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Column I can’t bear to look into someone's eyes and tell them they will probably die

My patients see my white coat as a lifejacket. But the truth is that the chance of surviving drug-resistant TB is down to the roll of a dice, writes Dr Jennifer Hughes.

MY ROLE AS a doctor is to make it possible for Andile to play football again.

He used to train three times a week in Khayelitsha, one of the largest townships in South Africa – miles and miles of little box-like brick houses interspaced with tin shacks on the edge of Cape Town. As he puts it, he was the type of player who doesn’t waste himself running aimlessly after the ball; he, rather, analysed the game to make decisive passes that led his team to a victory. But today, what Andile wishes above all is to be able to run, even aimlessly – to feel his heart beat hard against his chest, to feel his lungs explode from the hard-won efforts of playing a game.

But he can’t walk 10 metres without having to bend over to catch his breath. His lungs are so weak that he can’t even laugh. Tuberculosis has devoured them.

One of humankind’s most vicious enemies

TB is a very old disease. It used to be called phthisis, or consumption, and killed George Orwell and Anton Chekhov, Franz Kafka and John Keats, Simon Bolivar and Frédéric Chopin. Even today, TB kills 1.5 million people every year and ranks right behind HIV as the largest infectious killer worldwide. But since it all but disappeared in most of the richest parts of the world half a century ago, developments in new TB treatments ground to a halt. This has allowed plenty of time for one of humankind’s most vicious enemies to develop ways to beat the defences that were engineered to fight it.

Today, nearly half a million people across the globe are infected by strains of tuberculosis against which existing drugs are powerless. In South Africa, the country where I work, 15,000 people were diagnosed as having drug-resistant TB in 2012. The huge majority of them (up to 80 per cent) caught it by unknowingly breathing it.

When they become ill they come see me, their doctor, asking that I fix them. At those moments, I wish I had chosen to become a school teacher or a city planner or an engineer – surely these are able to make a bigger difference in people’s lives than me.

Because as a doctor, what am I to tell my patients? That yes, we just celebrated the cure of 30-year old Siyabulela, but that he is only my fourth patient to beat extensively drug resistant tuberculosis (XDR-TB), a disease that jumps to its next victim every time someone infected sneezes. The three other people who started the same treatment for the same disease at the same time are long dead.

Their survival is down to the roll of a dice

I can’t bear having to look someone in the eyes and tell them that I cannot give them better odds of survival than a roll of a dice. Roll a six, you’ll live. If not, you’ll be dead within two years. In South Africa, only 13 per cent of XDR-TB patients get cured with the current treatment regimen.

And then I have to tell them, in order to try for that slim shot at survival, you’ll have to endure a harrowing two years of treatment. For at least the first six months, you’ll get daily injections that hurt so much that you can’t sit down – and the very same drugs we’ll be injecting you with could also make you permanently deaf. My arsenal with which to tackle drug-resistant TB is so limited that another drug that I may be forced to prescribe might make you lose your mind, and bring on such acute psychotic episodes that you will be a danger to yourself.

But, I have to explain to my patients, you’ll only know in two years if it was all worth it – that is, if you drew a six when you rolled that dice.

I’m sick and tired of using plasters to patch up gaping wounds. Give me something I can really work with! Give me something that can save lives!

They see my white doctor’s coat as a lifejacket

We need a brand new treatment regimen against TB. Treatment that actually works. Treatment that hasn’t been dredged up from the Dark Ages of modern medicine and re-used because, well, it’s better than nothing.

But there is some hope on the horizon. For the first time in 50 years, new drugs are being developed to treat TB. They represent great strides forward, but they can’t be used in isolation. TB is so powerful that you need a full cocktail of drugs to beat it. The only way to catch up to the new face of this old disease is to find new combinations of drugs that are simple, accessible and more tolerable than current treatment and can be implemented rapidly in countries where DR-TB is rife.

But by the time that dream is realised – in five, seven, 10 years? – 80 per cent of the patients I see every day, who see my white doctor’s coat as a lifejacket, will be dead and gone, forgotten by all but their devastated families in the poorest corners of the planet.

We need governments, donors, pharmaceutical firms and research organisations to walk the extra mile, to help deliver new, shorter and more effective treatment combinations – giving people a chance at a cure, a chance at a life.

You can show your support for this campaign by signing MSF’s “Test Me, Treat Me” DR-TB manifesto – developed by patients and doctors – here: msfaccess.org/tbmanifesto. The petition calls for universal access to DR-TB testing and treatment, better treatment regimens and adequate funding for these programmes.

Please! Those of you who may have the power to turn this crisis around: save today the lives that otherwise will be lost by tomorrow.

Dr Jennifer Hughes is a medical officer working for MSF in Khayelitsha, in collaboration with Department of Health and local stakeholders, to address the epidemic of drug-resistant tuberculosis. She trained in the UK but worked in the Eastern Cape of South Africa for two years before joining MSF in Khayelitsha four years ago.

Read: ‘Extensively drug-resistant’ tuberculosis on the rise worldwide

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9 Comments
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    Mute 087 bed
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    Jul 24th 2024, 12:45 PM

    Makes no difference who you vote for, You still get the WEF government

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    Mute Vincent Alexander
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    Jul 24th 2024, 1:12 PM

    @087 bed: WEF? – World Economic Forum?

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    Mute 9QRixo8H
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    Jul 24th 2024, 1:16 PM

    @087 bed: see https://conspiracychart.com for all things NWO, chemtrails, chipping, and replacement theories.

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    Mute 087 bed
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    Jul 24th 2024, 1:36 PM

    @9QRixo8H: Are you a qualified tool or still an apprentice, All you do here is push disinformation in the comments.

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    Mute Dominic Leleu
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    Jul 24th 2024, 12:24 PM

    I wonder if the same secret service would protect Netanyahou…. That could solve a lot of problems

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    Mute Alan
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    Jul 24th 2024, 12:31 PM

    @Dominic Leleu: and potential assassins should be vetted by the NRA to ensure a more positive outcome. Might be an idea to invite putin, xi, orban and others

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    Mute Dominic Leleu
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    Jul 24th 2024, 12:31 PM

    @Alan: agreed

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    Mute Andrew Kiely
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    Jul 24th 2024, 12:22 PM

    When thinking about Simon Coveney , this a verbatim quote
    Owning your own home is not a bad aspiration, but if there was more certainty in the rental market in Ireland, you would see more people choosing to rent and to invest in rental property,” said Coveney.

    “The attitude towards long-term rental is changing in Ireland and we need to respond to that with market conditions that reinforce and encourage that change of mindset.”

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    Mute Kevin Kerr
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    Jul 24th 2024, 12:52 PM

    @Andrew Kiely: what’s your point?

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    Mute SV3tN8M4
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    Jul 24th 2024, 1:20 PM

    @SYaxJ2Ts: His point is, that Coveney’s prophecy, hope & implementation of same came through in Govt policy & is part of the problem today. It wouldn’t affect you Kevin as a Govt lackey on a big salary, but it affects thousands of young working Irish people who are paying extortionate rent & who can’t buy or afford a home in Ireland today.

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    Mute Kevin Kerr
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    Jul 24th 2024, 1:26 PM

    @SV3tN8M4: context is key here, and I don’t know when this quote is from, but surely certainty in the rental market is a good thing, albeit aspirational rather than real? You know, some security of tenure, rent certainty, that kind of thing. Anything to add here? Or are you just going to sling insults

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    Mute Kevin Kerr
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    Jul 24th 2024, 1:33 PM

    @SV3tN8M4: and any chance of backing up your claim from yesterday that SF will introduce sleight of hand legislation to increase granting of asylum applications? I’ve asked twice already. Surely you’ve managed to find the relevant evidence by now

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    Mute Peter Byrne
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    Jul 24th 2024, 1:37 PM

    @SV3tN8M4: I suppose all those people the Gardai have charged were all working very hard to buy a house and provide for their families. Most of them staying in the city centre at the taxpayers cost

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    Mute SV3tN8M4
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    Jul 24th 2024, 6:52 PM

    @Peter Byrne: Wouldn’t know Peter, don’t have anything to do with them, too busy working trying to make ends meet & pay my mortgage. You must be a happy man today that you & your buddies got a top up of 750,000, you might get your bumper Exit package & NDA now. Harris likes to reward Deceit & Incompetence, some of those in your organization are no better than those you judged above.

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    Mute Antony Stack
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    Jul 24th 2024, 9:04 PM

    @Andrew Kiely:
    I’ve just spent a week in Metz France.
    As in other European cities all accommodation within the city is in apartments. Apartments cannot be used for property speculation. If an apartment is unoccupied for an extended period it has to be sold back to the freehold company (owners association).

    If you want to live in a house – to go to a village 10 -20 km out.

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    Mute mickey mac
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    Jul 24th 2024, 2:24 PM

    Buttimer has repeatedly been rejected by the cork electorate, and now finally by his own party. Maybe this time the penny will drop

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    Mute Uí Braonáin
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    Jul 24th 2024, 3:11 PM

    @mickey mac: Once Fine Gael learned that Buttimer was attending pro-Palestinian events that was end for him.

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    Mute SV3tN8M4
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    Jul 24th 2024, 6:54 PM

    @mickey mac: He is left there for Tokenistic reasons by Fine Gael.

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    Mute Antony Stack
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    Jul 24th 2024, 1:58 PM

    Simon Coveney looked well, which is important in politics. But after that he lacked leadership. He fronted up the ‘ same-s marriage’ referendum by parroting the party line and adding in his own daughters. One of them might be that way.

    Fair point but not compelling. let them have all the rights of marriage, but call it something else. Marriage always meant man and woman.

    Neologisms are used every day to overturn the established order.
    For example – gender was a grammatical term to distinguish three different forms of a noun. Male and female got into it because they were two obvious categories. But there was never a case of an obvious male having a female noun form or visa versa.
    Generally a neuter gender noun is a noun that denotes a lifeless thing. A thing which is neither male nor female.

    But as anyone who learned French knows a pen and a pencil have different genders even though they both are technically neuter.
    La plume de ma tante
    Le crayon de ma tante

    In fact there is no neuter gender in French. An omission which the French chattering class are struggling to cope with.

    Anyhow this is a long way from Simon Coveney – other than to point out that weak leaders are easily pushed into fronting up anything which a mob (nowadays a Twitter mob) wants.

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    Mute Diarmuid
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    Jul 24th 2024, 12:58 PM

    There is certainly a FG seat in Cork SC, especially as it’s now a 5 seater. Going to a battle royal between Úna McCarthy and Shane O Callaghan to whose ahead after the first count. That’s vital. As it’s extremely unlikely both will get elected

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