On 24 March 1882, Dr Robert Koch published his discovery of Mycobacterium tuberculosis. 135 years later, 24 March is World Tuberculosis day and the second of a two-year campaign by the World Health Organisation. This year, the WHO has focussed on addressing the stigma, discrimination and cultural barriers that prevent people accessing TB care. We spoke to Sorsha Roberts of the charity Health Poverty Action, about their strategies for treating TB amongst the San people of Namibia.
Why Namibia and the San?
Namibia has one of the highest incidence rates of TB in the world. Within the country, the indigenous San people in particular have one of the highest rates of multidrug resistant TB. Whilst Namibia’s German-speaking population has a life expectancy of 79 years, the San people rarely live beyond 50. The San are an indigenous, largely nomadic group of people living across parts of Southern Africa. Known for their clicking languages, their unique culture has sometimes resulted in unfair discrimination against them. The San, and other ethnic groups in the area, often report ill-treatment from local health workers and are less confident when attempting to access health care services. These cultural barriers, when combined with a lack of nutritious food, and the nomadic lifestyle of the San, contribute to the spread of multi drug resistant TB.
How do we overcome the barriers identified by the WHO?
It is important to work closely in partnership with communities to understand what their barriers are to accessing healthcare, and to educate them about their health rights. We try to give communities the practical knowledge they need to take charge of their own health, whilst also strengthening existing health systems to ensure they receive good quality, culturally appropriate care. I’ll give you an example: when ≠ioma N!ania began having chest pains and sweating in the night, he didn’t know what his symptoms meant. It wasn’t until a community representative from his local area attended some health training from us that he learnt he had TB.
“When he returned from his training, he started to teach us in the village that chest pain and night sweats can be signs of TB. He encouraged me to go for a test.”
After he was diagnosed ≠ioma was given both treatment and training to teach him how to prevent the spread of his TB. He was also provided with temporary accommodation near the Tsumkwe clinic, as well as meals to support his recovery. But not everyone can come to stay near the clinic throughout their treatment. Many San people live a nomadic lifestyle which makes moving to a big town for months of treatment very difficult, both socially and financially. We need to prioritise early diagnosis and treatment to prevent hospitalisation to ensure that those infected with TB can remain in their communities whilst completing their treatment.
We train treatment supervisors to visit families, take samples for diagnosis, and visit them again to deliver their medicines. To prevent the further spread of multidrug resistant TB it is essential patients complete their course of medicine- even if this takes months or years. Treatment supervisors visit patients regularly to ensure they don’t stop their treatment for any reason.
We have also been working in partnership with the San people to set up Clinic Health Committees. These committees bring together community representatives to meet with local health officials, providing a space for the San people’s voices to be heard, so that local services can be adapted and made accessible to their cultural and local needs. Feedback about health services is collected by the committees, and then passed on to government officials at regional and even national level.
Has this approach been successful?
Although the process has often been challenging and slow, the voices of the San are finally being heard. As a result, the national government has recognised the need for greater support to stop the spread of drug-resistant TB in Tsumkwe. As the world continues to tackle TB, it will be crucial to take on not just the medical causes of TB, but also the cultural and social barriers preventing different groups from accessing treatment. In Tsumkwe this means healthcare needs to keep adapting to suit the culture and nomadic lifestyle of the San people, and make it easier for them to access healthcare and treatment without drastically altering their day to day lives. Despite these challenges, the healthcare professionals we work alongside in Namibia, but also all over the world are determined to deliver the best possible care to their patients.
Last year, Health Poverty Action trained 2,520 doctors, midwives, nurses and healthcare workers to improve the quality of care in the poorest communities and worked with 9,792 local health workers, community health volunteers and leaders to improve the health of their communities. To support them, please consider donating to their As One campaign.