatment. However, it is also important to remember
that once TB patients are on medication, they stop being infectious and we
should at no time discriminate against people with TB, because what happened to
them could also happen to you and me. The key factor is thus to encourage
anyone who might have TB to get tested and commence with TB treatment if they
do test positive.

TB is also a disease that preys on people whose immune systems are down,
such as the chronically ill and those living with HIV and AIDS. But this does
not mean that only people with HIV and AIDS can get TB. Anyone can get TB,
whether you are HIV positive or HIV negative, whether you are young or old.
Furthermore, because TB and HIV so often go hand in hand, it is very important
that if you are diagnosed with one of these diseases, you also get tested for
the other.

In taking responsibility for your health you should thus get tested for TB
if you display any of the symptoms, which include:
* coughing for more than two weeks
* coughing up blood
* no appetite
* pain in the chest
* weight loss
* lumps and swellings
* tiredness or weakness of the whole body
* sweating at night, even when its cold
* getting a fever which comes and goes
* becoming short of breath for no reason.

If you are living with someone who has TB, it is also essential that you get
tested regularly. You can visit your nearest healthcare facility to get tested
and if you do have TB, you will be put onto treatment for at least six months.
Treatment is free of charge. But remember that it costs government R400 to cure
a normal case of TB, and R40 000 to cure a case of MDR-TB. You must therefore
not be wasteful, but finish your treatment as directed by your healthcare
practitioner.

Allow me to repeat myself: Do not stop your TB treatment until you have been
directed by a healthcare worker to do so! This is a critical point and it is an
aspect that is not only causing us headaches and giving us grey hairs, because
aside from it costing money, worst of all is that it is costing lives. We have
a serious problem with defaulters in many of our communities. There are people
who get tested for TB and start the treatment, only to disappear from the face
of the earth until such time as they decide to get tested again, and resume
treatment again.

These people are not only gambling with their own lives, but they are also
putting the health of their friends and their families at risk. This is because
the TB treatment has been designed in such a way that it requires regularity,
accuracy and endurance – otherwise it will not work. TB medication works only
if you take it everyday, at the same time each day, until such time as your
sputum tests come back negative for TB and your health worker informs you that
you can stop your treatment.

Unfortunately, when considering that the TB cure rate in the province is
currently only at 47,8% and that there has been a steady increase in the number
of MDR-TB cases in the province, it becomes evident that, as I mentioned
earlier, we are experiencing a huge problem with defaulters here in the
Northern Cape. The big question is why? Why do people risk losing their life to
a disease that is curable, regardless of whether you are HIV negative or HIV
positive?

The answer is two-fold. We know of people who purposefully stop taking their
treatment simply so that they can remain ill, and continue receiving the grant.
This is completely unacceptable. Not complying with TB treatment can lead to
you developing Multi Drug Resistant TB and Extreme Drug Resistant TB, both of
which are far more dangerous, take much longer to cure and are also more
infectious.

In fact, as I mentioned earlier, in the Northern Cape we currently have nine
people who have contracted XDR-TB and they are required to stay in the
quarantine unit at the Gordonia Hospital for at least 24 months before they
will be allowed to return home. Furthermore, both MDR-TB and XDR-TB can be
passed on directly to another person, regardless of whether they have ever had
TB or not.
This in turn means that if you stop taking your TB treatment, you could be
responsible for directly infecting other people with MDR-TB or XDR-TB, purely
as a result of your own negligence.

However, non-compliance with treatment is not always intentional. We must
concede that remembering to take medication every day, at the same time for a
period of six to 24 months, depending on what type of TB you have, is
difficult. It can also be demoralising and lead to carelessness. It is for this
reason that TB management becomes the responsibility of the greater community
and in others words the responsibility of you and me. I therefore call upon you
for assistance. Perhaps there are some of you here who are willing to sign up
as DOT's supporters.

The role of DOT's supporters in the fight against this disease is critical
and should not be underestimated, as it is their task to support and check up
on TB patients to ensure that they have the necessary treatment and that they
are taking their medication properly. We should not, however, place all the
responsibility on our DOT's supporters and we should remember that we have a
responsibility to ourselves, as well as to our relatives and friends.

It is also necessary to address the issue of disclosure, which is just as
critical if we wish to halt the spread of TB and eventually eradicate it. This
is because if people don't disclose their status for fear of being
discriminated against, they won't receive the support that is necessary to see
them being cured. In terms of this, you should know that after a person with TB
has been put on treatment, he or she will no longer be infectious. There are
also measures that can be followed to ensure that the TB doesn't spread, such
as keeping all areas well ventilated by keeping the windows open and
maintaining a flow of fresh air.

Small things, such as learning to cough with your hand in front of your
mouth, can also stop the spread of the TB germ and as communities; we should
therefore educate ourselves on these matters. At the same time we have to
address the issue of HIV and AIDS. In many patients, the development of
clinical TB is the first sign of underlying HIV infection. TB is also a major
cause of death amongst people living with HIV and AIDS.

Therefore, just as much as we have to stop the spread of TB and improve its
cure rate, we also have to curb the spread of HIV and AIDS, for which there
remains no cure. We know that HIV and AIDS is predominantly being spread
through unprotected sex. We also know that substance abuse is fuelling its
spread, because after a few drinks at the taverns or the pub, we lose our
inhibitions and indulge in unsafe sex. As communities, we therefore need to
change our behaviour. We need to re-establish moral guidelines and instil a
sense of moral responsibility within our households.

As parents, aunts and uncles you need to set an example for the youth. Don't
let them see you stumbling in the streets or bringing strangers’ home to your
bed. Furthermore, you must not put our children at risk. You have no place
sending them to the bottle store to buy drinks and cigarettes and you also have
no right to send them on errands once the sun has set, for we have a very high
incidence of rape in the Northern Cape and this is further fuelling the
incidence of HIV infections. We must thus do everything in our power to protect
our children.

As responsible citizens of this country, you should also take it upon
yourself to have an HIV test, as I myself have done. In fact, this is the first
step in combating HIV and AIDS. This is because the process of building up the
courage to get tested and the anxiety that accompanies the period in which you
are waiting for your results, instils a sense of fear of the virus in you.

This fear is important, because as I said earlier there is no cure for HIV
and AIDS and once the virus has entered your body, you can never get rid of it.
Therefore, this fear should ultimately see you change your behaviour for the
better. Then, once we know our status, we can take a conscious decision and the
necessary action to do everything in our power to either remain HIV negative if
we test negative, or to accept our status and live positively, if we test
positive for HIV.

The next thing we must do is to abide by the ABC:
* Abstain if you are still young;
* Be faithful if you are in a relationship
* Condomise at all times, as the correct and consistent use of a condom can
significantly reduce your chances of getting infected with HIV. It can also
protect you from getting other Sexually Transmitted Infections such as
syphilis, and also from unwanted pregnancy.

It is also important that if you are HIV positive, you protect yourself from
re-infection by using a condom. You should not think that because the virus is
already inside of you, there is no need to protect yourself. This is not true
and the more times you are exposed to the virus, the worse your health will
become. Whenever you engage in sexual relations it is also important that you
know the status of the person with whom you are going to be intimate, as it is
not possible to tell just by looking at a person whether they are HIV positive,
as it can take years before people who are infected start to show any symptoms
of the disease.

So don't be fooled into thinking you are safe. As long as you are sexually
active you are never safe and you have to take every possible precaution to
protect yourself. So take responsibility for your own health, and also remember
that a healthy lifestyle involves eating lots of fruits and vegetables, cutting
out too much red meat and eating more chicken and fish. It also entails getting
at least 30 minutes of exercise at least three times a week, and very
importantly it means guarding yourself against HIV and AIDS.

Furthermore, if you are already HIV positive, living healthy is just as
important in order for you to be able to continue living a fulfilling life.
There is also treatment for HIV positive people, which although cannot cure
you, can immensely improve your quality of life.

Meanwhile, although government cannot keep you healthy, as your health
depends largely on you, as government we will do everything in our power to
assist you on your road to good health. A draft of South Africa's new AIDS plan
was unveiled at last week's national consultative conference on HIV and AIDS,
whereby our Deputy President, Phumzile Mlambo-Ngcuka, so aptly stated that:
"This strategy must have hands and feet it must walk and work."

Provincial government is in full support of this, and in February the
Northern Cape Department of Health already hosted a Certificate Recognition
Awards Ceremony for our Community Health Workers and NGOs, in order to pay
tribute to the hard work that they are doing to assist government in preventing
diseases, promoting healthy lifestyles and caring for the chronic and
terminally ill.

Also, only last weekend provincial government further hosted a Community
Health Worker Summit, to strengthen ties with between existing partners and
also to maximise the positive effect that the large scale, face-to-face
interaction of our Community Health Workers are having.

Meanwhile, government has further committed itself to:
* halving the number of new HIV infections by 2011
*reducing mother-to-child-transmission of HIV to less than 5%
* providing treatment to 80% of all people diagnosed with HIV.

As your provincial government, we will therefore continue to strive to meet
these targets, just as we will strive to attain an 85% TB cure rate. At
present, TB services have been strengthened to prevent further emergence and
spread of XDR-TB. Government has also commenced with surveillance of XDR-TB
amongst multi-drug resistant TB (MDR-TB) and re-treatment of TB cases by
conducting drug susceptibility tests. Education awareness around TB has further
been amplified, as has training and advocacy, while infection control measures
in TB settings at all levels of healthcare services have also been
stepped-up.

The TB management and control calls for concerted effort from all
stakeholders, including the private sector. Furthermore, the availability of
drugs, attitude change of the patients and continuous advocacy will contribute
immensely to the achievement of our target of an 85% TB cure rate by 2014. And
in saying so, I once again ask you for your support in attaining these
goals.

Be responsible, be safe and support and care for your family, friends and
neighbours because "TB Anywhere is TB Everywhere", but a battle fought by
unified forces, is a battle won.

I thank you.

Issued by: Department of Health, Northern Cape Provincial Government
24 March 2007