19 Jul 2015 14:20pm
By Anna Tervahartiala
(NAMPA FEATURES SERVICE)
WINDHOEK, 19 JUL (NAMPA) - The unpainted walls of the tuberculosis ward next to the Keetmanshoop District Hospital stand silently in the sun.
The construction of the ward which was meant to be completed in May 2014 was brought to a standstill in February 2014 due to disagreements between the contractor and the consulting team. There were even talks of terminating the tender with the main contractor QE Construction CC working on the site which was handed over for construction in December 2012.
According to Esther Paulus, the public relations officer of the Ministry of Health and Social Services, a solution to the disputes was reached after investigations by the Ministry of Health and Ministry of Transport. Details on the results of the investigation or solutions were however not provided. Even though the contractor has received the green light to continue, the contract amendments are still being negotiated and finalised. The delays in construction may result in alterations in the original budget of the ward, which has been stated to be N.dollars 38 million.
The construction is to continue in August and is due to be completed around April 2016. The facilities of the ward are thus expected to be fully operational in June 2016. Until then, the tuberculosis patients of the Keetmanshoop district will be treated on the second floor of the hospital, occupying up to 50 beds.
It is not the best arrangement but the risk of infection is minimised, the acting Chief Medical Officer of the //Karas Region, Job Ndile insists.
All promises of continuation of construction aside, the need for a separate ward for TB patients remains crucial today.
Tuberculosis is a disease caused by bacteria which most often affects the lungs, but it can spread through the lymph nodes and bloodstream to other organs. The most common symptoms of TB are a prolonged cough, fever, night sweats and weight loss. Unless treated, TB can be fatal.
TB is an airborne disease and is thus easy to spread. The World Health Organisation estimates that about one-third of the worlds population carries the TB bacteria, but in most cases the bacteria does not develop into an active disease. According to Ndile in towns such as Keetmanshoop, it is impossible to avoid being exposed to TB.
Tuberculosis is a disease of poverty, Ndile states.
Overcrowding, dust, poor ventilation, malnutrition, tobacco and alcohol abuse are all factors that do not cause the disease, but attribute to the creation of a suitable environment for the disease to develop.
About 10 per cent of the people infected with TB develop a disease within approximately a year. For the remaining 90 per cent the immunity system of the body arrests the infection, Ndile explains.
It is only when the immune system of the person carrying the bacteria is weakened that TB becomes active. Due to the nature of the bacteria, TB infections go hand-in-hand with HIV/AIDS.
In this part of the world, HIV patients die because of tuberculosis, Ndile says.
In //Karas alone, 2014 saw 622 tuberculosis cases of which 42 per cent were HIV co-infections.
Although the number of TB cases came down 10 per cent from the previous year, the //Karas Region nonetheless remains a high risk area.
Overall, according to an article published by local English daily newspaper The Namibian in March 2015, Namibia remains the fourth worst TB affected country in the world.
In spite of the downward trend of tuberculosis, according to a recent health report of the //Karas Region, the number of HIV infections in the region has been on the rise, growing from 16,5 per cent in 2012 to 17 per cent in 2014.
In order to tackle the issue of both TB as well as HIV, regional health officials have focused on building awareness on grassroots level. The region has seen an emphasis on community-based outreach teams and so called DOTS or Directly Observed Therapy Stations in which TB patients are observed taking their medication. A DOT can also be a person who observes the one on treatment taking the medication.
Two antibiotics, Rifampicin and Isoniazid, are used to treat TB. When a person is diagnosed for the first time, the treatment period is six months. If the disease reoccurs a second time or develops into a multi-drug resistant (MDR) or extensively-drug resistant (XDR) tuberculosis, the treatment period can be up to 21 months. Due to the lengthy treatment the DOTS have proved to have a crucial role in ensuring that TB is cured.
MDR and XDR are developed when someone on treatment does not take the prescribed medication properly or is taking the medication in wrong quantities, Ndile explained, emphasising the harmful impacts mistreated TB might have on both the individual as well as the ones in contact with the individual carrying the disease.
According to statistics provided by the health director, the rates of MDR have also receded during the past years. The year 2013 saw five reported cases of MDR whereas 2014 saw only three.
One of the cruxes of treatment lies in the unpleasant side effects of the medication used. Side effects can range from nausea and rashes to damage to the kidneys and liver. Even though the side effects of the treatment can be discouraging, Ndile emphasised that if TB develops into MDR or XDR, the harm of the side effects can be worse, though manageable with proper control and follow-ups.
Our objective is not to prevent infection, but to prevent the severity of the disease, he says.
Even though a new TB ward will not solve the issue of the prevalence of TB in the region, the ward is a step towards providing the patients both with and without TB a safe environment for treatment.
Until then, the sun will continue to rise and set on the skeleton of the ward-to-be.