Five Lives: Getting on to Effective TB Treatment Earlier

‘Five Lives’ are the stories of people that Médecins Sans Frontières/Doctors Without Borders (MSF) works with every day, whose health and lives often hang on a simple medical intervention.

These personal experiences are a snapshot of the unnecessary suffering MSF medical staff see first-hand daily in places where people can’t get adequate medical care and that could be avoided with proper, sustainable funding and investment.

Download a copy of the briefing 'Five Lives: How a Financial Transaction Tax Could Support Global Health'

We’re doctors and nurses, not bankers, but we can see how investing in real futures - like the futures of the people profiled here - will transform the lives of those made vulnerable through illness, and create a strong foundation for their families and their communities to build on.

That’s why MSF supports calls to direct a small but permanent portion of a new financial transaction tax (FTT), proposed by some governments, to meet global health needs. 

A regular stream of funding would help provide some funding to address unchecked health crises around the world.

The accounts told here of individuals that have benefitted from a medical intervention, might be just a drop in the ocean, but what we see in their story is the possibility of an amazing impact if the interventions that saved their lives could be made available on a wider scale. An allocation of proceeds from the FTT for global health could help make that possible.

ife 3: Phumeza

South Africa 2011 © Samantha Reinder

" I had so many different tests but they still couldn't see what was wrong. I just got more sick."

At 21 years old Phumeza should have her whole life to look forward to. Right now she’s confined to a bed in a tuberculosis (TB) care centre in Khayelitsha near Cape Town, on treatment for the most virulent form of TB currently known –  extensively drug-resistant TB, or XDR-TB. 

Last year for the first time in 10 years the number of people dying from TB worldwide dropped but still every year we miss diagnosing and treating around three million cases of TB, and half of those people die as a result of not being treated. So many people with this curable disease fall through the net because, until recently, the tests to confirm that someone has active TB or not have been so completely inadequate

Now, a new test using molecular technology is clearing the path for getting many more people on the treatment they need earlier.  It’s still only a start -  too many patients will still be kept waiting for a diagnosis so they can get the treatment they need but some first steps have at least been taken to improve TB diagnostics.
Phumeza doesn’t know how she contracted TB, she thinks it could have been on a crowded bus or at school. She knows she felt ill and that no-one could tell her what was wrong. So began a long and painful journey of misdiagnosis and waiting while she just got sicker and sicker. “At first, they gave me aspirins and paracetamol” says Phumeza. “. They didn’t see any TB on the smear they took. I had so many different tests but they still couldn’t see what was wrong!  I just got more sick.”

Finally, nearly two months later Phumeza was diagnosed in hospital with MDR-TB (multidrug-resistant TB) by which time she was so ill she was forced to drop out of school. “Sometimes I didn’t know whether I was coming or going,” she says of the experience.

This agonising wait could have been much shorter had Phumeza’s nurses had access to a new desktop diagnostic machine, that has since arrived in Khayelitsha's clinics. The device can diagnose drug-resistant TB within just two hours - older diagnostic methods take up to four months to confirm drug-resistant TB and many patients have died, while waiting for a diagnosis that arrived too late.

“This new test is so empowering”, says MSF’s medical officer Dr. Ian Proudfoot, who works at the Ubuntu clinic in Khayelitsha where the new test is being trialled. “It’s completely the opposite of the immense sense of powerlessness you feel when…you’re seeing a patient dying in front of you and are absolutely powerless to do something about it because you don’t have a diagnosis."

Phumeza herself is now on the treatment she needs finally. But she’s reassured the test will spare others in her position the agonising wait in future by delivering quicker and more accurate results.

"I don't blame the doctors for not diagnosing me earlier - the smear test couldn't give them the right results. But this new test will save lives."

What it costs to diagnose and cut the time to life-saving TB treatment:

  • One test cartridge of the new test costs at best US$17 and the each machine is priced at $17 000 in developing countries. Those costs are still very high for developing countries and efforts must be made to reduce them and come up with a test that is equally well performing but cheaper;
  • Treatment for drug-resistant TB can be up to almost US$9 000 - nearly 475 times more than a US$19 treatment course for drug-sensitive TB;
  • The funding shortfall: WHO estimates that for 2012 there is US$1.5 billion shortfall to prevent, test, and treat TB properly;
  • US$1 billion is needed for research and development for better tools including the development of a rapid and more affordable point-of -care TB test and new and better drugs.

In 2010, MSF treated close to 30 000 people for tuberculosis. This includes 1 000 people with drug-resistant TB across 15 countries.

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