treatment September 2011Magazine of the Treatment Action Campaign

Iminyaka emine yokulwa ne-TB: U-Xoliswa Harmans uxoxa indaba yakhe emangalisayo

I-TB ingelashwa!

I-TB yambuliwe: Incwadi okulula ukuyiqonda ngesayensi ye-TB

Umbuzo wokuvalelwa ngenxa yesifo: Inqubomgomo entsha

kungenzeka ishintshe yonke into

OkuqukethweIhlelo 40 – Septhemba 2011

isiZulu

amakhasi 2–5

amakhasi 6–15

amakhasi 16–28

Ikheli Leposi: PO Box 2069, Cape Town 8001Ikheli Lendawo: Westminster House, 122 Longmarket Street, 3rd Floor, Cape Town 8000 Ucingo: 0861 END HIVIfeksi: +27 21 422 1720 Iwebhusayithi: www.tac.org.zaAmahhovisi Esifunda e-TACKhayelitsha District: 021 364 5489Ekurhuleni District: 011 873 4130Lusikisiki District: 039 253 1951Pietermaritzburg District: 033 394 0845 Gert Sibande District: 017 811 5085Mopani District: 015 307 3381

Equal Treatment is published by the Treatment Action Campaign.

Umhleli: Marcus Low

Umhleli Wezithombe: Andrea Zeelie

Umhleli Wekhophi: Cathy Goudie

Abafake isandla: Nathan Geffen, Mary-Jane Matsolo, Catherine Tomlinson, Agnieszka Wlodarski, Elizabeth Mills, Claire Wingfield, Elizabeth Vale, Luckyboy Nkhondwane

Isithombe sekhava: Chelsea Maclachlan

Izithombe: Chelsea Maclachlan, Adam Malapa, Jose Cendon, Bruno De Kock, Gawain Kripke, Mariella Furrer, Elizabeth Mills, Travel Aficionado, Elizabeth Vale, Luckyboy Mkhondwane ne-Bookslive.co.za. Umfanekiso osekhasini le-13 ngu-Brice Reignier. Umfanekiso osekhasini lama-27 ngu-Sizwe Nguqe.

Sibonga u-Xoliswa Harmans ngokukhethekile mgokuxoxa indaba yakhe, ku- Claire Wingfield we-Treatment Action Group, ku-Alex Müller, Nathan Geffen no-Kay Kim bonke abafake isandla ku- TBOnline.info.

Ukuhambisa: Market Insertion Bureau

Ukuhlelwa kwebhuku: Designs4development, www.d4d.co.za

Ukuphrinta: CTP Book Printers

Ukuhumusha: Bohle Conference and Language Services

I-TAC izinikele ekuhlinzekeni abantu abane-HIV, imindeni yabo kanye nabanikezeli bokunakekela ulwazi olungenaphutha ngemithi esindisa impilo kanye nokwelashwa. I-TAC kanye nabaholi bayo bazimele abekho embonini eyenza imithi yezokwelapha kanjalo nezimboni zemithi yemvelo kanye nehlukile futhi ayinatshisekelo yemali kuzo.

Leli hlelo le-Equal Treatment lixhaswe ngezimali yi-Global Fund to Fight AIDS, Tuberculosis and Malaria, kanye ne-Oxfam Australia.

Leli phephabhuku liyatholakala futhi ngesiTsonga, isiXhosa nesiNgisi.

Ungakhiphela la mahlelo e-Equal Treatment kanye nawangaphambilini kuleli kheli: www.tac.org.za/community/equaltreatment/

Indaba ka-Xoliswa nomlando we-TBUXoliswa Harmans wazabalaza ne-TB iminyaka emine. Indaba yakhe emangazayo siyilandela ngomlando omfishane wokuthi lesi sifo sesiyicekele phansi kangakanani imiphakathi amakhulukhulu eminyaka kanye nenqubekela phambili ehamba kancane esesiyenzile ekulweni naso.

Isayensi ye-TBIsayensi ye-TB akufanele ukuthi yethuse. Encwadini yethu okulula ukuyiqonda ye-sayensi ye-TB sembula yonke into kusukela ekumelaneni nemithi ukuya kumenenjayithisi ye-TB. Futhi, ungaphuthelwa yiphosta yethu yemithi ye-TB kanye nemiphumela yayo emibi, noma uhambo lukaMandla noSipho esikhaleni esisekhasini 13.

Ukuvalelwa ngenxa yesifo, okusha okuvelile kanye nohlelo lwe-SACTWUUkuhlukaniswa ngempoqo kweziguli ze-DR-TB kwenza izihloko eziphambili eminyakeni embalwa eyedlule. I-Equal Treatment iphenya inqubomgomo yokunakekela entsha esisatshalaliswe nakwezinye izindawo enikeza ezinye izixazululo. Emva kwalokho sikunika ulwazi olusha ngokuhlolwa kwe-TB okusha okuthokozisayo futhi sibheke phambili emithini ye-TB yesikhathi esizayo. Siye sathola futhi ngalokho enye inyunyana yezohwebo ekwenzayo ukusiza abasebenzi ukuthi bahlale bephilile. Ekugcineni, ekhasini 28 sikulethela izindaba zakamuva zamagatsha e-TAC. Thola ukuthi amalungu e-TAC ayifundisa kanjani intsha esencane nge-HIV nezifo ezithathelwana ngocansi ama-STI.

2

Umhlaba we-TB udinga intukuthelo nobushoshovu“Isifo sinqotshiwe.”

La mazwi ashiwo ngonyaka ka-1962 ngumsebenzi we- International Union Against TB. Babenephutha. Kodwa Inyunyana yayinethemba elikhulu ngenxa yokuthi imithi elwa ne-TB ngempumelelo yayitholakele. Isifo esibulalayo esase sibulele abantu emhlabeni wonke iminyaka eyizinkulungwane eziyishumi, i-TB yayisilapheka. EYurophu naseNyakatho Melika, ukufa nge-TB kwehla ngokumangalisayo.

Kamuva esiganyini sekhulunyaka, cishe isigidi nohhafu sabantu sabulawa yi-TB unyaka ngamunye. ENingizimu Afrika, inamba yokufa nge-TB eyarekhodwa yaphindwa kathathu phakathi kuka-1997 no-2005. Isifo sisekude kabi nokuthi sinqotshwe. Pho kungani izinto zahamba kabi? Kunzima ukwazi ngokuqinisekileyo, kodwa nazi ezinye zezimpendulo ezinokuba khona:

Okokuqala, umzamo owafakwa ekuqedeni i-TB emazweni acebile awuzange ukopishwe emazweni ampofu. Okwesibili, i-TB yaphinde yabuya nobhubhane lwe-AIDS. Okwesithathu, amadolobhakazi amakhulu emazweni asathuthuka anamadolobhana ayizindlwana lapho abantu abangondlekile bephila ezimeni ezimbi, nezinabantu abaningi ngokweqile. Lokhu kuvumela ukuthi i-TB iphile kahle. Okwesine, izinhlelo zezempilo emazweni ampofu awakwazi ukumelana nezinamba ezinkulu zezimo ze-TB.

Ngaphezu kwalokhu, eshumini leminyaka eledlule umhlaba ubone ukukhula kwe-TB engazweli emithini (DR-TB). Manje abantu abaningi abaxilongwe ngesifo kungaba singelashwa kuphela emva kokwelashwa ngemithi kwesikhathi eside ngokweqile nokunzima, noma abakwazi ukwelapheka nhlobo.

Yini okudinga ukwenziwa ukuze kunqotshwe i-TB? 1. Sidinga imithi engconoAkukaze kube nokuvunywa kwekilasi lemithi emisha ye-TB emashumini eminyaka. Kodwa manje sekunenqubekela phambili. Umuthi omusha othokozisayo kakhulu i-TMC207, owenziwa inkampani eyenza imithi i-Tibotec. Izinhlolo zokwelashwa ezincane zikhombisa ukuthi welapha iziguli ze-TB ezingazweli emithini eminingi ngokushesha futhi ubukeka unemiphumela emibi kakhulu embalwa. Kodwa eminyakeni eyisikhombisa emva kokutholakala kwe-TMC207 kusengekacaci ukuthi izogunyazelwa nini ukusebenza. I-TB akusiso isifo esinenzuzo, imboni eyenza imithi ihamba

kancane kakhulu emithini ye-TB.

Enye inkinga enkulu ukuthi imithi ye-DR-TB iyabiza kakhulu

futhi empeleni aseyabiza kakhulu eshumini leminyaka

eledlule.

2. Sidinga ukuxilongwa okungconoKaningi kungathatha amasonto ayisithupha ukuxilonga i-TB futhi ngisho kajana ukuxilonga i-DR-TB. Manje kunokuxilongwa okusha kwe-TB, umshini i-GeneXpert, oxilonga i-TB ngokungenaphutha emahoreni amabili. Kusiza futhi ukukhomba iziguli ezingazweli emuthini. INingizimu Afrika ithenge le mishini eminingana, kodwa kudingeka ukuthi sibe nowodwa kuyona yonke imitholampilo ye-TB enogesi. Kodwa-ke, ukuhlola nge-GeneXpert ngakunye kubiza ngaphezu kuka-R100. Kudingeka ukuthi sifake ingcindezi kumakhi, u-Cepheid, ukuthi ehlise inani lentengo.

3. Sidinga ukuthi uhlelo lwethu lwezempilo lusebenze kangconoImitholampilo ye-TB idinga ukunikezelwa kwemithi okuthembekile. Ukunikezela okuthembekile kuholela ekumelaneni nomuthi. Imitholampilo kufanele futhi ukuthi ibe nokulawulwa kwesifo okufanele. Abantu akufanele ukuthi bathole i-TB uma beya emtholampilo! Futhi, abasebenzi bezempilo kufanele balandelele umkhondo wabantu abaxhumana nabantu abane-TB bese ubacela ukuthi bahlungelwe i-TB.

4. Ukuvinjelwa kwe-TBUkwelashwa ngezidambisigciwane kunciphisa ingozi ye-TB. Kunobufakazi obukhulayo, abukapheleli, ukuthi uma ufaka umuntu one-HIV ekwelashweni, umphakathi uyasizakala ngezinga eliphansana lezimo ze-TB ezintsha.

5. Umhlaba we-TB udinga ukushukunyiswaIngqungquthela yomhlaba elandelayo ye-TB izobanjelwa, futhi eFransi. Ngaphandle kweKapa, lapho eyake yabanjelwa khona eminyakeni eminingana eyadlula kudala, ayikabanjelwa ezindaweni ezinobunzima be-TB obuphezulu. Ngamanye amazwi, kwenzeka kude namakhaya eziguli ezine-TB nakodokotela be-TB abanolwazi kakhulu kanye nonesi. Ubushoshovu obuguquguqukayo babo bobabili iziguli kanye nabasebenzi bezempilo esibabonile ekuphenduleni ezidingweni ze-HIV okufanele ithunyelwe emhlabeni we-TB. Uma kufanele sithole imithi engcono, izinhlelo zokuxilonga kanye nezempilo ze-TB, sidinga umzabalazo omkhudlwana kanye nentukuthelo enkudlwana!

nguNathan Geffen, usikhwama we-TAC kanye nomhleli we-TBOnline.info

Umbiko womhleliIsith

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a

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WAMI WEMINYAKA

EMINE

UMZABALAZO

Iminyaka emine u-Xoliswa Harmans wazabalaza

nesifo sofuba i-TB kanye ne-TB engazweli emithini ye-TB . Uxoxela u-Mary-

Jane Matsolo indaba yakhe emangazayo.

Isithombe ngu-Chelsea Maclachlan.

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Emva kwemizamo eminingi ehlulekile, ngagcina ngihlangene no-Xolisa Harmans endlini encane yokuhlanganela emahhovisi e-Médecins Sans Frontières eKhayelitsha. Uma umbona okukuqala ubungeke uqagele ukuthi lo muntu wesifazane ozikhulumelayo oneminyaka engama-37 uke waba nomzabalazo omude kangaka wokuba ne-TB engazweli emithini eminingi (MDR-TB).

Wazalelwa e-Queenstown futhi uyilungu lesonto loFakazi BakaJehova, manje usehlala ku-Site C, eKhayelitsha. Evaleleke kuleliya hhovisi elincane u-Xoliswa uyangilandisa ngale minyaka emine yomzabalazo akawubekezelela ne-MDR-TB kanye ne-XDR-TB (i-TB emelana nomuthi kakhulu). Akusiso isithombe esiqhakazile.

UXoliswa waxilongwa okokuqala i-TB ngonyaka ka-2006 lapho eqala ukuba nezimpawu ezifana nokuncipha emzimbeni, ukukhwehlela, kanye nokujuluka ebusuku. Esimeni sakhe i-TB kwakuyisifo esibona intuba njengoba wayene-HIV futhi. Izinyanga eziyisithupha u-Xoliswa waphuza imithi yakhe ye-TB, kodwa ezinyangeni ezintathu ngemuva kokuba eyiqedile wayesalokhu engakaphili. Ihlombe lakhe langakwesokunxele lalivuvukele futhi kwakunesigaxa ekhwapheni lakhe. Wayesalokhu encipha emzimbeni.

Lapho u-Xoliswa ephindela eyokwenza okunye ukuhlolwa kwe-TB imiphumela yabuya ingenayo i-TB. Umndeni wakhe wanquma ukumthatha umphindisele e-Queenstown lapho ababezokwazi ukumnakekela khona. Ngesikhathi ese-Queenstowwn u-Xoliswa walaliswa esibhedlela e-Frere ukuze odokotela bamhlinze isigaxa esisekhwapheni lakhe, okwashiya imbobo enkulu. ngaleso sikhathi, ihlombe lakhe laliqhubeka nokuvuvukala.

Emva kokuhlinzwa u-Xoliswa kwakudingeka ukuthi athole imbangela yokuvuvukala kwakhe. Wabuyela eKapa wayeseya eSibhedlela i-Groote Schuur lapho akaphinde waxilongwa khona i-TB futhi. Kwakudingeka okunye ukwelashwa izinyanga eziyisithupha, kodwa manje ohlotsheni lwemithi yakhe kwabandakanywa izinyanga ezimbili zokujovwa nge-stretomycin zonke izinsuku. U-Xoliswa wachaza le mijovo njengezinto ezibuhlungu kakhulu ake zizwa. Zazishiya amagquma ezinqeni zakhe okwakufanele ukuthi azihlikihle.

Imiphumela yokuhlolwa kukaXoliswa yabuya ikhombisa ukuthi wayengazweli ku-rifafour naku-streptomycin. Lokhu kwakusho ukuthi manje wayesene-MDR-TB. Welashwa nge-kanamycin, umjovo zonke izinsuku izinyanga eziyisithupha.

“Ingxaki yaqala ngonyaka ka-2008, ngomhla ka-15 Okthoba. Asobe ngalukhohlwa lolo suku!” kusho u-Xoliswa lapho ecabanga izehlakalo ezenzeka.

“Ngangiyojova nge-kanamycin yami eyinjwayelo emtholmpilo i-Nolungile. Lapho ngifika, usista ophethe wangitshela ukuthi mangilinde ngaphandle kwamasango omtholampilo ngilinde i-ambulensi, ngaphandle kwananoma iyiphi incazelo ngalokho okwakwenzeka kimi nokuthi i-ambulensi yayingiyisaphi. Kwachazwa ngokuhamba kwesikhathi ... lapho ngifika e- Brooklyn Chest Hospital … ukuthi ngangine- XDR-TB. U-Dkt Swedu, owayesebenza ngalelo langa, wathi kimi, ‘Mama, sekukuwe-ke manje. Ukuthi ufuna ukuphila noma cha, kuncike kuwe konke.”

“Ngesikhathi [ngangisesibhedlela] abangane bami bangishiya kwathi nesoka enganginalo ngaleso sikhathi nalo langijikela langishiya. Kwakungumama wami kuphela [namanye] amalungu omndeni eza ukuzongibona. Kwakunzima kakhulu emndenini wami ukwamukela isimo sami manje, ngoba kwakufanele ngibashiye. Udadewethu wathuthela eKapa ukuze abe seduze nami angisize.

“Ngahlala e-Brooklyn Chest Hospital ngazitshela ukuthi ngangizophuza imithi yami ngilwe nalesi sifo ngisho ngabe kwakunzima,” kuqhubeka uXoliswa. “... Eminye yemiphumela emibi yemithi kwakuyisifo sohudo esinamandla ngokweqile esaholela ekuncipheni komzimba, nokucanuzela kwenhliziyo okungabekezeleki, ukubala okumbalwa.”

“Ngaphuma esibhedlela ngaqhubeka nemithi yami emtholampilo iNolungile futhi, kodwa kulokhu kwakufanele ukuthi ngicophelele kakhulu [uku] gqoka imaski evala umlomo namakhala ukuze ngingadluliseli i-TB kwabanye abantu noma ngiyithole kwabanye abantu. Lapho ngingena ngaphakathi etekisini ngabona ukuthi akukho mafasitela ayevuliwe, ngangizocela abagibeli ukuthi bavule okungenani ifasitela elilodwa kanti uma bala ngangizovele ngifake imaski yami. Ngangikhumbula amagama ka-Dkt Swendu angenza ngaqina. Lapho ngibuyela emtholampilo ngisho amalungu eqembu lami [lo]kusizana ayengesaba.

“Ngomhla ka-20 Okthoba 2010 ngaxilongwa kwathiwa ekugcineni angisenayo i-TB futhi ngakhishwa emtholampilo iNolungile. Ngangiyinqobile i-TB ekugcineni, emva kweminyaka yomzabalazo emine. Yhu! Kwakungakholakali. Kwakunesikhathi lapho engangicabanga khona ukuthi ngangifa kodwa ngokubekezela kwaba nomvuzo.”

U-Xoliswa waxilongwa i-TB ngonyaka ka-2006 lapho eqala ukuba ezimpawu zesifo ezifana nokuncipha emzimbeni, ukukhwehlela kanye nokujuluka ebusuku.

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“Uma ukubaluleka kwesifo kubantu kukalwa ngenamba yokufa esikubangile, isifo sofuba-ke kufanele sithathwe njengesibaluleke kakhulu kunazo zonke lezo ezesatshwayo, ubhubhane, ikholera nezinye ezifana nazo. Oyedwa kubantu abayisikhombisa kubona bonke abantu ubulawa yisifo sofuba.” - Robert Koch

Odokotela ababili baseJalimani, u-Franz

Ziehl no-Friedrich Neelsen, benza indlela

yokuxilonga i-TB ngaphansi kwemayikhroskophu. Indlela yabo, ibizwa

ngokuthi i-acid-fast stain, isasetshenziswa ukuxilonga

i-TB.

Ngeminyaka yo-1890

U-Albert Schatz, isitshudeni seziqu ze-PhD saseMelika,

sehlukanisa i-streptomycin.

1943

U-Swede Jörgen Lehmann uthola i-para-aminosalicylic acid (PAS), manje

esetshenziswa ekwelashweni kwe-TB engazweli emithini eminingi (MDR-TB).

1944

Umphumela wokulwa ne-TB we-isoniazid

utholwe ngabacwaningi kubandakanya usosayensi waseJalimani u-Gerhard

Domagk.

1952

Iqembu labacwaningo lase-Italy lenza umuthi

omusha obizwa ngokuthi i-rifampicin

(RIF).

1959

“Ngaletha ungcweti kwezesifuba lapha. Uthi kufanele ngingene esanathoriyamu, mhlawumbe izinyanga ezi-4. Kunesizungu esibi, kodwa-ke mhlawumbe kungcono kakhulu uma bengakwazi ukungelapha.” u-George Orwell, umbhali wamanoveli kanye nombhali wezepolitiki. U-Orwell wabulawa yi-TB ngo-1950. Wayengomunye weziguli zokuqala ukuzama i- streptomycin ne-PAS.

Ngemuva kokuqhubeka kweminyaka engama-20

eyandulela, iminyaka yo-1960 ingumaka omkhulu ekulweni ne-TB. Abantu banethembe lokuthi isifo singanqotshwa.

“Ukuba nganginesifo sofuba... lo mqondo, obewethusa ngaphambilini, awusaqhqhazelisi muntu ... sekuvele ama-antibhayothiki, isanathotiyamu yanyamalala; ngokucabanga komphakathi … isifo sesinqotshiwe.” – Umsebenzi ovela ku-International Union Against Tuberculosis, 1962. Njengoba ecashuniwe ngonyaka ka-1964 ngu-Salman Waksman, ingxenye yethimba eyathola i-streptomycin.

I-TB ngesikhathi esedlule sobumnyamaUbufakazi obudala be-TB i-hominid eyayisigamu sesigidi seminyaka ubudala esatholakala njengenkwali yamatshe eNtshonalanga ne-Turkey. Inezingozi ogebhezini lekhanda elikhombisa isifo se-TB.

Ukwenzeka kwe-TB kwakudadlana okwaqinisekiswa ukuhlaziywa kwezakhi zofuzo kuvela ezinsaleleni zeminyaka yobudala engu-18,000 we-bison eseyaphela eNyakatho Melika.

Izimo eziqinisekisiwe ezindala kakhulu ze-TB kubantu zatholakala ezinsaleleni zohlaka lwamathambo omama nosana lwakhe endaweni eyayicwilile ngaphambi komlando kwa-Israyeli. Ithimba lezesayensi lakhipha i-DNA yabhaktheriya emathanjeni eyaqondana nezinsalela ze-DNA yesifo sofuba i-Mycobacterium.

I-TB kwakuyisifo esijwayelekile eGibhithe yakudala. I-DNA ye-TB yatholakala ohlakeni lwamathambo oluyiminyaka yobudala engu-5,400 futhi nasezidunjini ezigciniwe eGibhithe ezibhekelwa ukusuka ngeminyaka yawo-2050 BC.

Qal

a la

pha

Izithombe zitholakale ku-Wikimedia Commons. Isithombe se- GeneXpert ngu-Elizabeth Mills.

Ngeminyak - Ngeminyaka

yo-1960

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U-Hippocrates, othathwa njengomuntu

owasungula imithi yasentshonalanga,

uchaza i-TB njengesifo esijwayeleke kakhulu

sesikhathi sakhe.

500 BC Ukuqubuka kwamadolobhakazi ehambisana

nezimo ezimbi zokuhlala kuholela ekukhuleni kwezifo eziphathelene ne-TB

nokufa. Kula makhuluminyaka alandelayo, ukubuswa ngamanye amazwe kanye nokuqalwa kwezimboni nakho kwaba

nesandla ekusabalaleni kwe-TB.

Ama-Middle ages

1546

IRiphabhliki yase-Lucca (ingxenye yase-Italy) iphasisa

umthetho obeka ngempoqo izindlela zokulawula isifo se-TB eziqinile. Ukuhlolwa kwemizimba

emva kokufa kuyadingeka, ukuvumela ukuthi umoya omusha

udlule kuthathwa njengomsebenzi, kanti iziguli ziyakhuthazwa ukuthi zingakhiphi

izikhwehlela ngaphande kwasengilazini noma kuveseli. IRiphabhliki futhi igcizelela ukugezwa

kwezinto zokusebenza kanye nezinto zokulala okusetshenziswa abantu abane-TB.

1699

Udokotela waseFransi

u-Jean-Antoine Villemin ufakazela

ukuthi i-TB iyathathelwana.

1868U-Robert Koch,

udokotela waseJalimani,

umemezela ukuthi isifo sofuba

i-Mycobacterium iyimbangela

ye-TB.

1882

Lapho i-HIV isabalalela emhlabeni osathuthuka,

abantu abaningi baba ne-TB. Ukucabanga okuhle kweminyaka yo-1960 into

yesikhathi esidlulile njengoba i-TB iba yimbangela yokuqala

yokufa phakathi kwabantu abane-HIV eNingizimu Afrika.

Iminyaka yo-1990

Kuqubuka i-MDR-TB e-New York

City. Ukubheduka kususa izinhlansi

zentshisekelo ocwaningweni

lwe-TB.

1991 – 1992 Kwenzwa izihloko

ezihamba phambili njengoba iziguli

ze-DR-TB zibaleka kumawodi

okuhlukaniswa ngempoqo

ezibhedlela ze-TB eNingizimu Afrika.

2008 Abacwaningi babika okutholakele okuhle ngomuthi omusha obizwa ngokuthi

i-TMC207 yokwelapha i-MDR-TB. Eminye

imithi emisha ye-TB kanye nokwakhiwa

osekwenziwe ngcono kwemithi emidala

nakho kusendleleni.

2009

Ukuhlola okusha kwe-TB okubizwa nge-GeneXpert kungenisiwe eNigizimu

Afrika, kwehlisa kakhulu isikhathi sokuhlolela

i-TB.

2011

“Izimpawu zesifo zikanje: kunemfiva engabonakali, ngokujwayelekile iqala uma sekuya emphethelweni osuku futhi iba ngcono ngokufika kosuku olusha; lokhu kuphelekezelwa ukukhwehlela kakhulu ekuqaleni nasekupheleni kobusuku, nokukhishwa kwesikhwehlela...Izwi kungenzeka lihhadlazele noma linswininize liye phezulu, ukuphefumula kunzima, izihlathi ziphaphathekile bese kuthi umzimba wonke. Amehlo anokubukeka okukhathele, kanti isiguli sikhathele ... Kwezinye izimo kunomsindo oswebezayo noma ogohhozayo esifubeni...” U-Caelius Aurelianus, udokotela waseRoma, echaza i-TB ekhulwininyaka lesi-5 AD.

Isifo sofuba (TB) beyaziwa ngamagama amaningi iminyaka ngeminyaka: idliso, i-phthisis, i-scrofula, isifo sika-Pott, Inkosi yezifo kanye nesifo esimhlophe (noma ubhubhane olumhlophe).

Udokotela wase-Italy u-Girolamo Fracastoro

waphawula ukuthi i-TB iyathathelwana. Umbhalo

wakhe uphakamisa ukuthi ukuqonda ukuthi

i-TB ibangwa ama-ejenti athathelwanayo

amancane aphila emzimbeni.

5

I-TB N

GALE

SO

SIKH

ATHI

NAMA

NJE

6

TB/HIV izifo ezihlangeneAbantu abane-HIV

MDR-TB

XDR-TB

Abaxilongwe ne-TB

njengamanje

Abantu baseNingizimu

Afrika sebebonke49,004,031

5,600,000

490,000

58%HIV+

TB

INingizimu Afrika inezehlakalo eziphezulu kunazo zonke ze-TB emhlabeni, emva kweNdiya neShayina.

Indiya IShayina INingizimu Afrika

Ukuvama

Isehlakalo Izinga Lokutheleleka

9,070

594

TB 340,066 izimo ezintsha ze-TB 65,916 abelashwayo

Umuntu ongelashiwe one-TB ephilayo ingasisabalalisa isifo cishe ukufika kubantu abayi-15 ngonyaka.

Ukwelashwa

MDR-TB

Izinsuku njengesiguli esisesibhedlela

Ukuvakasha njengesiguli esigulela ngaphandle

TB1 1 2 3 4 5 6 7

1 2 3 4 5 6 78 9 10 11 12 13 14

IzindlekoUkwelashwa kwe-TB

Ukwelashwa kwe-MDR-TB R181,600

TB hospital

Imithombo: World Health Organization. 2010 Global Tuberculosis Control Report.

World Health Organization. 2010 Tuberculosis Country Profiles: South Africa.

Bangaki abantu abane-TB?

R1,680

1724

31

38

45

52

59

1623

30

37

44

51

58

1522

29

36

43

50

57

1825

32

39

46

53

60

1926

33

40

47

54

61

2027

34

41

48

55

62

2128

35

42

49

56

63

6673

808794

6572

798693

6471

788592

6774

818895

6875

8289

6976

8390

7077

8491

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15

22

16

23

17

24

18 19 20 21

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kuthathelana ukufika emasontweni ayishumi (isibonelo ematheni omile). Ibhaktheriya lingamela izihlanzi ezinamandla kakhulu futhi kaningi lihlala lisesimeni salo sokulala. Lidinga i-oksijini ukuze liphile – ngakho-ke libizwa ngokuthi ibhaktheriya elidinga umoya (aerobic bacterium).

Isifo sofuba i-mycobacterium sikhula kancane, siziphinda ngokuzalana njalo emahoreni angama-24 ukuya kuma-48. Kuncane kakhulu lokhu kubhaktheriya. Amanye amabhaktheriya angazalana njalo emizuzwini engama-20.

Linomzimba omise kwensimbi cishe ubude obungamamilimitha angu-0.2, obungeze babonwa ngamehlo enyama – kuphela ngaphansi kwemakhroskophu. Umzimba weseli uzungezwe udonga lwamaseli aqine ngokungajwayelekile nokuyindida. Lolu donga lwamaseli lwenza ukuthi kube nzima kabi ukwelapha nokuxilonga i-TB.

ISAYENSI YE-TB

Yini i-TB?Akufani ne-HIV, isifo sofuba (TB) asibangwa igciwane. Asibhozomeli amaseli bese siwasebenzisa ukuzizalanisa ngendlela lelo gciwane elenza ngayo.

I-TB ibangwa wuhlobo lwebhaktheriya. Amabhaktheriya mancane kakhulu impela izinto eziphilayo ezineseli eyodwa. Sithola izinhlobo ezahlukene eziningi zamabhaktheriya emhlabathini, ekudleni, emizimbeni yethu, kanye nanoma yikuphi nje emhlabeni. Amningi amabhaktheriya asizungezile kanti emizimbeni yethu akukho monakalo awenzayo kanti amanye asilungele ngisho ukusilungela.

Ibhaktheriya elithize ngqo elibhekene nomsebenzi omkhulu kakhulu ku-TB yabantu libizwa ngokuthi i-Mycobacterium. Igama elithi mycobacterum (elisho ukuthi “fungus-bacteria”) lanikezwa ngoba la maseli uma esekhulile elabhorethri futhi uwahlola ngaphansi kwemakhroskophu abhekeka njenge-fangasi.

Isifo sofuba i-mycobacterium sibulawa ngokushesha ukubekeka engozini yelanga eliyihlaba ngqo. Uma kuvikelekile ekushiseni kwelanga, kuhlala kuphila futhi

I-TB kaningi isabalala uma omunye umuntu ekhwehlela. Vala umlomo wakho kanye nekhala lapho ukhwehlela futhi ubuso bakho ububhekise eceleni uma kukhona umuntu okhwehlelayo eduze kwakho.

Ilungu le-TAC uSizwe Nguqe ugqoka imaski lapho evolontiya emtholampilo Ubuntu eKhayelitsha. Isithombe ngu-Chelsea Maclachlan.

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I-Bronchiole

I-Alveoli

Uma uhogela ibhaktheriya le-TB, asheshe adlule ngomlomo nekhala bese eya emaphashini. Aya kulokhu esikubiza ngokuthi i-bronchioli yokugcina kanye ne-alveoli yamaphaphu akho.

• Ama-terminal bronchhioli izingxenye ezincane kakhulu ze-bronchi, izakhiwo ezihola umoya osuka emigudwini yomoya phezulu (ikhala, umlomo noqhoqhoqho) uya kumathishu amaphaphu akho.

• Ama-alveoli yizingxenye zethishu yamaphaphu futhi kunezindawo lapho i-oksijini evela emoyeni idonswa khona idluliselwa egazini lakho futhi isiwe kwezinye izitho zomzimba eziwudingayo.

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Isigaba 1: Abavikeli be-Macrophage bahlasela i-TB

Isigaba sokuqala senzeka esontweni lokuqala uhogele ibhaktheriya le-TB. Uma ibhaktheriya lifika ku-alveoli yamaphaphu akho, ligwinywa amaseli akhethekile ohlelo lokuvimbela amagciwane olubizwa ngokuthi ama-macrophage. La ma-macrophage avamise ukutholakala kuthishu ye-elveoli, umsebenzi wawo ukugwinya nokuyekisa

Uma kunamabhaktheriya amaningi kakhulu e-TB, noma uma i-microphanage angaqinile ngokwanele ukumelana nayo, i-TB ingazalana ngaphakathi ku-microphage. Lokhu kuholela ekucekelweni phansi kwemicrophage kanye nesifo sokunye, ama-macrophage aseduze agwinya amabhaktheriya.

Isigaba 4: Isizinda sezempi se-TB

Cishe esimeni esisodwa ezimeni ezingama-20 , iphaphu aliphili ngokufanele futhi i-TB iphinde ivuseleleke emva kwezinyanga eziyi-12 ukuya kwezingama-24 kulandela ukutheleleka kokuqala. Isifo sofuba i-Mycobacterium esiphinde yavuka izalana ngokushesha futhi yakha umgodi kuthishu yephaphu, lapho izivikeli mzimba zomzimba wakho zingeke zikwazi ukufinyelela kubhaktheriya.

Isigaba 2: I-TB ifike yakhe ephashini lakho

Uma ama-macrophage engakwazi ukulawula i-TB, isifo sakho singena esigabeni sesibili emva cishe kwesonto, lapho amabhaktheriya ephindaphindeka ngokushesha okukhulu. Lesi sigaba sihlala kuze kube yisonto lesithathu emva kokutheleleka kokuqala.

Emva cishe kwesonto lesithathu, umzimba wakho uletha amaseli ezivikeli mzimba amaningi kanye nesifo sofuba i-Mycobacteriyamu kuvamise ukuyeka ukuphindaphindeka ngokushesha. Kulesi sigaba ama-macrophage kanye ne-TB ngokujwayelekilee kufinyelela kubhalansi futhi isifo siba ngaphansi kolawulo. Okungenani kubantu abayisishiyagalolunye kwabayishumi isifo siyama lapha futhi ayibi i-TB ephilayo.

Ngisho ngabe isifo sakho silawulekile, enye i-TB ingaphila iminyaka ngaphakathi kwama-macrophage. La

1

4

2

Ukusuka lapha, i-TB isheshe isabalale futhi ihlasele umzimba wakho bese uba nezimpawu kanye nezimpawu zesifo se-TB ephilayo njengokukhwehlela. Kulesi sigaba, uthelelana kakhulu ngoba isikhwehlela sakho (amafinyila owakhwehlelayo esuka emphinjeni wakho) anamabhaktheriya e-TB aphilayo. Ukuphinde aphile futhi kungenzeka uma izivikeli mzimba zakho zibuthaka, isibonelo zenziwa ukutheleleka nge-HIV noma indlala.

ma-macrophage athelelekile avalelekile ephashini lakho lonke ngodonga lwama-macrophage aphilile. Kulesi sigaba awathelelani, ngenxa yokuthi ama-macrophage angeke angene emigudwini yomoya wakho futhi angeke ukhwehlele ukhiphele ngaphandle noma uphefumulele ngaphandle. Uma izivimbeli mzimba zakho ziqinile , iphaphu liyaphila kusale kuphela imbobo kanye nesibazi kuthishu. Lesi sibazi ngokuhamba kwesikhathi singabonwa ku-X-reyi futhi siwuphawu lokuthi uke watheleleka ngesifo sofuba i-Mycobacterium.

Isigaba 3: Izivimbeli mzimba ziyalwa

Izigaba ezine zokutheleleka

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I-Pulmonary TB (i-TB yamaphaphu)• Ukukhwehlela amasonto amabili

noma ngaphezulu

• Ukukhwehlela uketshezi oluqinile noma igazi

• Uhlevane, imfiva kanye nokujuluka ebusuku

• Ukuncipha komzimba kanye nokungathandi ukudla

• Ubuhlungu besifuba kanye nobunzima bokuphefumula

I-Extra-pulmonary TB (i-TB eyenzeka ngaphandle kwamaphaphu)• Ubuhlungu noma ukuvuvukala

kwesisu

• Ubuhlungu noma igazi uma uchama

• Imfiva, ukucanuzela kwenhliziyo

• Ukuqaqamba nezinhlungu emgogodleni noma emajoyintini

• Izinkinga zokuzala

! Izimpawu zesifo se-TB

Hlolelwa i-TBUma uba nezimpawu ezingenhla kufanele ucele ukuhlolelwa i-TB emtholampilo. Uma une-HIV, usengozini enkulu ephezulu kakhulu yokuba ne-TB futhi kufanele uzame ukuthi uhlolwe ngokuvamile kangangokuba kungenzeka.

Indlela enkulu yokuhlolelwa i-TB ukuthatha isikhwehlela (amathe akhwehlelwe evela emphinjeni) futhi uyihlolele namagciwane e-TB. Ukuhlolwa kuzobuya lokho okuthathiwe kungenayo noma kubuye kunayo.

Ukuhlolwa okuthi unayo kusho ukuthi kunokutheleleka nge-TB emaphashini akho futhi kufanele uqale ukwelashwa ngokushesha.

Ukuhlolwa okuthi awunayo kusho ukuthi kungenzeka ukuthi awunayo i-TB. Kodwa-ke, abantu abaningi abane-HIV

bahlolwa bangabi nayo, yize besenayo i-TB ephilayo.

Uma une-HIV futhi unezimpawu zesifo se-TB kodwa ekuhlolweni kwe-TB ungenayo,

kunokunye ukuhlola okungenziwa umtholampilo wakho ukubona ukuthi ingabe unayo ngempela yini i-TB ephilayo. I-X-reyi yesifuba ingasiza ukukuxilonga. Futhi, ungenza nalokhu abakubiza ukuhlolwa kohlobo lwamabhaktheriya

e-TB, kodwa kuthatha amasonto ambalwa ukuletha umphumela. (Bheka ikhasi 20-21

ngokunye ukuhlolwa kwe-TB).

Yelashwa kanjani i-HIV ne-TB ndawonyeUkuba ne-HIV ngokushesha kwandisa ingozi yokuba ne-TB ephilayo. ENingizimu Afrika balinganiselwa kuma-58% abantu abane-TB ephilayo futhi bane-HIV. I-TB futhi ingumbulali wabantu abane-HIV ohamba phambili.

Ukwelapha i-TB kanye ne-HIV kanye kanye ngezinye izikhathi kungaba nzima kakhulu. Njengoba ama-ARV esiza izivikeli mzimba ukuthi zisinde, izivikeli mzimba ziqala ukulwa ne-TB. Lokhu kubizwa ngokuthi i-IRIS ((Immune Reconstitution Inflammatory Syndrome). Kungenzeka ukuthi iziguli zizizwe zigula kakhulu impela futhi kuyingozi. Ngenhlanhla, ucwaningo eminyakeni yakamuva lukucacisile ukuthi kukusiphi isigaba lapho kufanele kunikezwe khona imithi ethize.

• Uma unesibalo se-CD4 esingaphansi kwama-350 futhi uxilongwe i-TB, kufanele ukuthi ufakwe ekwelashweni kwe-TB ngokushesha. Kufanele uqale ukwelashwa i-HIV ngokushesha lapho kuphela isigaba esibi kakhulu se-TB – izinyanga ezimbili zokuqala –ziphelile.

• Uma isibalo sakho se-CD4 siphansi kakhulu – isibonelo, ngaphansi kwama-50 – kufanele ufakwe kukho kokubili ukwelashwa kwe-HIV kanye nokwe-TB ngokushesha.

Umzimba wakho uzilwela kanjani• Uma ngabe izivikeli mzimba zomzimba wakho ziqinile,

ziyakwazi ukugcina amabhaktheriya futhi ukutheleleka akusabalaleli phambili. Lokhu kubizwa nge-TB elele noma i-TB ebalulekile engenazimpawu (izigaba 1 ukuya ku-3).

• Uma izivikeli mzimba zakho zibuthaka, angeke zikwazi ukugcina amabhaktheriya e-TB, asheshe asabalale. Uba nezimpawu bese ugula. Lokhu kubizwa ngokuthi i-TB ephilayo noma i-TB ebalulekile eqhubekayo (izigaba 1 ukuya ku-3, kodwa ngaphandle kokulawulwa kokugcina ngaphezu kwesigaba sesi-3 se-TB).

• Uma izivikeli mzimba zakho ziqinile ekuqaleni futhi zikwazi ukugcina amabhaktheriya e-TB, kodwa ngokulandelayo ababuthaka ungabe usakwazi ukuwalawula, amabhaktheriya aqala angene esimeni sokulala kodwa aphinde avuseleleke futhi bese eqala ukusabalala kanzima (isigaba 4). Lokhu kubizwa nge-TB yesibili noma i-TB ephinde yavuselelwa. Ingavuswa futhi ukutheleleka okusha namabhaktheriya e-TB, okuholela ekuvuseleleni futhi ukutheleleka kokuqala.

I-TB ingelapheka!

I-TB ivamise ukudinga ukwelashwa izinyanga eziyisithupha. Kubalulekile

ukuhlala uphuza imithi yakho izinyanga eziyisithupha ezigcwele, ngisho ngabe usuzizwa ungcono. Uma ushesha uyeka kungenzeka ugule noma ube nokungezweli emthini. Ngisho ngabe imiphumela emibi yokwelashelwa i-TB ingaba

mibi, imiphumela yokungayiphuzi imithi kungenzeka ibe mibi ngokwedlulele. (Bheka

ikhasi 12 ukuze uthole ulwazi oluthe xaxa ngokwelashwa kwe-TB).

Le athikili iguqulwe ngu-Marcus Low encwadini eshicilelwe ngu-Alex Muller kuwebhusayithi TBOnline.info.

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Kaningi kuyenzeka ukuthi abantu batheleleke nge-TB esivele ingasezweli emithini. Ukwethulwa kwezindlela ezingcono zokuyixilonga i-TB kuzosho ukuthi angeke unikezwe ukwelashwa osuvele ungazweli kukho. Noma ngabe kwenzekani, ithemba kuphela onalo ukusebenzisana kakhulu nodokotela wakho futhi uphuze imithi yakho ngendlela eshiwo.

Yini i-MDR-ne-XDR-TB?• Umaungazwelikuyoyomibiliimithiemibili

elwa ne-TB yomugqa wokuqala enamandla kakhulu, i-isoniazid (INH) ne-rifampicin (RIF), une-TB engazweli emithini eminingi (MDR-TB)

• Umaungazwelikunanomayimiphiimithiekilasini le- fluoroquinolone (isibonelo i-ciprofloxacin noma i-moxifloxacin), kanye okungenani owodwa kwemithathu yemithi yomugqa wesibili ejovwayo (capreomycin, kanamycin, ne- amikacin), kusho ukuthi-ke une-TB engezweli ngokuphelele emithini (DR).

Zombili izimo ze-TB engazweli emthini kungenzeka zibulale. Okwamanje, iziguli ze-XDR-TB ikakhulukazi zisengozini ephezulu kakhulu yokufa. Sidinga ukuthi sibe lokhu sikhankasela ukwenziwa kwemithi emisha yokwelapha lezi zimo. (Bheka ikhasi 22-24 ukuze uthole ulwazi oluthe xaxa ngemithi ye-TB emisha).

Inkinga enkuluI-TB engazweli emthini iyinkinga enkulu kakhulu kunokuba kufanele ngenxa yokuphathwa okubi kwezinhlelo zokunakekelwa kwezempilo.

Ngonyaka ka-2008 kwakulinganiselwa ezehlakalweni ezintsha ezingu-440,000 ze-MDR-TB emhlabeni wonke jikelele, uma kuqhathaniswa no-511,000 ngonyaka ka-2007, ngokwe-World Health Organization. I-MDR-TB iphendulela ngaphansi kwama-5% ezehlakalo ze-TB emhlabeni jikelele. Cishe ama-5% okutheleleka nge-MDR-TB aqhubekela ku-XDR-TB. Kodwa-ke, kubalulekile ukwazi ukuthi ngenxa yokungabikwa kahle okubi kakhulu kwezehlakalo ze-MDR ne-XDR-TB, izinamba ezingenhla ngezokulinganisela nje kuphela. Eqinisweni, ngaphansi kwama-10% azo zonke izifo zixolongwa ngempela.

Uhlelo Lwamazwe Omhlaba Jikelele lokuQeda i-TB luhlambekisela ukuthi phakathi kuka-201 no-2015, izehlakalo eziyizigidi ezingu-1.3 ze-MDR ne-XDR –TB zizodinga ukwelashwa emazweni angama-27 anesehlakalo esiphezulu kakhulu sokungazweli kwe-TB emthini, kubandakanya iNingizimu Afrika. Lokhu kwelashwa kuzoba nenani lentengo eliyizigidi gidi ezingu- US$16.2.

I-TB ENGEZWELI EMITHINIEzimeni eziningi kakhulu, uma uphuza imithi ye-TB izinyanga eziyisithupha ezigcwele njengoba kushiwo, i-TB izokwelapheka. Kodwa-ke, uma uphuza imithi njengoba kudingeka, uma umtholampilo uphelelwa yimithi, noma uyeka ukuyiphuza ngenxa yemiphumela emibi, i-TB emzimbeni wakho kungenzeka ukuthi ingezweli emthini futhi imithi kungenzeka ingasasebenzi. Uma lokhu kwenzeka, kuzofuneka uqale usebenzise imithi emisha nebiza kakhulu enemiphumela emibi engaphathani kahle nhlobo.

Le athikili iguqulwe ngu-Marcus Low encwadini eshicilelwe ngu-Alex Muller no-Kay Kim kuwebhusayithi TBOnline.info.

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I-TB Yamaphaphu (Pulmonary TB)I-Pulmonary TB i-TB yamaphaphu. Iwuhlobo lwe-TB olujwayeleke kakhulu njengoba ukutheleleka kwenzeka uma uhogela ibhaktheriya iya ephashini. (Funda ngezimpawu ze-TB yamaphaphu ekhasini 9).

I-Extrapulmonary TB (Izinhlobo zonke ze-TB)I-Extrapulmonary TB itemu eliyisambulela sazo zonke izinhlobo zesifo se-TB ezingenzeka ngaphandle kwamaphaphu. I-TB ingathelela cishe nanoma yisiphi isitho somzimba wakho, kodwa ezinye izitho njengama-lymph node kanye nohlelo lwemizwa olukhulu (ubuchopho nomgogodla) kutheleleka kakhulu ngokujwayelekile.

I-Pleural TB (I-TB Yolwelwesi oluphatha amaphaphu)I-pleura isikhumba esincane esiwulwelwesi olukekelezele amaphaphu bese luwehlukanisa odongeni lomgodi wesifuba. Lunezingqimba ezimbili; olulodwa lunamathele emaphashini kanti olunye odongeni lwesifuba. Kunesikhala esincane phakathi kwalezi zingqimba lapho amabhaktheriya e-TB angaqoqelana khona azalane. Ngenxa yalokhu, indawo iyavuvukala futhi uma uthelelekile uzoba nemfiva futhi ube

nobuhlungu lapho uphefumula. Lokhu kuvuvukala kwenza ukuthi i-pleura ikhiphe uketshezi, oluma phakathi kwezingqimba ezimbili. Lolu ketshezi lubizwa ngokuthi i-pleuura effusion (umgudu odlula uketshezi olubangwa ukuvuvukala lungene emzimbeni). Ukuxilonga i-pleura TB, umsebenzi wezempilo kufanele athathe isampula le-pleural effusion fluid ayoluhlolela i-TB. Lokhu kwenziwa ngokufaka inalithi idlule odongeni lwesifuba iye esikhaleni esiphakathi kwezingqimba ze-pleura nokuthatha uketshezi oluncane.

Uhlelo lwakho lwemizwa olukhulu lwakhiwa ubuchopho kanye nomgogodla. i-TB ingathelela kokubili, futhi kaningi kakhulu lokhu kwenza imenenjayithisi ye-TB – isifo solwelwesi oluncane olwemboze ubuchopho. Izimpawu zincike ekutheni ubuchopho bakho bushaya ngakuphi. ngokuvamile abantu abanemenenjayithisi ye-TB balala kakhulu. Abezweli ngokujwayelekile, abakwazi ukunyakazisa izandla zabo noma izinyawo noma bahambe, futhi angeke bakwazi ukukhuluma noma ukugxilisa amehlo abo. Imenenjayithisi ye-TB iyingozi futhi kunzima ukuyelapha. Ukuyixilonga, abaqeqeshelwe ezempilo kufanele benze i-lumbar puncture. Lokhu kubandakanya ukufaka inalithi emgogodleni ukuze kufinyelelwe oketshezini olusemgogodleni, oluxhumene nobuchopho bakho, ukuthola ukuthi ingabe akhona yini amabhaktheriya kulolo ketshezi. Uketshezi lubizwa ngokuthi uketshezi lomgogodla olubalulekile (central spinal fluid, noma i-CSF).

I-TB yethambo noma yejoyinti I-TB ingathelela futhi amathambo noma amajoyinti. Lokhu kubanga ubuhlungu nokuvuvukala kwendawo ethintekile. Kaningi kakhulu abantu abacabangi ukuthi izimpawu zabo zibangwa yi-TB, kodwa ngengozi, noma okunye ukulimala. Ukuxilonga i-TB yethambo noma yejoyinti, abaqeqeshelwe ezempilo kufanele bathathe

i-X-reyi, futhi kaningi basebenzisa izindlela eziyindida kakhulu zama-X-reyi ezifana nama-CT scan (computer tomographic scans) noma ama-MRI (magnetic resonance imaging). Njengezinye izinhlobo ze-TB engaphandle kweyamaphaphu, isampula elincane lamabhaktheriya e-TB kufanele akhishwe ethanjeni noma ejoyintini kusetshenziswa inalithi.

I-TB ohlelweni lwemizwa olukhulu nemenenjayithisi ye-TB

I-TB ye-Lymph nodeLolu uhlobo oluvamise kakhulu lwe-TB engaphandle kwasemaphashini. I-TB kaningi ithelela ama-lymph node entanyeni nangaphezu kwama-clavicle (amathambo amancane ngezansi kwamahlombe akho), abe esevuvukala bese kuthi isikhumba esiwazungezile sivuvukale. Nanoma yiyiphi i-lymph node emzimbeni wakho

ingatheleleka. Kaningi ama-lymph node avuvukele abanga ezinye izinkinga ngenxa yobukhulu bawo. Ukuxilonga i-TB yama-lymph node, umsebenzi wezempilo uthatha isampula le-node ethelelekile. Lokhu kusho ukuthi kufanele ahlabe i-lymph node ngesirinji bese ethatha amaseli ambalwa ukuze awahlole ngaphansi kwemakhroskophu.

Isithombe ngu-Chelsea Maclachlan. 11

ISAY

ENSI

YE-T

B

Imithi ye-TB

Yazi imithi yakho ye-TB

Imithi ye-MDR-TB

Imithi ye-TB Izakhiwo ezikhona Imiphumela emibiRifampicin (R)

150 mg R0.58 R1.29450 mg R1.05600 mg R0.89R (60 mg)/ H (60 mg) [paed] R0.99R (300 mg)/ H (150 mg) R0.71 R1.01R (150 mg)/ H (75 mg) R0.41R (150 mg)/ E (275 mg)/ H (75 mg)/ Z (400 mg) R0.47 R0.73

Ukucanuzela kwenhliziyo, ukuhlanza, ubuhlungu besisu, nezimpawu ezifana nezeflu. I-Rifampicin kungenzeka yenze umbala Kokukhishwa umzimba (izinyembezi umjuluko, isidoda kanye nomchamo) owolintshi noma obomvu. I-Hepatitis ingumphumela omubi ongajwayelekile.

Isoniazid (H) 100mg R0.08300 mg R0.49 R0.66

Imfiva, ukuqubuka, i-peripheral neuropathy, i-neurotoxicity (ukulimala kwethishu yemizwa) kanye ne-hepatoxicity (ukulimala kwesibindi). Imiphumela emibi engajwayelekile ibandakanya ukugula ngengqondo, ijondisi kanye nokugoqana komzimba.

Ethambutol (E)

100mg R0.37 400mg R0.44

Ukucanuzela kwenhliziyo, ikhanda elibuhlungu, isiyezi kanye nomonakalo ekuboneni.

Pyrazinamide (P)

Ukucanuzela kwenhliziyo, ukuhlanza, ubuhlungu emajoyintini nejondisi.

Streptomycin (S)

S (1 gm/3ml) R8.10 Ukulahlekelwa ukuzwa, ukulimala kwezinso, isiyezi, kuxhumanisa izinto okonakele, ukuqubuka, imfiva, izifo zeyisti kanye nenkwethu yomlomo.

Iziguli ezingazweli ku-rifampicin ne-isoniazid zinesifo sofuba sokungazweli emithini eminingi (MDR). Imithi ye-MDR-TB inemiphumela emibi kakhulu impela. Ukuphuza imithi ye-TB engenhla njengoba kushiwo kuzonciphisa amathuba okudinga imithi ye-MDR-TB ekhonjiswe ngenhla.

Umuthi we-MDR-TB

Umthamo ngeyunithi ngayinye Imiphumela emibi

Kanamycin (Km)

1 gm / 3 ml ibhodlela R17.00

Ukonakala kwezinso, ukulahlekelwa ukuzwa, isiyezi, yonke imizwa (ukonakala kuzo zonke izingxenye zemizwa), ubuhlungu endaweni okujovwe kuyo kanye nokuqubuka.

Amikacin (Am)

100 mg R17.79 Ukonakala kwezinso, ukulahlekelwa ukuzwa, isiyezi, yonke imizwa, ubuhlungu endaweni okujovwe kuyo, ukuqubuka, i-hypokalaemia (iphotheziyamu ephansi egazini) kanye ne- hypomagnesaemia (imagneziyamu ephansi egazini).250 mg R34.43

500 mg R50.571000 mg R78.98

Capreomycin (Cm)

1 g R82.91 R120.00 Ukonakala kwezinso, ukulahlekelwa ukuzwa, i- hypokalaemia (iphotheziyamu ephansi egazini), ukuqubuka, kanye nobuhlungu endaweni okujovwe kuyo.

Moxifloxacin (Mfx)

400 mg R3.87 R18.87 Ukucanuzela kwenhliziyo, isifo sohudo, ingxaki yokulala, isiyezi, izifo ezibangwa yiyisti kanye nokuzwela ekukhanyeni. Imiphumela emibi engavamile ebandakanya ukulimala/ukudabuka komsipha.

Levofloxacin (Lfx)

250 mg R12.62 Ukucanuzela kwenhliziyo, isifo sohudo, ingxaki yokulala, isiyezi nokuzwela ekukhanyeni. Imiphumela emibi engavamile ebandakanya yonke imizwa kanye nokudabuka komsipha.500 mg R19.98

Ofloxacin (Ofx)

200 mg R8.61 Ukucanuzela kwenhliziyo, ukuhlanza, ikhanda elibuhlungu, i-malaise (umuzwa ojwayelekile wokuzizwa ungaphilile kahle), i-insomia (ukungafikelwa ubuthongo), isiyezi kanye nokuzwela ekukhanyeni. Imiphumela emibi engavamile kubandakanya ukudabuka komsipha kanye nezinzwa zonke zomzimba.400 mg R16.86

Ethionamide (Eto)

250 mg R1.45 R1.69 Ukucanuzela kwenhliziyo, ukuhlanza, isiyezi kanye nokukhathala kwengqondo. Imiphumela emibi engavamile ebandakanya ijondisi, ukudangala, i-peripheral neuritis (ukunsonsotha kwezandla nezinyawo) kanjalo nokuphazamiseka kokubona.

Prothionamide (Pto)

Ukucanuzela kwenhliziyo, ukuhlanza, ukudangala, ukuhhema, ijondisi, ukuphazamiseka kokuya esikhathini kanye nokonokala kwezinzwa zonke.

Cycloserine (Cs)

Ubuhlungu bekhanda obungapheli, isiyezi, amaphupho amabi, ihala, ukuhhema, ukudideka nokuphazamiseka kokulala. I-cycloserine kufanele isheshe imiswe uma isiguli sifuna ukuzibulala noma silahlekelwa ingqondo. Eminye imiphumela emibi ibandakanya ukuqubuka, ukonakala kwezinzwa zonke, ijondisi kanye nokuphazamiseka kokubona.

Terizidone (Trd)

250 mg R6.43 R13.59 Ukudangala, ixhala, ukuhlaselwa ukwesaba, isifo sengqondo, ukuhhema, i-paranoia (ukugula ngengqondo kodwa okuhlukile ekuhhemeni), isiyezi, ukukhuluma okungaqondile kanye nokugoqana komzimba. I-terizidone kufanele imiswe ngokushesha uma isiguli sifuna ukuzibulala noma sigula ngengqondo. Eminye imiphumela emibi ibandakanya ukucanuzela kwenhliziyo, ukuhlanza kanye nama-aleji yesikhumba.

Para-aminosalicylic acid (PAS)

Ukucanuzela kwenhliziyo, isifo sohudo, ukukhathala kwengqondo, i-hepatitis, i-hypothyroidism (uma i-thyroid gland ikhiqiza ihomoni ye-thyroid engenele) kanye ne-malabsorption syndrome (ukonakala emandleni amathumbu okumunca ukudla). I-PAS akufanele isetshenziswe ezigulini ezizwelayo ku-aspirin.

Clofazimine (Cfz)

Isikhumba esomile nesixebukayo, ukucanuzela kwenhliziyo, ubuhlungu besisu kanjalo nokuphelelwa umbala kwesikhumba, i-retina, i-cornea kanye nomchamo. I-Clofazimine nayo ingakubanga ukungaphatheki kahle kwamehlo, ukuzwela ekukhanyeni, ikhanda elibuhlungu, imfiva, ushukela owandile egazini kanye nokulimala kwesibindi.

Linezolid 600 mg iphilisi R593.01 Ukucanuzela kwenhliziyo, isifo sohudo, isiyezi, ukungalali, ukonakala kwazo zonke izinzwa, ukuphazamiseka kokubona, amakaka anegazi kanye nezifo zeyisti.20 mg/ml isasipen-

shini (150 ml ibhodlela) R2,967.10

Iziguli ezingazweli ku-isoniazid, rifampicin, fluoroquinolone kanye nemithi ejovwayo yomugqa wesibili zine-TB engazweli emithini kakhulu.

Umuthi njengephilisi, , umjovo noma iphakethe

Amanani entengo engxenye ezimele ngokubomvu. Ingxenye kahulumeni ngokulwandle. Uma inani

lentengo lingabaliwe, alitholakali engxenyeni.

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Imiphumela emibi yemithi ye-TB mibi, kodwa ukufa nokuba nokungazweli emthini kubi kakhulu.

Mandla, uyaphila?!

Zivikele iZinyanga eZiyisithupha eZilandelayo.

Zisayekile ukuhlasela okwaManje. kodwa kungenZeka Zibuye.

Inyanga yesI-2

Inyanga yesI-5

Inyanga yesI- 4

kodwa uMa seZiyekile? angeke ngiphile nalokhu kukhanya ingunaphakade.

Mandla. kungani ungasicishanga isihlangu sakho? kwenZekani uMa okwangaphandle kubuya?

lokho kukhanya kunginika ikhanda elibuhlungu, ndoda. ngaphandle, angiboni lutho

olwaseZiZweni.

cha!

Mandla, uyaphila?

ngicabanga ukuthi ngiyafa.

uyaquMa!ngicabanga kanjalo.

wena sipho?

Um

fane

kiso

ngu

-Bric

e R

eign

ier.

13

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Umtholampilo: Imitholampilo yakhiwe ngezinhlelo zokungenisa umoya ezikhethekile ukuqinisekisa ukuthi umoya uhlala uzungeza. Imitholampilo futhi inezinto ezihleliwe njengophahla oluphezulu noma izimbobo ezindongeni

ukuvumela umoya ukuthi ungene futhi uphume.

Ikhaya: Ukuvula amafasitela abhekene noma iminyango emzini wakho kuzoba umphumela ofanayo. Ukwenza uhlaka oluphambene, kufanele ukwazi ukudweba umugqa oqondile phakathi kwamafasitela

amabili avulekile.

Ikhaya: Ungakwazi futhi ukuthi nisabalale ekhaya ngokusebenzisa ingadi noma isitubhu uma nivakashelwe abangane. Uma omunye umuntu egula, bayeke baphumule khona bezosinda endlini

eseceleni.

Umtholampilo: Amabhentshi asemtholampilo abekwe ukuthi anikeze abantu isikhala esiningi abazolinda kuwo.

ikhaya

umtho-lampilo ikhaya

2. Ukugcwala kwabantu ngokweqile

Ukulawula isifo ekhaya

umtho-lampilo

Isith

ombe

ngu

-Che

lsea

Mac

lach

lan.

Isith

ombe

ngu

-Che

lsea

Mac

lach

lan.

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ngu

-Che

lsea

Mac

lach

lan.

Isith

ombe

ngu

-Ada

m M

alap

a.

1. Izimbobo zokungenisa umoya

14

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Umtholampilo: Amamaski anikezela ngokuvimbela umzimba ukuthi udlulisele. Iziguli ze-TB kufanele njalo zigqoke amamaski. Emitholampilo, abasebenzi bezempilo nabo

bagqoka amamaski.

Umtholampilo: Ingalo yethu ihlinzeka ngesivimbo futhi ifihla umlomo wethu kanye nekhala ukuze singasabalalisi i-TB. Ekhaya, khumbula lezi zimpawu!

3. Imaski

4. Ukukhwehlela nokuthimula

Ikhaya: Ekhaya, abanakekeli kanye namalungu omndeni bangawagqoka nabo amamaski.

Ikhaya: Khumbuza umndeni ngalokhu uma besebenzisa izandla zabo ukuvala ukukhwehlela kanye nokuthimula. Uma unokukhwehlela noma ukuthimula ezandleni zakho, kugeze ngokushesha.

umtho-lampilo ikhaya

umtho-lampilo

ikhaya

Wonke umuntu usengozini yokuthola i-TB, ngisho nasekhaya. Funda ukuthi uyinciphisa kanjani ingozi ngokulandela amasu imitholampilo ewasebenzisayo ukulawula ukusabalala kwesifo.

Isith

ombe

ngu

-Bru

no D

e C

ock/

Méd

ecin

s San

s Fro

ntiè

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-Jos

e C

endo

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-Gaw

ain

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ke.

Izith

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-Che

lsea

Mac

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lan.

15

ISAY

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Umbuzo Wokuvalela ngokwehlukanisa

ukuhlukaniswa ngempoqo kweziguli ezine-tB engazweli emthini kwenze izihloko eziphambili eminyakeni esandakudlula. u-Agnieszka wlodarski ovela

kuSIGABA27 uhlola izixazululo ezinikezelwa yinqubomgomo entsha yeNingizimu Afrika yokunakekelwa okwenzelwa ezindaweni ezahlukene.

Ugadi uqapha umngcele we- Jose Pearson Tuberculosis Hospital. Iziguli kaningi zizama ukubaleka esibhedlela, ikakhulukazi ngezikhathi zamaholidi. Isithombe ngu-Mariella Furrer.

abantu abanesifo esithile

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Umlando omfishane wokwelashwa ngokuhlukaniswa eNingizimu Afrika Unyaka ka-2008 nonyaka ka-2009 wabona izihloko ezihamba phambili ‘ngokubaleka’ kweziguli ezibhedlela ezisebenza ngokukhethekile nge-TB engazweli emthini (DR-TB) eGauteng, eMpumalanga Kapa kanye neNtshonalanga Kapa. Ngokweziqondiso zokwelapha zoMnyango Wezempilo ngesikhathi, iziguli kwakufanele ukuthi zahlukaniswe esigabeni sokuqala sokwelashelwa kwazo i-DR-TB. Lokhu kuvamise ukusho izinyanga eziyisithupha zokwehlukaniswa kodwa ngezinye izikhathi kuthatha isikhathi eside.

Iziguli zazingajabule ngokuba kude nemindeni yazo kanye nemiphambo yazo yokuzeseka. Zazikhathazeka kaningi ngokuthi imindeni yazo izophila kanjani. Labo abasebenzayo bazizwa benexhala lokuthi bazolahlekelwa imisebenzi yabo um behamba isikhathi eside kakhulu. Ukwengeza ekukhathazekeni kwabo, izimo kulezi zibhedlela kaningi zazizimbi.

Kwezinye izimo Umnyango Wezempilo wafaka izicelo zemiyalelo yenkantolo owawuzodinga ukuthi iziguli ‘ezeqile’ zibuyiselwe ezibhedlela ezikhethekile ukuthi ziyoqeda ukwelashwa kwazo. Kodwa-ke, ukuhlukaniswa ngempoqo kuyingxaki ngokokubona komthetho. Ngenxa yalokhu, kwatholakala isinqumo senkantolo eyodwa esatholakala ngokuphoqa iziguli ezine ezine-DR-TB ukuthi zaziqale ukwelashwa esibhedlela esikhethekile (icala lika-‘MEC Wezempilo, eNtshonalanga Kapa ephikisana no-Goliath kanye nabanye’).

Ingabe ukuhlukaniswa ngempoqo kusemthethweni?Ecaleni lika-Goliath inkantolo yanquma yavuna ukuhlukaniswa okuyimpoqo, kodwa ukwahluleka kungenzeka ukuthi bekungahluka ukuba inkantolo yayicabange icala ngokweSigaba 36 soMthethosisekelo waseNingizimu Afrika.

Isigaba 36 siqinisekisa ukuthi emphakathini ovulelekile nobusa ngokwentando yeningi amalungelo omuntu angeze aba nomkhawulo (ukuhlukaniswa ngempoqo okubeka umngcele elungelweni lenkululeko lokunyakaza) ngaphande kokubuza okusemthethweni okucabanga izinto ezahlukene. NgokweSigaaba 36 okulandelayo kuzokalwa:

(a) isimo selungelo okufanele libekelwe umkhawulo (kuleli cala ilungelo lesiguli lenkululeko yokunyakaza njengoba kuqinisekiswe Isigaba 12 somthethosisekelo wethu);

(b) ukubaluleka kokubeka umkhawulo emalungelweni omuntu (inkantolo ingaphikisana ngokuthi ukuvikelwa komphakathi kanye nempilo yomphakathi kusengozini);

(c) isimo kanye nobungako bomkhawulo(okuwukuhlukaniswa); futhi

(d) izindlela ezingabeki umngcele kakhulu ukufeza inhloso efanayo.

Izinto eyesibili neyesine zifanele kakhulu. Singeze sathethelela ukwehlukanisa iziguli uma kungenamibhede eyanele ezibhedlela ezikhethekile ukuhlinzeka ukwelashwa kwawo wonke umuntu one-DR-TB. Abantu bekufanele baphindele emiphakathini yabo ngesikhathi besohlwini lokulinda lwasesibhedlela. Lokhu kusho ukuthi ngisho kuthiyori izinkantolo bezingalibekela umkhawulo ilungelo lesiguli lenkululeko yokunyakaza, umngcele ubungeke usize ngalutho njengoba abanye abaningi abane-DR-TB bethunyelwa emiphakathini yabo kanti inhloso yokuqinisekisa ezempilo angeke kuhlangantshezwane nayo.

Ecaleni lika-Goliath, uma inkantolo yaayenze uphenyo ngeSigaba 36 okungenni bekungacabanga ngokunakekela okuncike emphakathini obekungaba ngcono kunokuhlukniswa. Lolu phenyo kungenzeka futhi lubhekele eminye imiphumela emibi yokuhlukaniswa, njengokuba kude nomndeni wakho isikhathi eside.

Isikhathi sokunikezela kubantu abehlukene ukunakekela kwe-DR-TBUkunqoba izinkinga zokwelashwa ngokwehlukanisa eNingizimu Afrika ukwenza inqubomgomo entsha yokunakekelwa okunikezelwe abanye abantu. Le nqubomgomo ifuna ukubhekana nezindaba eziningana lapho izishoshovu zikhankasele uguquko. Lezi zindaba zibandakanya ubunzima ezigulini ezilele esibhedlela izinyanga eziyisithupha, kanye nezinhlu zokulinda ezinde ngenxa yenamba enomkhawulo embhedeni wasezibhedlela.

U-Ronelle wayelaliswe esibhedlela i- “Sunshine” Ward at Jose Pearson Tuberculosis Hospital ngaphezu kweminyaka emithathu. Isithombe ngu-Mariella Furrer.

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Cishe ezehlakalweni ezazisiwe ezingu-9,070 ze-TB engazweli emithini eminingi (MDR-TB) ngonyaka ka-2009, ezweni lonke iziguli ezingaphansi kwezi-5000 ezaqala ukwelashwa ngalowo nyaka ofanayo. Abaphathi beziguli ezine-MDR-TB abasendaweni ngezindawo (kodwa hhayi i-TB engazweli emthini ngokuphelele noma i-DR-TB) bazonciphisa inamba yezinsuku phakathi kokuxilongwa kanye nokuqala ukwelashwa. Umphumela wokugcina uzoba ukukhava kokwelashwa okungcono, ukudluliswa kwe-DR-TB okucishisiwe, kanye nokuthi kwenzeke ukuthi iziguli zithole ukwelashelwa eduze nasekhaya. Lokhu futhi kungenza ukuthi kube nokwanda kokwamukeleka emphkathini kokwelashwa kwe-MDR-TB.

Ngokwenqubomgomo ewuhlaka ngabaphathi abasezindaweni ngezindawo be-MDR-TB, indlela entsha izosiza iziguli:

• Ngokwamukelaimisebenziebhekenenabouqobo kanye nezidingo njengoba bezoba seduzane namakhaya abo;

• Ukunciphisaukudluliswakwe-MDR-TBngokusheshe kuqalwe ukwelashwa, okuzokwenza ukuthi kutholakale imibhede eminingana ekhona ekugcineni;

• Ukwenzangconoukubambelelaekwelashwenikusetshenziswa izinhlelo ezincike emphakathini; futhi;

• Ukunciphisaizindlekongokunciphisaukuhlalaokude ezibhedlela ezikhethekile.

Inqubomgomo ewuhlaka ekwelashweni okwenzelwa ezindaweni ngezindawo iphakamisa uhlaka lwezempilo olulandelayo lokuphathwa kweziguli ze-DR-TB:

Ukuphathwa kwe-DR-TB ezindaweni ngezindawo kusho ukudlulisela umsebenzi okubhekenwe nawo weziguli ze-MDR-TB ukwehlisa amazinga ohlelo lwezempilo kuphela uma behlangabezana nezindlela zokukhetha ezithize. Kubandakanya ukuphathwa kwe-DR-TB kumayunithi e-DR-TB asezindaweni ngezindawo, amayunithi ayisathelayithi e-MDR-TB, noma emphakathini kusetshenziswa amathimba angomahamba nendlwana, abanakekeli bomphakathi kanye nosizo lwasekhaya. Iziqondiso ze-MDR-TB ze-World Health Organization zichaza ukunakekelwa okuncike emphakathini kanye nosizo njengananoma yisiphi isinyathelo noma usizo oluhlinzekwe ngumphakathi, kubandakanya izimo lapho iziguli zithola khona ukwelashwa zihlala ngaphandle kwasesibhedlela.

I-flow chart yohlelo olusha lokwelapha okuhanjiswe kwezinye izindawo

Iyinithi ye-DR-TB enkulu

Iyunithi ye-DR-TB ehanjiswe

kwezinye

Decentralised DR-TB Unit

Iyunithi ye-MDR-TB

eyisathelayithi

Iyunithi ye-MDR-TB

eyisathelayithi

Iyunithi ye-MDR-TB

eyisathelayithi

Iyunithi ye-MDR-TB

eyisathelayithi

Ithimba Elingu-

mahamba nendlwane

Ithimba Elingu-

mahamba nendlwane

Ithimba Elingu-

mahamba nendlwane

Ithimba Elingu-

mahamba nendlwane

Ukunakekela Kwezempilo

Okubalulekile

Ukunakekela Kwezempilo

Okubalulekile

Ukunakekela Kwezempilo

Okubalulekile

Ukunakekela Kwezempilo

Okubalulekile

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Yini esingayenza ukusiza ukwelashwa kwe- DR-TB okuhanjiswe kwezinye izindawo?• Izinhlanganozomphakathiwabantukufanelezisebenze

ndawonye ukuqinisekisa ukuthi inqubomgomo entsha ibhekela konke ukukhathazeka kwabantu baseNingizimu Afrika okuvuswe ukwelashwa kwe-MDR-TB.

• Abakhankasibadingaukushiyelanangolwazingokuthiiqaliswa kanjani ukusetshenziswa inqubomgomo emhlabeni wangempela.

• Kufanelesiqinisekiseukuthiukuhanjiswakwezinyeizindawo izindleko zakho zenziwe kahle futhi zabhajethelwa. Lezi yizinto ezibalulekile ezinganquma impumelelo yenqubomgomo entsha nanoma iyiphi.

• Kufanelesifuneukwesekaikakhulukazingamalungeloamaqembu abekeke engozini njengezingane, abahambela kwamanye amazwe, abakhoseli kanye nabasebenzi basemgodini .

• Inanielifanayolokuzinikelakanyenokunakekelaeliqhube impendulo ku-HIV kufanele futhi lisetshenziswe ukubhekela ubhubhane lwe-TB eNingizimu Afrika.

• Sidingaukwesekaimpenduloye-TBne-DR-TBezungezaemalungelweni abantu. Imithombo: AIDS Law Project Report, ‘Protecting Public Health’, (2009); Case 13741/07;

Communicable Diseases and Notifiable Conditions Regulations.

Izibhedlela ezigcwele ngokweqile angeke zihlinzeke ngokunakekela okwanele ezigulini ezibuthakathaka. Isithombe ngu-Mariella Furrer.

Imitholampilo esezindaweni ezahlukene ivumela iziguli ukuthi zifune ukwelashwa eduze nasemakhaya. Isithombe ngu-Chelsea Maclachlan.

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Ngaphezu kweminyaka eyikhulu i-TB beyixolongwa kusetshenziswa indlela ebizwa ngokuthi i-smear microscopy. Manje, sesinokuhlola kokubili okusheshayo nokuthembeke kakhudlwana. Lokhu kuhlola kubizwa ngokuhlola i-GeneXpert MTB-RIF – noma i- GeneXpert ukufingqa.

Ingabe busebenza kanjani ubuchwepheshe be-GeneXpert?Isitayela sakudala se-smear microscopy sidinga ochwepheshe abanamakhono ukuthi bachithe amahora benza imisebenzi ehlukene yaselabhorethri. Iplatifomu ye-GeneXpert okuningi kwalezi zinyathelo kuyazenzela futhi kwenza ukuthi kukwazeke ukuqeda ukuhlola okuningi kusetshenziswa ochwepheshe baselabhorethri abambalwa. Yingakho nje manje iziguli sezikwazi ukuthi imiphumela yokuhlolwa emahoreni nje kunamasonto.

Uchwepheshe welabhorethri ulungisa isampula lesikhwehlela eliqoqwe emtholampilo, alibeke kukhathriji, abeke ikhathriji emshinini we-GeneXpert, umshini bese wenza konke.

Njenge-smear microscopy, kunezigaba ezintathu ekuhlolweni:

1. Ukulungiswa kwesampula: Ochwepheshe baxova isampula lesikhwehlela ngamakhemikhali akhethekile kakhulu ahlukahlukene. La makhemikhali asiza ukuhlukanisa indawo ethize ngqo ye-TB DNA, kodwa angeke sikwazi ukubona i-TB ngaphansi kwe-makhroskophi.

2. Ukukhulisa: Uma i-TB DNA ethize ngqo seyihlukanisiwe, ochwepheshe badinga eningi yayl ukuze kube lula ukuhlola. Lolu hlelo lokuhlukanisa indawo efunekayo ye-DNA kanye nokukopisha umfanekiso kuphela leyo ndawo kubizwa ngokuthi ukukhulisa.

3. Ukuthola: Uma ngabe sekunama-DNA amaningi akopishiwe ochwepheshe bangazama ukuwathola. Imolekhuli esetshenzisiwe kulokhu kuthola siyibiza nge-probe. I-probe yenziwe kusetshenziswa ikhodi yezakhi zofuzo eyenza ukuthi kunamathele ku-DNA ochwepheshe baselabhorethri abayiseshayo (kulesi simo i-TB). I-probe kuvamise ukuthi yenziwe ukuze kuthi uma inamathela ku-DNA ishintshe umbala noma ikhanye kakhulu. Uma uchwepheshe eyibheka esebenzisa imakhroskophu bese ebona ukuthi umbala ushintshile noma elinye isampula selikhanya kakhulu, uyazi ukuthi i-probe kukhona i-TB eseyiyitholile. Lokhu kusho ukuthi isampula lesikhwehlela linayo. I-GeneXpert konke lokhu kuyazenzekela.

Kokubili ukugcoba okuyisitayela sakudala kanye nomshini i-GeneXpert omusha sha kuyasetshenziswa e-Site B Clinic eKhayelitsha ukuxilonga i-TB. U-Elizabeth Mills wahamba wayophenya.

I-Xpert MTB/RIF ukuhlolwa okuzwelayo. Kubantu abayi-100 njalo abane-TB ephilayo izoxilonga ngokulungile abangama-98 kulezi zehlakalo. Ngokuphikisana, i-smear macroscopy kukhomba i-TB ezehlakalweni ezingama-68 kweziyi-100. Lokhu kusho ukuthi i-smear macroscopy izokweqa izehlakalo ezingama-32 ekubeni ukuhlola kwe-GeneXpert kuzokweqa ezimbili kuphela.

OKUNGCONOUKUHLOLWA KWE-TB

Imakhroskophu

yokugcoba

ngokuthathiwe

Ukuhlola kwe-

Xpert MTB/RIF

Amahora ama-2 ( Kudinga umsebenzi omningi

owenziwa ngochwepheshe baselabhorethri.

Eqinisweni, kungathatha amasonto ukuthola

imiphumela.)

Amahora ama-2 (Kungenziwa ukuhlolwa

okuningi kanye kanye kungabi ngomzamo

omncane wochwepheshe elebhu.)

68% 98%

ChaUkuxilongwa

kokungazweli ku- rifampicin

1886 (Wenziwe ngu-Franz Ziehl no-Friedrich Neelsen)

2004 (Wenziwe inkampani ebizwa ngokuthi yi-

Cepheid, Inc.)

Unyaka owenzwe

ngawo

Ukuxilongwa kokungazweli

komuthi

Ukuzwela

Isikhathi esidingekayo

1 2

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I-GeneXpert ibalulekile ikkhulukazi ekuxilongeni i-TB kubantu abane-HIV. Lokhu kungenxa yokuthi i-smear microscopy kunezinga eliphezulu lokungabi nayo okungesilo iqiniso (uma ukuhlolwa kuthi awunayo i-TB ephilayo, kodwa empeleni unayo). I-GeneXpert izoqinisekisa ukuthi izehlakalo ezimbalwa ze-TB ezihamba zingaxilongwanga futhi zingelashiwe.

INingizimu Afrika manje seyithenge imishini engama-30. Ngonyaka ka-2011 enkulumeni yebhajethi, uNgqongqohe Wezempilo u-Aaron Motsoaledi uzibophezelele ukuhlinzeka i-GeneXpert kumalabhorethri e- National Health Laboratory Systems (NHLS) ekupheleni kuka-2012.

Kodwa-ke, izindleko ziyinkinga enkulu. Umshini i-GeneXpert ubiza u-US$17,000 (ZAR R117,800) kanti ikhathriji ngayinye esetshenziswa ngokuhlola ngakunye ibiza u-$16.86 (R118.02).

I-Cepheid kufanele yehlise izindleko zemishini kanye namakhathriji ngokushesha.

I-NLHS kufanele futhi iphenye ukuthi ingazehlisa kanjani izindleko eziphezulu ezihambisana nayo, njengokuhanjiswa, ukuphrinta nentela, okulinganiselwa ku-R83.29 ngokuhlola ngakunye.

INingizimu Afrika kufanele yelule izinzuzo zohlelo lwe-GeneXpert ezinganeni. Kunzima ukuqoqa amasampula esikhwehlela ezinganeni ukuze sihlolwe kusetshenziswa iplatifomu ye-GeneXpert. Imitholampilo idinga ukucabanga ngokushesha izindlela ezilula zokuqoqa amasampula ezinganeni. I-MSF isebenzise ngempumelelo umshini wenkungu, nawo owaziwa ngokuthi inebhulayiza, ebekwa ebusweni bengane. Lokhu kufanele kwenziwe ukuthi kutholakale kuyo yonke imitholampilo lapho amasampula ezikhwehlela eqoqwa khona ezinganeni.

Yenza ukuthi ukuhlolwa kube lula!

Isithombe ngu-Elizabeth Mills.

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Ngu-Claire Wingfield, Treatment Action Group

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Injabulo ngalezi zinhlanganisela iqedwa ukukhathazeka ngokuthola imvume yokulawula emhlabeni jikelele kungenzeka kube inselele. Kuncike ekutheni amazwe aziguqula kanjani izidingo zawo zokulawula, amandla okuxilonga, kanye nezinhlelo zokwelapha i-DR-TB, le mithi ingathatha iminyaka ukuthi ibe khona jikelele emazweni lapho i-TB iwububhane khona.

TMC207I-TNV207 seyiqhubeke kakhulu nokwenziwa, ngakho-ke onke mehlo aseku-Tibotec. Inkampani seyiqalile uhlelo lokusebenzisa ukuzwelana nokwandisa uhlolo lokufinyelela ekufinyeleleni kwangaphambi kokugunyazwa ezigulini ezinokhetho lokwelashwa olunomkhawulo noma ezingenamuthi wokwelashwa. Lezi zinhlolo zezinhlelo bezisetshenziselwa izidambisigciwane kanye nemithi yomdlavuza. Kodwa-ke, akukho muthi we-TB oke wenziwa ukuthi utholakale ngale ndlela. I-TMC207 ngakho-ke isewudaba lokuhlolwa ukuqinisekisa ukufinyelela okunokwenzeka kusheshe emuthini owethembisayo ngesikhathi kuqinisekiswa futhi ukuthi usetshenziswa ngendlela efanele.

Ukukhathazeka ukuthi uma izinhlanganisela zisetshenziswa ngendlela engafanele – nemithi ehambisanayo embalwa esebenza ngempumelelo – kuzoba nezinhlobo ezintsha zokumelana nemithi ze-TB ezingavela ngokushesha. Lokhu kungabeka umkhawulo emtheleleni wesikhathi eside wananoma yimuphi umuthi obhubhaneni. Kudingeka sizivume lezi zinselele ndawonye nesidingo esiphuthumayo sokuqinisekisa ukufinyelela emithini

Amakhulunyaka esifo sofuba silokhu singelapheki. Kwase kuthi, phakathi kweminyaka yo-1940 no-1970 ukutholakala kwama-antibhayothiki amasha kanye nokwelashwa ngenhlanganisela kwashintsha yonke into. Sasinemithi, ngakho-ke kwakuyindaba yesikhathi nje ukuthi siyihambise futhi siyisebenzise ngendlela elungile. Ngeshwa lokhu kulula ukukusho kunokukwenza.

Ngemuva kuka-1963, lapho kwakutholakala ikilasi Elisha lemithi ye-TB, ukwenziwa kwemithi emisha kwabe sekuma ukwenziwa kwemithi emisha. Kwakungesikho nje ngeminyaka yo-1990, lapho ukuvela kokungazweli emithini kwe-TB (DR-TB) kwashayisana nobhubhane lwe-HIV e-United States naseYurophu, abacwaningi kanye nezinkampani ezenza imithi zavuselela uthando lwazo lokwenza imithi engcono ye-TB .

Kusukela ngalesi sikhathi ucwaningo lokwelashwa kwe-TB seluvuseleleke kabusha. Manje sesinemithi emisha esendleleni ezayo eshumini leminyaka. Izinhlanganisela eziyisithpha ezivela emakilasini emithi evele ikhona nemisha iyahlolwa ezinhlolweni zokwelapha, okwamanje nezifundo zangaphambi kokwelashwa . Imithi esivele ikhona ebisetshenziswa ngaphandle kwelebuli (ngamanye amazwi, izinhloso ezingagunyazelwe) ukwelapha i-TB sezihloselwe futhi ukuze zifinyeze ubude bokwelapha, ukunciphisa imiphumela elimazayo, nokwenza ngcono imiphumela yokwelapha.

Izinhlanganisela eziqhubeke kakhulu zokwelapha yi-TMC207 (i-bedaquiline esandokuqanjwa kabusha) evela kwa-Tibotec kanye ne-OPC-67683 (i-delamanid eqanjwe kabusha) evela kwa-Otsuka Pharmaceuticals. Zombili izinhlanganisela zisesigabeni esesihambe kakhulu zezinhlolo zokwelapha. Onyakeni, izinkampani kulindeleke ukuthi zifune imvume yokusebenzisa le mithi ekwelapheni i-DR-TB.

Emva kwamashumi eminyaka enqubekela phambili encane, imithi emisha ye-TB isisendleleni ekugcineni. Kodwa-ke, ezinye izinselele zizodinga ukuthi ngaphambi kokuba le mithi ifinyelele emtholampilo wangakini.

yesikhathi esizayoImithi

Siyayidinga i-TMC207

Nakuba i-TMC207 isahlolwa, ulwazi njengamanje olutholakalayo lube nomthelela ezigulini eziningi ezine-TB engazweli emthini wokuthi ziyafuna ukuwuphuza lo muthi ukwenza ngcono ithuba lazo lokuphila nokunciphisa isikhathi sokwelashwa. Izishoshovu zicele i-Tibotec ukuthi lo muthi iwenze ukuthi utholakale, kodwa selokhu kungakenzeki.

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Umuthi Ukusetshenziswa Isigaba Isimo

Ukwenza izinloso ezintsha zemithi evele ikhona

rifapentine + isoniazid LTBI ukufinyezwa kokwelashwa Isigaba II Uphelile

isoniazid LTBI Isigaba III Ukuhlaziywa kolwazi

rifapentine DS-TB ukufinyezwa kokwelashwa Isigaba II Ukubhalisa

rifapentine + moxifloxacin DS-TB ukufinyezwa kokwelashwa Isigaba II Ukubhalisa

moxifloxacin DS-TB ukufinyezwa kokwelashwa Isigaba III Ukubhalisa

gatifloxacin DS-TB ukufinyezwa kokwelashwa Isigaba III Ukuhlaziya ulwazi

Imithi emisha

AZD5847 TBA Isigaba II Awukabhaliswa

PNU-100480 DR-TB Isigaba II Awukabhaliswa

SQ 109 DS-TB/ DR-TB Isigaba II Ukubhalisa

PA-824* DS-TB Isigaba II Ukubhalisa

OPC-67683*(delamanid) DR-TB Isigaba IIb Ukuhlaziya ulwazi & Nokulandelela iziguli

TMC207*(bedaquiline) DS-TB Isigaba II Ukubhalisa

DR-TB Isigaba IIb Ukuhlaziya ulwazi & Nokulandelela iziguli

* Kukhonjiswa ekilasini lomuthi omusha

ye-TB enezinguquko kubantu abafayo. Kunezingxoxo eziningi kangangokuthi kungahlinzekwa kangcono kakhulu lokhu kufinyelela – ngaphambi nangemuva kwemvume – nokuthi singaqiniseka kanjani ukuthi iziguli ziyazuza ezinhlelweni zeqophelo eliphezulu ezingenayo imingcele engenasidingo. Khona lapho, kufanele kuthathwe izinyathelo ukubeka umkhawulo kanye nokuqapha ukuvela kokungazweli emthini.

Kunomsebenzi okubhekenwe nawo wokusebenzisa ngendlela efanele umuthi omusha okungesiwona nje

owabenzi kuphela. Izinhlelo ze-TB kuzwelonke kanye nabakhankasi bokwelashwa babamba iqhaza elikhulu ekwethulweni ngempumelelo kwananoma yimuphi umuthi omusha noma uhlobo olusha. Izinhlelo ze-TB kufanele ziqinisekise ukunikezela okuthembekile kwemithi yeqophelo eliqinisekisiwe kanye nokufinyelela ngesikhathi ekuhlolweni kokungazweli emthini. Ukusheshe kuxilongwe i-TB kubalulekile ukuze kufakwe iziguli ekwelashweni okulungile, kuncishiswe ukuthelelana, kanye nokwenza ngcono imiphumela yokwelapha. Abakhankasi kufanele bafune ukungenelela okwethembisayo kwezinhlelo zikazwelonke, kubandakanya ukwenziwa kwezinqubomgomo zokuqondisa ukuqala kwazo ukusetshenziswa.

Imithi emisha yezinganeIzingane zenza cishe ama-20 omthwalo we-TB emhlabeni jikelele. Lokhu mhlawumbe kuwunikeza izibalo ezincane ngenxa yobunzima bokuqinisekisa ukuxilogwa kwe-TB ezinganeni. Futhi zisengozini ekhulile ngokuqhubeka kwesifo ngokushesha. Kodwa kuze kube manje ayikho kulezi zinhlanganisela ebisike yahlolwa ezinganeni. Izingane kufanele zisheshe zifakwe ohlelweni lokwenziwa kwemithi ukuze nazo zizosizakala emithini emisha. Kunesidingo esisha futhi socwaningo oluthe xaxa ekuphepheni nasekusebenzeni kahle ngokusebenzisa imithi ekhona njengamanje ye-NDR-TB ukwelapha izingane ezinokungazweli emithini ye-TB.

Nangale kwenqubekela phambili esandukwenzeka ocwaningweni lomuthi we-TB kufanele sihlale siqaphele ekwethembeni kwethu. Yize imithi manje esenziwa kuyiyona ethembisayo emashumini eminyaka, ayikakeneli ukuqeda i-TB njengesabisa izimpilo zomphakathi. Asinalwazi

oluqoqiwe lokuthi le mithi singayisebenzisa kahle kangakanani ezinganeni nolwazi olunomkhawulo ngokuthi ingahlangana kanjani nokwelashwa ngezidmbisigciwane. Ngenxa yalokhu, labo bantu kunokwenzeka ukuthi baguliswe isifo esibi kakhulu kungadingeka ukuthi balindele imithi emisha. Ukwethembisa ukuthi imithi emisha isendleleni nokuthi kufanele silungiselele ukuyinikezela ngempumelelo noma nini uma idingeka.

LTBI = Ukutheleleka nge-TB Elele; DS-TB = I-TB Ezwela Emuthini; DR-TB = I-TB Engazweli Emuthini

Isithombe yi-Jose Cendon/Médecins Sans Frontières.

Imithi evele ikhona kanye nemithi emisha ye-TB ezinhlolweni zokwelashwa kusukela ngoJuni 2011

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I-South African Clothing and Textile Worker’s Union (SACTWU) yenze Uhlelo Lwempilo Yomsebenzi olukhombisa ukuthi abaqashi nezinyunyana bangahlanganyela kanjani ukwenza izimo zokusebenza ezinempilo. Okubalulekile, lolu hlelo lusebenzisa indlela yokunakekela kwezempilo okubalulekile okuhambisa phambili ukuvimbeka nokuthatha i-TB njengento embi.

Luyini Uhlelo Lwezempilo Yomsebenzi Lwe-SACTWU?I-SACTAWU inyunyana yezohwebo enkulu kanazo zoke embonini yezimpahla zokugqoka nezindwangu eNingizimu Afrika. Uhlelo lwayo Lwezempilo Yomsebenzi (Worker Health Programme (SWHP)) lwaqala ngonyaka ka-1998 njengephrojekthi yemfundo ye-HIV/AIDS.

Namhlanje i-SWHP ihlinzeka ngokunakekela okuphelele – yonke into kusukela ekuhlungeni ukuya ekuhloleni

Ngu-Elizabeth Vale

Indawo yokusebenza enempilo yinhle kuwo wonke umuntu. Abasebenzi abafinyelela ekunakekelweni kwezempilo okuseqophelweni eliphezulu nokwesekwa bahlala bephilile, baphila kangcono futhi bayakwazi ukuhlinzekela imindeni yabo. Izinhlelo zezempilo emsebenzini nazo zifanele abaqashi ngoba abasebenzi abaphilile basebenza ngokukhuthala kakhulu.

i-TB emsebenziniQeda

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ukuya ekwelapheni nasekwesekeni. Uhlelo lusebenzisa abaqeqeshi, amakhansela angaqeqeshiwe, onesi kanye nabanakekeli abasemakhaya. Ukusebenzisa amathimba angomahambanendlwana, kuhlinzeka abasebenzi bamafektri ngokufinyelela ekunakekelweni kwezempilo okubalulekile, akunandaba ukuthi bakuphi.

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Onyakeni owedlule, i-SWHP yandile yanikezela uhlelo lwe-TB oluphelele, kubandakanya imfundo yasemsebenzini kanye namaseshini okuqeqesha. “Besihlola uhlelo lokwelapha i-TB emadolobhenikazi aseNtshonalanga Kapa”, kusho u-Nikki Soboil, Umqondisi we-SWHP. “Iyabasebenzela ... abasebenzi, futhi nabaqashi bajabule kakhulu.”

Lusebenza kanjani Uhlelo Lwe-SACTAWU Lwezempilo Emsebenzini?1. Ukuqeqesha Abaqeqeshi be-SWHP bavakashela izindawo zokusebenza zonke izinsuku ukuyokwenza amaseshini ezemfundo e-TB ne-HIV efemini. Lezi zingxoxo zivamise ukwenzeka kuphuzwa itiye noma ngelantshi enkantini. Njengoba isikhathi sinomkhawulo, abaqeqeshi bethula imiyalezo esebenzisekayo “yokuya ekhaya” egxile ekuvimbeleni, ekwaziseni abasebenzi ngokulawula ukutheleleka okuyisisekelo kanye nezimpawu zesifo se-TB. Abaqeqeshi bashiya amaphosta kanye nezinye izinto zokukhuthaza ukulawula isifo, ukuhlunga kanye nokuhlolwa.

Ukwengeza kulezi zingxoxo, i-SWHP ihlosele futhi amagosa okuqeqesha okujulile. Amagosa aya emihlanganweni yokufundisana emibili ukuya kwemithathu emahhovisi enyunyana, akhava i-HIV, TB kanye namalungelo endaweni yokusebenza.

2. Ukulawula isifo Ngesikhathi samaseshini ezemfundo efektri, abaqeqeshi be-SWHP bakhuthaza izindlela eziyisisekelo zokulawula

ukusabalala kwe-TB, njengokuvula amafasitela, ukukhwehlelela kuthishu kanye nokugeza izandla. I-SWHP futhi ikhuluma nabaphathi befektri ngokulawula isifo. Lokhu kungabandakanya ukuphakamisa amalambu e-UV, amathishu noma ukungena nokuphuma komoya okungcono. I-SWHP ikwazile ukunikezela amafektri ngokokukhipha ijeli engena-alkhoholi yokugeza izandla. Abaqeqeshi bakhuthaza amalungu e-SACTAWU, asebenza embonini yezimpahla zokugqoka nezindwangu, ukuthi basebenzise iziqephu zendwangu ukwenza amasayiduku.

3. Ukuhlungelwa nokuhlolelwa i-TB Abaqeqeshi ngokwenjwayelo bahlungela iqembu i-TB, bebuza abasebenzi ukuthi kukhona yini izimpawu zesifo abanazo. Amathimba onesi kanye namakhansela angaqeqeshiwe balandelela lokhu kuvakasha zonke izinsuku ukuhlola nokuhlungela i-TB.

Ukuhlowa kwe-TB kubandakanya izitsha zokuqoqa isikhwehlela endaweni yokusebenza noma uma abasebenzi bevakashela umtholampilo we-SWHP ukuyohlola. Uma imitholampilo ye-SWHP ikude, abasebenzi badluliselwa emtholampilo woMnyango Wezempilo ukuyohlola. Kulezi zimo, unesi ovela ku-SWHP uyafona ukuhlola ukuthi umsebenzi useyilandile yini imiphumela yakhe yokuhlolwa.

Uma imiphumela yesikhwehlela ingenayo i-TB kodwa umsebenzi enezimpawu zesifo zokwelashwa ze-TB, i-SWHP yenza ukuhlolwa kwamabhaktheriya bese bemdlulisela kuma-X-reyi umsebenzi uma kudingeka.

4. Ukwelashwa kwe-TB Umtholampilo we-SWHP e-Salt River yiyona kuphela indawo yokwelapha i-TB okungesiyona ekahulumeni, nengazimele eNtshonalanga Kapa. Abasebenzi bangakhetha ukuthi bazokwelashwa yi-SWHP noma emtholampilo wasendaweni woMnyango Wezempilo. Amalungu e-SACTAWU amaningi kakhulu ahlolwe atholakala ene-TB elashwa kusetshenziswa umtholampilo we-SWHP ngaphandle uma behamba noma besebenziea kude. Kuze kube namhlanje, i-SWHP inezinga lokuphilisa elingama-100%.

U-Soboil uthi impumelelo yohlelo lokwelapha lusizwa ukubambisana okuhle kanye nethimba elizinikele. “Ukubambisana kubalulekile ngempela ... . Umnyango Wezempilo ... usixhumanisa nemitholampilo ethize ngenxa yalokho siyakwazi ukudluliseka kalula. Siyakwazi ukuthola imithi kalula futhi amakhithi ethu okuhlola siwathola kubo. Kufanele kube nokubambisana okuthize kungenjalo angeke kusebenze.”

Umxhumanisi wezokuqeqesha u- Gregory Hoedemaker ukhuluma nabasebenzi njengengxenye yohlelo lokuqwashisa. Isithombe ngomusa we-South African Clothing and Textile Workers’ Union.

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5. Usizo Emasontweni amabili okuqala okwelashwa i-TB, abasebenzi bathatha ilivu yokugula. Ngalesi sikhathi, kuyenzeka bavakashele umtholampilo zonke izinsuku noma unesi we-SWHP uya kubo. Onesi be-SACTAWU basebenzisa uhlelo lokwelapha ngokuqapha ngqo (directly observed therapy (DOT)) ukuqapha ukubambelela kweziguli, kodwa banquma ukuthi bazosiqapha ngokuvama kangakanani isiguli kuncike ekutheni wenza kahle kangakanani lowo muntu ekwelashweni. Abasebenzi bangakhetha futhi ukuthola i-DOT efemini yabo, lapho-ke basekelwa ngosuphavayiza babo noma onesi emsebenzini. I-SWHP ixhumana nabaphathi kanye nonesi emsebenzini ngokwelashwa kwabasebenzi, ilivu yokugula kanye nezinye izinto okufanele zenziwe, ukuze kwenzeke ukwelashwa ngokwemithetho yomsebenzi.

Ubudlelwano benyunyana nomqashiI-SWHP izohlolela wonke umuntu i-TB efektri nangale kokuthi uyilungu le-SACTAWU yini noma cha. Nakuba amalungu e-SACTAWU kuphela kanye nemindeni yawo eza emitholampilo ye-SACTAWU, abanye badluliselwa emitholampilo yoMnyango Wezempilo ukuyonakekelwa khona.

Uhlelo lwe-TB lwe-SACTAWU ludinga ukwesekwa umqashi ukuze lufeze inhlolo yalo: yokuthuthukisa impilo yabasebenzi. Uma impilo yabasebenzi iqondwa ukuthi isiza bubilini, izinyunyana kanye nabaqashi bayakwazi ukusebenza ndawonye bephokophele kule nhloso.

Yini esingayifunda oHlelweni Lwempilo Yabasebenzi Lwe-SACTAWU?Sidinga imitholampilo ebhekela abasebenziImitholampilo eminingi kakhulu eNingizimu Afrika ivula phakathi kuka-07:30 no-15:00. lokhu kusho ukuthi abantu abasebenzayo kaningi abakwazi ukuwasebenzisa. Ngokuhlukile, imitholampilo ye-SACTAWU ivula kusukela ngo-06:30 ukuya ku-18:30, kubandakanya Imigqibelo. Engxenyeni enkulu, imitholampilo ye-SACTAWU isebenza ngokubeka izikhathi ukuze amalungu ezokwazi ukubhuka izikhathi ezifanele bona kangcono. Bamukelekile futhi ukuza ngokuthi bazizele nje. Imitholampilo eminingi eNingizimu Afrika idinga ukubhekela abasebenzi ngokuvula ngezikhathi ezingaphandle kwamahora ayinjwayelo okusebenza.

Ukubambisana kwenza umehlukoI-SWHP ikwazile ukubambisana noMnyango Wezempilo kanye nabaxhasi bamazwe omhlaba jikelele ukwenza uhlelo lube yimpumelelo. Imiphambo yokuxhumana kanye nobudlelwano bugcina uhlelo lusebenza, luqinisekisa ukudluliselwa okusebenza kahle kanye nokufinyelela kuzidingongqangi.

Sidinga abantu abazinikele, abaqeqeshiwe ukubhekana nezindaba zezempilo emsebenziniAmathimba e-SWHP azinikele emsebenzini wawo futhi anikezwe amandla ngolwazi oludingekayo. Bahambisana nezintuthuko zesayensi, ukuxilonga kanye nezindlela zokulawula isifo, kanye nabo bonke abasebenzi abangafundile bathole ukuqeqeshwa ngokuthola izitifiketi.

Sidinga ukufinyelela ngale kwabasebenzi ngabanyeUhlelo Lwezempilo Yabasebenzi lwe-SACTAWU lwelulela ngale kwbasebenzi ngabanye ukuya emindenini yabo nasemiphakathini. USista Vuyiswa, omunye wonesi emtholampilo we-SACTAWU eSalt River, uthi ingxenye enhle kakhulu yomsebenzi wakhe ukuthi ngokwazi isiguli esisodwa se-TB, uthola ukwazi umndeni waso futhi. “Ukwakha ubudlelwano nemindeni kukhuthaza imindeni ... ukweseka isiguli ekwelashweni nokungivumela ukuthi ngihlole ngokuhlungela i-TB amanye amalungu omndeni.” I-SWHP seyiqalile futhi ukufinyelela ezikoleni, lapho ihlinzeka khona ngemfundo ye-TB eyisisekelo.

USista Vuyiswa ukholwa ukuthi ukuphila kahle kwabasebenzi into ehamba phambili ohlwini olukhulu lohlelo.Isithombe ngu-Elizabeth Vale.

Izinhlelo zomsebenzi azikhuthazi nje kuphela iziguli ukuthi zifune ukwelashwa kodwa futhi ziphoqelela nomuzwa omkhulu wokuqonda ngaphakathi emphakathini ngokubanzi. Umfanekiso nguSizwe Nguqe.

kwenZenjani kuMbali?

uyigqoka kanjani iMaski eMphakathini?

angithandi ukugqoka le Maski. akungiphathi kahle. kodwa kufanele

ngiyigqoke ukuZe ngiZokwaZi ukuvikela abanye abantu ekusabalalei

kwe-tb. ngifisa sengathi abantu bangayeka ukungibuka.

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Ngu-Luckyboy Mkhondwane

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I-TAC ikhumbula uSithembiso MkhizeIlungu lesikhathi eside le-TAC uSithembiso Mkhize ushone ngomhla ka-17 Juni 22011. USithembiso wajoyina i-TAC ngonyaka ka-2002. Ubengumsebenzi Wokufundisa Ngokuvimbela Nokwelashwa we-TAC eThekwini. USithembiso ubebandakanyeka emkhankasweni oyimpumelelo owenziwa yi-TAC wokuqinisekisa ukwelashwa ngama-ARV kweziboshwa eJele lase-Westville. Ngesikhathi edlula emhlabeni uSithembiso ubeqashwe yiNyuvesi yaKwaZulu-Natali eMgungundlovu. Sengathi umphefumulo wakhe ungalala ngokuthula.

Akwanele okwenziwa ezikoleni zethu ukufundisa intsha esencane nge-HIV, ubulili, ukukhulelwa kwentsha kanye nokuvinjelwa kwezifo ezithathelwana ngocansi (ama-STI). Lolu udaba olubaluleke kakhulu njengoba intsha esencane, njengawo wonke umuntu, isengozini yokutheleleka uma iya ocansini.

Amalungu eGatsha le-Treatment Action Campaign (TAC) eKatlehong South bebekhathazekile ngezehlakalo eziphezulu zokukhulelwa kwentsha esencane endaweni yawo. Babekhathazekile futhi ngemibiko evela emtholampilo wasendaweni okhombisa ukuthi inamba enkulu yezingane zasezikoleni eziphakeme ziza emtholampilo zizofuna ukwelashelwa igonoriya, i-STI ejwayelekile. Banquma ukuthi kufanele benze okuthize bese bephakamisa lolu daba nabalingani be-TAC.

UNthabiseng Maretlane Umkhankasi Wezempilo Emphakathini we-TAC ovela eKatlehong South. Esebenzisana noDikeledi Senong, ongumsebenzi Wokufundisa Ngokuvimbela Nokwelashwa we-TAC uMaretlane sebebhekene nenkinga. Bobabili baqale ukunikezela amaseshini ezemfundo akhava ukukhulelwa kwentsha esencane, ama-STI, HIV kanye noshintsho

lwendlela yokuziphatha eKatlehong High School kanye neThuto Pele High School. Bobabili izitshudeni kanye nothisha ezikoleni ezimbili balwemukele uhlelo.

Amaseshini ezemfundo anikeza izitshudeni iplatifomu yokukhuluma ngokukhululeka ngobulili bocansi kanye nezinselele ababhekana nazo njengentsha esencane. Kaningi bacabanga ukuthi abakwazi ukuxoxa ngalezi zindaba nabazali babo nothisha. Njenoba uMaretlane noSening bobabili kungabesifazane abasebancane, kulula ukuthi intsha ikhulume nabo.

“Izitshudeni ziyakhuluma kakhulu futhi ziyajabula uma zikhuluma ngezindaba zobulili nezobulili bocansi, kanti nezinga labo lokuhlanganyela liyathokozisa kakhulu,” kusho uMaretlane. “ Kodwa badinga imfundo enkulu kakhulu ezindabeni ezifana ne-HIV, ama-STI kanye nobulili bocansi.”

Intsha esencane ayikwazi ukuhlukanisa phakathi kwe-HIV ne-AIDS, kusho uMaretlane, ngisho bazi ukuthi i-HIV idluliswa kanjani. “Ukukhathazeka kwabo okukhulu” eqaphele, “ukukhulelwa.”

“Ngingathanda ukulubona lolu hlelo luphuma luya kuzo zonke izikole eziphakeme endaweni,” kusho uMaretlane. “Ikakhulukazi ne-HTC-(HIV Counselling and Testing) ephakanyisiwe emkhankasweni wezikole, njengoba izitshudeni zizozilungeselela kangcono ukuhlolelwa i-HIV nangokusebenzisa uhlelo banganikezwa amandla okwamukela isimo sabo uma behlolwe baba phozithivu.”

I-TAC ikhumbula u-Xolani KhumaloIlungu lesikhathi eside le-TAC uXolani Khumalo ushone ngomhla ka-13 Juni 2011. UXolani, Umsebenzi Wokufundisa Ngokuvimbela Nokwelashwa eMgungundlovu, wajoyina i-TAC ngonyaka ka-2004. Ngonyaka ka-2009 waba nguMkhankaseli Wezempilo Emphakathini we-TAC, akabe nguye kwaze kwafika isikhathi sokudlula emhlabeni. UXolani wayenamandla kakhulu futhi esebenza kanzima. Uzokhunjulwa kakhulu ngumndeni wakhe, abalingani bakhe emsebenzini, amalungu egatsha nomphakathi. Sengathi umphefumulo wakhe ungalala ngokuthula.

Isithombe ngu-Luckyboy Mkhondwane.

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TB/HIV CARE ASSOCIATIONwww.tbhivcare.org • Tel 021 425 0050

A = Appetite Loss T = TirednessC = Chest Pains

N = Night Sweats & Fever O = Ongoing Cough W = Weight Loss

IF YOU HAVE ONE OF THESE SYMPTOMS OF TB,

BY GOING TO YOUR NEAREST CLINIC

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