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Uniting against discrimination to end TB


For World Tuberculosis (TB) Day this year, WHO is putting a particular focus on uniting efforts to end TB. An important part of this is addressing the stigma, discrimination and cultural barriers that prevent people accessing care.

Namibia, Tsumkwe
Tsumkwe Clinic TB food & medication.
Members of the community, adults and children, attend the clinic to receive food and then their regular dose of TB medication. Maria Heinrich (in yellow) assists with feeding and disbursing medication to TB patients
Photo © Eric Miller

Namibia has one of the highest incidence rates of TB in the world. Within the country, the indigenous San people in particular have one of the highest rates of multi drug resistant TB. Whilst Namibia’s German-speaking population has a life expectancy of 79 years, the San people rarely live beyond 50.

The San are an indigenous, largely nomadic group of people living across parts of Southern Africa. Known for their clicking languages, their unique culture has sometimes resulted in unfair discrimination against them. The San, and other ethnic groups in the area, often report ill treatment from local health workers and are less confident when attempting to access health care services.

These cultural barriers, when combined with a lack of nutritious food, and the nomadic lifestyle of the San, contribute to the spread of multi drug resistant TB. To tackle TB effectively Health Poverty Action works with the San people and the health centres to overcome the many complicated social and practical barriers to accessing treatment.

Awareness and access

When ≠ioma N!ania began having chest pains and sweating in the night, he didn’t know what his symptoms meant. It wasn’t until a community representative from his local area attended some health training from Health Poverty Action that he learnt he had TB.

“When he returned from his training, he started to teach us in the village that chest pain and night sweats can be signs of TB. He encouraged me to go for a test.”

After he was diagnosed ≠ioma was given both treatment, and training to teach him how to prevent the spread of his TB. He was also provided with temporary accommodation near the Tsumkwe clinic, as well as nutritious meals two times a day to support his recovery.

“The project is really helping us a lot. We now know that if we are coughing we should put our hand over our mouth, and that we must sleep alone in our room of the tent.”
But not everyone can come to stay near the clinic throughout their treatment. Many San people live a nomadic lifestyle which makes moving to a big town for months of treatment very difficult- both socially and financially. Our priority is to ensure diagnosis and treatment begins early enough to prevent hospitalisation, and ensure those infected with TB can remain in their communities whilst completing their treatment.

Health Poverty Action is training treatment supervisors to visit families, take samples for diagnosis, and visit them again to deliver their medicines. To prevent the further spread of multi drug resistant TB it is essential patients complete their course of medicine- even if this takes months or years. Treatment supervisors visit patients regularly to ensure they don’t stop their treatment for any reason.

Di//ao Cwi is a young woman who lives in a village 36km from the nearest clinic in Tsumkwe. After a healthworker visited her village to do tests, she was diagnosed with TB, and wouldn’t have been able to keep up her long course of medication without visits from her treatment supervisor.

“My treatment supervisor made sure I took the prescribed medicine every day. I really thank him for being with me right through my treatment”.

Breaking down cultural barriers

One of the ways we have been working in partnership with the San people is by setting up Clinic Health Committees. These committees bring together community representatives to meet with local health officials, providing a space for the San people’s voices to be heard, so that local services can be adapted and made accessible to their cultural and local needs. Feedback about health services is collected by the committees, and then passed on to government officials at regional and even national level.

Namibia, Tsumkwe.
Village a short distance from Tsumkwe
Photo © Eric Miller

Although the process has often been challenging and slow, the voices of the San are finally being heard. As a result, the national government has recognised the need for greater support to stop the spread of drug-resistant TB in Tsumkwe.

As the world continues to tackle TB, it will be crucial to take on not just the medical causes of TB, but also the cultural and social barriers preventing different groups from accessing treatment. In Tsumkwe this means healthcare needs keep adapting to suit the culture and nomadic lifestyle of the San people, and make it easier for them to access healthcare and treatment without drastically altering their day to day lives.

See the full blog on the BOND website here.

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