As we celebrate World Tuberculosis Day, many in Africa face a dilemma. Unlike HIV, cancer and other non-communicable diseases which are not transmitted from patient to family members through casual contact, TB can be transmitted by just staying in the same environment and breathing the same air.
The biggest contributors to the palliative care burden in Africa are still HIV, and its interplay between HIV and its associated cancers along with cancers linked to infectious agents. This therefore provides a fertile ground for TB in Africa which health care providers in palliative care, HIV and cancer need to be concerned about.
Because of this and the high prevalence of TB, many people in Africa have been exposed to the disease. When someone’s immunity is lowered because of stress, pregnancy , cancer, malnutrition, diabetes, immunity lowering medications, tobacco use or many other illnesses, TB infection rates increase.
Sadly this has resulted in many health workers in Africa being infected with TB.
There has been a failure of health systems in some parts of Africa to ensure availability, access and adherence to TB services. This is because of poor or late diagnosis, drug shortages and low access to trained health workers. It has also resulted in erratic treatment for some and also an emergence of multidrug resistant TB. This is then harder and more expensive to manage and results in a higher death rate.
Although HIV is rightly understood as a catastrophe in parts of Africa, it can also be an opportunity. The systems that have been put in place to control it provide an opportunity for TB control. Using the family approach, the patient’s contacts are screened for TB (verbal and laboratory) and treated, or referred to better services for TB care and treatment.
Palliative care providers in Africa cannot shy away from embracing simple TB detection methods, care, treatment and having clear TB referral mechanisms.
As we celebrate the World TB Day, the palliative care providers as well as the entire health care fraternity ought to remember not to ignore TB in their approaches to all patients and family members of their index patients.
Ministries of health across Africa should ensure that affordable systems to suspect, screen, diagnose, refer, treat and cure TB are in place. This calls for patients to have better access to health workers with the appropriate skills and knowledge as well as: timely diagnose, consistent access to TB medications within the system and a mechanism to trace all contacts at risk using the community resources.
By excluding TB care approaches in palliative care in Africa we not only put health workers at risk but also the general public. TB knows no barriers. We have to respect this and as palliative care providers need to embrace TB control measures.
Let us therefore mark the World TB Day with action based on knowledge, concern and compassion.