Tuberculosis in South Africa
It is difficult to imagine how many people have died because of the epidemics during the course of human history. Perhaps, the modern African history is even more rich in such episodes than the history of any other region due to the number of circumstances. Poor living conditions, problems with getting water, hygiene, dependence from “the white masters”and incurable diseases are indispensable part of the history of suffering and pain the African people write.
People in South Africa are living in comparatively normal conditions, which are obviously better than the ones of their neighbors in the central Africa. Their country is not torn by wars and revolutions, but years of apartheid, which is racial segregation in practice, have led to a number of problems in the social sphere. The medial care is one of such domains. Unequal health care led to outbursts of HIV and tuberculosis among the black population of South Africa, and the numbers of ill people were constantly neglected. Nowadays the situation with tuberculosis is among the main problems the Southern Africans face.
The epidemic of tuberculosis is a serious. The disease is difficult to cure and easy to transmit to the others. It is an infectious malady that is caused by Mycobacterium tuberculosis. The disease attacks the lungs in the majority of cases, though it can also attack the bones. It is transmitted by air when the ill people sneeze or cough. The problem with tuberculosis is that the disease can progress passively and when it stops being latent, the treatment becomes very difficult. The most wide spread symptoms of tuberculosis are fever, active weight loss, night sweats and heavy cough with blood. Tuberculosis is a rear disease and millions of people are dieing from it, especially in developing countries (Harries 2005).
It is possible to decrease the number of people who suffer from tuberculosis. The traditional method to prevent it is vaccination in the early childhood and treatment of those who have fallen ill. The vaccine from this disease which is BCG or bacillus Calmette-Guérin decreases the risk of being infected with tuberculosis from 20 percent to 60 percent. Nearly 90 percent of all children who are born in the world are vaccinated with BCG. It is not very popular in the United States and in Canada, where the number of people with active tuberculosis is not very high. One of the arguments that is used to explain such unpopularity of this means of tuberculosis prevention in those countries is that the vaccination leads to positive reaction on the tuberculin skin test even if the person is not ill. That is why the scientists try to find a new vaccine against tuberculosis.
Though, the situation on the African continent is more difficult than it is in the United States or in Canada, and people there are happy to be vaccinated with BCG. South Africa is not an exception and the fight with tuberculosis is the priority for the state heath system. In fact, South Africa has the epidemics of tuberculosis and its dimension is among the most serious ones in the word (Harries 2005).
The epidemics of tuberculosis in South Africa is divided into two pain parts – the pre HIV era and the HIV era. The majority of people who were infected with tuberculosis in South Africa in the HIV era have an increased level of resistance to medications that are used against tuberculosis, which makes it difficult to treat the disease. It became the result of double infecting of those people both with tuberculosis and HIV, and as the result the virus underwent mutations (Symons 2011).
According to the statistics, tuberculosis became the major cause of mortality only in 2010 in South Africa. More than 60 thousands of people died from it. According to the data of the World Health Organization concerning the Southern African region, there were approximately 500 thousand of people with tuberculosis in the active form, from whom 330 thousand of people were HIV positive in addition. It is considered that nearly 80 percent of the population of South Africa have the latent form of tuberculosis (Statistics South Africa 2014).
It is impossible to say who is in the group of risk. Tuberculosis is mostly spread among not white, young, poor males in South Africa, but it is impossible to state that other groups of people do not fall ill. Though, in 1970s the number of tuberculosis positive people decreased drastically. This detail can be explained by the fact that the information about ill black citizens was excluded from the official statistics. The data which was more real appeared only after 1990. Such detail explains the reduce interest of the state in the problem of mortality from this malady. Otherwise it might be quite strange that tuberculosis became the problem of the national level only in 2010, because it was decreasing the population in the country for almost 50 years (Symons 2011).
When such neglecting attitude towards the biggest part of the country’s population is mentioned, it is necessary to understand the reasons that led to such results and the reason is called the apartheid. The apartheid era is the politics of racial segregation led by the National Party from 1948 to 1994 and is an important issue that determines the situation with tuberculosis in South Africa. During all that time there were two separate heath systems in the country – one for Europeans, and another for non-Europeans. Mostly 97 percent of the state budget was used by the hospitals for white people. As the result, the state health system for the colored population of South Africa was not financed at all and remained on the primitive level (Statistics South Africa 2014).
Poor investment led to the fact that tuberculosis was not diagnosed, controlled and treated. Thousands of black people died from it and in addition they infected the others. During decades people with tuberculosis in the hospitals for non-Europeans received the most primitive treatment. They were staying there for a year and were treated by streptomycin, isoniazid and para acid, which is considered to be ineffective. In addition, such treatment led to drug resistance in many cases. It became a serious problem after 1980 in South Africa and still remains the priority of public heath system in the country.
With the time it was decided that people with tuberculosis can live at their homes and receive ambulatory treatment. In fact, it was made to decrease the amount of money the state has to send on treatment and living of the patients in the hospital. As the result of such reform, people with serious problems with health had to travel to the far away hospital, which was not only difficult for them but also problematic to afford.
The apartheid government in South Africa was not very interested in contract the epidemics of AIDS and in fact nothing was done in this sphere until 1994. As it was mentioned earlier, the HIV was one of the major causes that led to the growth of the tuberculosis rates in the country, so the neglect of HIV by the Southern African government is directly connected with the further epidemics of tuberculosis.
Lack of medical and governmental attention to the problem of HIV positive people was determined by the assumption that it is the disease only of queer men. It became a kind of an excuse in the eyes of the society that the apartheid government did not do something radical about preventing the epidemics. It was considered that a descent person would not have any possibility to get infected with AIDS. The problem received public attention only in 1990s, when international organizations started to work actively on abolishing the apartheid policy. As the result, when the international experts started their investigation of the tuberculosis problem in South Africa, they found out that it was not better than the situation with HIV and even people with the open form of tuberculosis were not treated in the appropriate way (Department of Health, Government of South Africa 2011).
There are several important reasons that have led to spreading of tuberculosis in South Africa. The industrial revolution affected the increase of tuberculosis rate and the most weak group of people was those who worked in the mines. The conditions of work underground were horrible and those who initially had problems with their respiratory system became incurable ill. The environment in the mines increases the risks of tuberculosis because they are dusty and have a bad ventilating system.
Though, those people had no other choice than to work hard in the mines, because there was no possibility for them to find another work that would be payed decently. This explains the fact that black men from the other sub-Saharan countries went to South Africa work as miners. According to the statistics, the number of tuberculosis positive men among miners is more than ten times higher that the number of ill people in the countries they come from (Statistics South Africa 2014).
Another social problem caused by the total poverty of the black population in South Africa is prostitution and transmission of tuberculosis among them. Sexual division of labor led to the situation where men were not supposed to earn for the entire family. That is why women had to provide for themselves, so they got involved in prostitution, which also incremented the spread of the disease and was the only possible way for them to earn money in the country of decreased opportunities for black population. They often worked near the mines and the workers with tuberculosis transmit the disease to those women. The prostitutes had no possibility to cure tuberculosis and the majority of them died from it, after spreading the disease among their other clients (Statistics South Africa 2014).
The new government of South Africa made much to gain control over the epidemics of tuberculosis in the country. The state progressed from total neglect of people with tuberculosis to their active detection and treatment. Nearly 70 percent of all people who suffer from the disease are now detected and almost 85 percent of them receive appropriate medication. It is a serious step to prevent the infecting of the others. Tuberculosis was declared to be the problem of the national level in South Africa in 2005, which supports the idea that the government understands the seriousness of the disaster (Statistics South Africa 2014).
As it was mentioned earlier, there is a problem of drug resistance to tuberculosis medication in South Africa. The program to fight the drug resistance was started by the State National department of Health in 2000 and is still actively practiced (SANAC 2011). There are still numerous challenges that the doctors have to overcome, among which are bad control of infections in the hospital, inability to place all patients in the hospital, lack of financing for the medications and delayed start of the treatment. It is evident that despite serious results of the Southern African health care system in the sphere of coping with tuberculosis, there is still much to be done in order to achieve the comparatively stable situation.
The problem of tuberculosis in South Africa showed on the example that when there is a problem, it will not vanish if ordinary citizens and the government will try to close their eyes on it. The problem was considered to be not descent for a long period of time, when people thought that tuberculosis is the result of HIV infection, and AIDS, in its turn, is the malady only of gay men. Descent citizens did not even imagine that the disease is extremely infecting and can reach the size of the national disaster. Another issue that is connected with prejudice on the even more deep level and directly led to the outburst of tuberculosis in the country is apartheid policy. It resulted in the fact that all budget money went to the support of the health system for the minority of the state’s population, to the white people. The others had to go to extremely poor hospitals for black people and got inadequate treatment there (SANAC 2011).
Such episodes from the history, when the nation went through sufferings, deaths, injustice and segregation led to the fact nowadays people in South Africa understand the value of life and freedom better, than they used to. The contrast between the free state when there is one health care system and when there are two of them, one of which is not financed at all, is evident for the majority of people. The lessons from the past made the citizens of South Africa pay more attention to the social sphere in organization of the country.
Department of Health (Government of South Africa). (2011). Tuberculosis Strategic plan for South Africa. Retrieved from: <www.info.gov.za/view/DownloadFileAction?id=72544>.
Harries, A. (2005). TB/HIV a Clinical Manual. Geneva: World Health Organization.
SANAC. (2011). National Strategic Plan on HIV, STIs and TB 2012 – 2016. Retrieved from: <www.health.gov.za/docs/strategic/2012/NSPfull.pdf>.
Statistics South Africa. (2014). Mortality and causes of death in South Africa, 2013: Findings from death notification. Retrieved from: <http://beta2.statssa.gov.za/publications/P03093/P030932013.pdf>.
Symons, G, A. (2011). A historical review of XDR tuberculosis in the Western Cape province of South Africa”, South African Medical Journal.