No. 70 / August, 18 2012
www.solidarmed.ch
w o d a h s e . h s t i s In o l u c r e b Tu o
th Leso
: V I of H
on 2 mpti u s n d 6 g co 3 erlan uerin mic z q e t i n d i o w oS ’s ep rial: C r ns t otho u s t Edito e e r L t se: ard 8 rkulo Labh s Tube u land r a l e k z i t i Sw iew: N ria in Interv a l a : M paign Cam
Editorial
Key Hospital SolidarMed Office Important town Political capital
Tanzania
Mbulu Arusha
Dareda Dodoma
Conquering consumption
Dar es Salaam
Ifakara
Not so long ago, doctors in Switzerland softened the blow by diagnosing their patients with «Koch’s disease». This harmless sounding euphemism could not avert their impending fate. Tuberculosis (TB) would make them too weak to work and the poverty already knocking on their doors would irrevocably enter their lives.
Lugala
Zambia
Chiúre
Mpanshya Katondwe
Chongwe Lusaka
Chainama College
Moçambique
Harare
Tuberculosis has always been a disease of the poor. And it still is today. Tuberculosis continues its global spread across the poorest regions of the world. Bad hygiene, poor nutrition, a weakened immune system and a lack of access to healthcare are key factors, as our TB expert Dr Karolin Pfeiffer explains (see page 3). After two years working as a SolidarMed doctor in Lesotho, Dr Niklaus Labhardt stresses the growing danger of TB in his interview on page 6. We know – theoretically – how to control TB. If people were less poor, their nutrition would be better and their immune systems would be stronger. By improving healthcare, SolidarMed has a significant impact on many people who can’t easily escape poverty. Health promotion improves hygiene standards and families know that they can receive life-saving treatment in the health institutions supported by SolidarMed. Switzerland has overcome poverty and only has isolated cases of tuberculosis. In Africa, the competent treatment of TB is more important than ever. Only healthy people can fight poverty in Africa and conquer consumption! Dr med Svend Capol, President of SolidarMed
Ancuabe Pemba
Zimbabwe
Masvingo Silveira Musiso
Maputo
Seboche Maseru
Paray
Lesotho
Imprint «SolidarMed aktuell» 70/2012 SolidarMed, Obergrundstrasse 97, Postfach, CH- 6000 Lucerne 4, Telefon +41 41 310 66 60, Fax +41 41 310 66 62, www.solidarmed.ch Editorial team: Silvia Bucher, Benjamin Gross, Joel Meir, Lisbeth Pembele Text: Benjamin Gross Graphic Design: Silvia Bucher Translation: Raphaela Scholz Cover photo: Football game in the mountains of Lesotho; Photo: SolidarMed Printing: Brunner AG, Druck und Medien, Kriens Print run: 15 500 (digital English version) «SolidarMed aktuell» is published four times a year – the next edition appears November 2012. An annual subscription costs CHF 5.00 and is deducted as a one-off from your donation. For members it is included in the annual fee. Membership: CHF 50.00 for individual membership; CHF 80.00 for families and institutions Donations and membership fees are to be transferred with the appropriate reference to: Within Switzerland: Postal account: 60-1433-9 in the name of SolidarMed, CH-6000 Lucerne 4 From abroad: IBAN: CH0909000000600014339, BIC: POFCHBEXX Bank details: Swiss Post, Postfinance, Nordring 8, 3030 Bern, Account number 60-1433-9, in the name of: SolidarMed, CH-6000 Lucerne 4 Online donations: www.solidarmed.ch «Donations» Direct debits: www.solidarmed.ch «Donations
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SolidarMed aktuell
Tuberculosis
A young man receives a warm blanket as a prize during a quiz on Tuberculosis. In the mountains of Lesotho in wintry July this is a welcome gift. Photo: Sabine Heinrich
In the shadow of HIV
Lesotho’s tuberculosis epidemic By Dr med Karolin Pfeiffer, SolidarMed
TB remains one of the most dangerous diseases in the world. Tuberculosis bacteria attack and destroy lung tissue. By further weakening the immune systems of the affected, the HIV epidemic in southern Africa presents a particular danger. SolidarMed responds by ensuring prompt diagnosis and competent treatment even in the most remote villages in Lesotho. TB remains one of the most dangerous diseases in the world. Tuberculosis bacteria attack and destroy lung tissue. By further weakening the immune systems of the affected, the HIV epidemic in southern Africa presents a particular danger. SolidarMed responds by ensuring prompt diagnosis and competent treatment even in the most remote villages in Lesotho. Just one hundred years ago, tuberculosis was the biggest health risk for the Swiss population – particularly for the poor. Today only about 500 people are infected with TB per year, and very few actually die from the disease. In-
dustrialisation and the associated improvement of living standards, especially in housing, have led to a drastic drop in TB cases in the last 100 years. Not so in Lesotho. TB is – after HIV/Aids – one of the most common diseases in Lesotho. Worldwide, around 1.4 million people died from tuberculosis in 2010. Their weakened immune system makes HIV positive people particularly susceptible to TB infection. Given the high HIV infection rate of up to 23.6% in recent years, the number of cases of TB has also started to rise. This has resulted in a double epidemic. SolidarMed aktuell
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Tuberculosis The double epidemic of Tuberculosis and HIV Despite major advances in treatment, tuberculosis remains the main cause of death for HIV patients. Yet in Africa in 2010, only 59% of TB patients were also tested for HIV at the time of their diagnosis. In terms of offering patients optimal treatment, this is a wasted opportunity as thanks to improved care for those doubly infected, mortality rates have been considerably reduced. Treating an existing HIV/ Aids infection with antiretroviral medication significantly improves the chances of survival. However, in 2010 only 46% of doubly infected patients also received treatment for HIV.
A challenging reality To combine the treatments for both diseases as early as possible, one must be able to diagnose both diseases rapid-
ly and initiate two sets of treatments promptly – and this requires a functioning health system. In addition, patients and health workers have to show a willingess to cooperate. In reality, there are still significant hurdles to be overcome to ensure continuity of care and treatment between a TB diagnosis and its treatment, between an HIV test and the start of antiretroviral therapy and between hospitals and the peripheral health centres.
Making a significant contribution SolidarMed is taking action - from TB prevention in the villages to rapid diagnosis and prompt treatment initiation right up to patient care during treatment. What›s more, patients in need are offered high quality treatment for HIV. This is how SolidarMed makes a signaificant contribution to the fight against both diseases. ▪ Photo: Niklaus Labhardt
SolidarMed helps with prevention and effective treatment Avoiding infections. In Lesotho’s mountains lies Seboche Hospital which has, since this year, a separate examination room for patients with persistent cough, which is one of the most common symptoms of tuberculosis. Here, potentially contagious patients can directly access diagnosis and treatment. Simply avoiding sitting with other patients in the waiting room prevents exposing others to the risk of infection. A rapidly diagnosed tuberculosis can be rapidly treated – and so also reduce the danger to health workers of exposure to this infection.
Rapid diagnosis. In Seboche Hospital, TB and HIV/Aids have been treated under the same roof and by the same nurse since 2011. In this way, patients don’t have to wait to start treatment twice.
Peer counselling. SolidarMed supports lay counsellors who inform positive patients about tuberculosis and HIV. Often, the counsellors themselves are HIV positive and can well understand the difficult situation of those affected.
Better care. Once in treatment, HIV and TB patients are supported in their villages by health advisors. SolidarMed’s «Primary Health Care» project tackles this issue by training village health workers and ensuring they are adequately supervised by hospital staff. Their tasks include TB prevention through sensitisation measures and the referral of suspected cases to the closest health centre.
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SolidarMed aktuell
Tuberculosis
«I defeated tuberculosis – and am alive despite HIV.» The story of Thandeka (38) from Taung in Lesotho
Three years ago I was very ill. I was coughing, felt very weak, I could hardly breathe and had a fever. My condition got worse and worse so I decided to go to Seboche Hospital and ask for help. A nurse suspected I could be infected with TB. She explained everything to me and tested me for the disease. The result was positive and I was advised to also have an HIV test, as having HIV increases your risk of TB infection. To my horror the HIV test was positive too. I began taking medication for tuberculosis and then started treatment for HIV. Thanks to the medication I felt much better. I had defeated TB, but I also knew that I was still infected with HIV and would have to take medication for the rest of my life. Then some friends told me about a healer who could cure HIV/ Aids! Full of hope I visited this man and following his advice stopped taking the medication. In the beginning I felt fine, but after two months I got very sick again. Then I got an unexpected visit from a counsellor who was trained by SolidarMed. I was ashamed that I had just stopped my treatment and told him that I had not had money for transport to the hospital. This man gave me money for transport. When I got to Seboche Hospital this time, I met with a woman (lay counsellor) whom I told everything. She explained to me how important it was to take the medication without interruptions and to come for follow-up. Since then I have continued my treatment and feel healthy – despite HIV. I want to thank SolidarMed very much for their partnership with Seboche Hospital. People from the entire region are benefitting from this. SolidarMed aktuell
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Interview
Not spectacular, but sustainable
Improving the quality of treatment for HIV and TB patients. Interview with Dr med Niklaus Labhardt, SolidarMed project manager SMART in Lesotho
Nach After two years in Lesotho, the SolidarMed doctor Dr Niklaus Labhardt is returning to Switzerland. In our interview he reports on the achievements and the challenges of a Swiss doctor in Lesotho, a country in which tuberculosis is one of the greatest dangers facing the population.
You and your family are leaving Lesotho. What are your current concerns? Professionally, my foremost concern is the completion of on-going activities and the handover of the project to my successor. Privately, we are in the process of saying our reluctant goodbyes to the people we leave behind. What are the main day-to-day concerns of people in Lesotho? The main concern and worry of the rural population is extreme poverty and the food shortages. After the floods of eighteen months ago and the drought this year, many people cannot provide for their families. The extremely high rate of HIV is both the result and a cause of poverty, as poverty increases risk-taking behaviour and the disease then results in a loss of income amongst affected families. What was your role in the past years? My work was very varied. It included, amongst other things, management, coordination with the Ministry of Health, direct clinical work as well as training and coaching of health staff. Training and coaching nurses in the care of HIV and TB patients was what I found the most satisfying. What can SolidarMed doctors achieve in Africa? You can achieve the most if - over a longer period of time you are recognised as part of the staff of a health institution. Improvements to processes and procedures can thus be attempted from the inside. This approach – in small steps and as part of a team – leads to results that may not be spectacular, but are in fact sustainable, as those affected are involved in and own the process of change. 6
SolidarMed aktuell
Looking back over your work in the past years, where do you see the most value? In the many small but crucial details which have improved the quality of treatment for HIV and tuberculosis patients in the project areas. The value of these achievements lies mainly in the fact that SolidarMed has succeeded in sensitising local health professionals as well as Ministry of Health personnel for these areas and secured their active involvement. What will SolidarMed focus on in future? The list of challenges remains long. In the short- to mediumterm, HIV and TB will continue to dominate healthcare in Lesotho. At the same time, the “classical” issues of primary health care like maternal and child health should not be forgotten. In addition, the epidemic of non-infectious chronic diseases like diabetes, hypertension and heart disease is also reaching rural Lesotho. The country is currently not adequately prepared for this. What do you leave behind in Lesotho? In the partner hospitals and the health centres, I leave behind a competent HIV team, an involved district health team as well as better infrastructure and (treatment) processes for HIV and TB patients. Privately, I leave behind many people with whom I had intensive exchanges in the past years. I will miss this in future. What are you taking home with you from Lesotho? The deep impression made upon me by the people of Lesotho - their dignity, their sense of social responsibility and their interpersonal commitment. ▪
Interview
Dr med Niklaus Labhardt at work. He worked in Lesotho as Project Manager for SolidarMed from 2010 to 2012. Photo: Dominik Labhardt
«The value of these achievements lies mainly in the fact that SolidarMed has succeeded in sensitising local health professionals as well as Ministry of Health personnel for these areas and secured their active involvement.»
pic at Read more on this to r de www.solidarmed.ch un «Lesotho»
Dr med Niklaus Labhardt, SolidarMed
SolidarMed aktuell
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Campaign
Malaria in Switzerland Swiss commuters got to experience how quickly one can get infected with malaria. The SolidarMed epidemic – whilst not dangerous – is very effective. Around 10 000 pedestrians suddenly discovered a small red sticker on their bag or jacket. These were stuck on by «mosquitos»sneaking through the train stations of Zurich, Lucerne, Basel and Berne. On four SolidarMed Sting Days in June, these «mozzies» spread malaria here in Switzerland as stealthily and as rapidly as in Africa. Thousands were infected in the space of a few hours. This campaign effectively called attention to the life-threatening disease of malaria. Those «stung» understood how quickly one could fall seriously ill. Thankfully, the SolidarMed form of malaria is not dangerous. Quite the opposite: those stung had a chance of winning something, thanks to a secret number of their sticker. Despite its playful approach, this campaign did not neglect the harsh facts. Once again, the Swiss were reminded that ever y 40 seconds, a child dies from malaria. Most of the 1,2 million malaria deaths per year are children. Thanks to this campaign, many more people know about malaria. This makes joint action against the disease possible in the first place.
Warning on the big screen in at Lucerne station
A «sting» with a sticker in front of Lucerne station
on Malaria: More informatio«Mnealanria» www.solidarmed.ch et campaign: Photos of the stre lida rMed/photos www.facebook.com/So Day campaign: Videos of the Sting www.youtube.com/use
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r/solida rmed
Photos: Silvia Bucher; Ulrich U. Schutz (Basel)
The Mosquito, Berne
A commuter is «stung» in Basel
Nik Hartmann, SolidarMed goodwill ambassador, Zurich