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Polity
Published: 24 Mar 2007
Peters: World TB Day (24/03/2007)
Date: 24/03/2007

Source: Northern Cape Provincial Government

Title: Peters: World TB Day


Speech by Northern Cape Premier Dipuo Peters at the Provincial World TB Day event, at Frank Roro Cricket Grounds, Ipopeng, Kimberley

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