THE Denis Hurley Centre clinic opens its doors early to serve meals and medication to homeless TB patients arriving for their daily dose in the gruelling six month treatment necessary to beat the disease.
Clinic coordinator Ruth Birtwhistle said the centre runs a Directly Observed Treatment (DOT) programme at the DHC centre in Durban’s CBD and at their satellite clinic on Dalton Road in Umbilo. The team also run a mobile clinic, catering to homeless patients on the street.
“Essentially, the DOT programme is for individuals who are on chronic medication, particularly TB medication, ARVs, anti-psychotic or anti-epileptic treatment,” explained Birtwistle.
When a homeless patient arrives at the clinic, healthcare practitioners run a range of tests including a TB test.
“Patients often come in very sick and have comorbidities. Often they have a secondary chest infection which we need to treat. We will test for TB and check the patients HIV status,” she explained.
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Once patients are tested, treatment begins on the same day.
“We are very lucky to work closely with the municipal clinic on Lancers Road where we have access to the National Health Laboratory Service (NHLS). We can collect sputum here at the centre and send it off to the clinic and collect the results ourselves. The patient doesn’t have to go to another clinic for testing. We get the results here and start treatment on the same day,” she said.
Birtwhistle said there are patients who visit the clinic daily to take their treatment with porridge and tea. On Fridays they collect the weekend medication for Saturday and Sunday.
“We also have patients who collect medication once a week or once a month. It depends on what their needs and availability is,” she said.
“We are having more and more success with carrying people through the six-month programme. We have 40 people at the Dalton Road clinic on the DOT programme for TB or HIV treatment at any given time.
“In that community, people live nearby and generally visit the clinic daily. Here at the centre we see between 70 and 100 people per day who visit the clinic for TB or HIV treatment,” she said.
Multi-drug resistant TB
While TB treatment spans over a six month period, patients with Multidrug-resistant TB (MDR TB) will be treated for at least nine months.
“We have 10 multi-drug resistant patients who are on a nine month course of TB treatment. We work with the TB department at King Dinizulu Hospital complex for this treatment. If we identify someone with MDR TB, they are admitted for a while and when they come out they are prescribed medication,” said Birtwistle.
When treating MDR TB patients, the clinic works alongside Advance Access & Delivery (AAD), an organisation which runs a methadone programme at Belhaven to assists recovering addicts to manage their withdrawal symptoms.
“A social worker we worked with previously has trained two formerly homeless men who walk around the City and find patients who are defaulting. Being formerly homeless, they know where to go. They take the medication and meals to the patients,” said Birtwhistle.
The long haul
After the first two weeks of treatment, symptoms clear up, said Birthwhistle.
“After the first two weeks of taking TB treatment, you’ve killed 99% of the bacteria. The next five and a half months of treatment is designed to kills that last 1% which is very persistent. after two weeks, patients are feeling better, they have gained weight and keeping them motivated to continue treatment is very important,” she said.
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Completing treatment is a challenge for a homeless patient who does not have access to sufficient nutrition.
“Patients get very hungry as they get better, that’s why it is important to provide food with the medication. Often they are taking four to seven tablets at a time for TB. For MDR TB, patients take up to 20 tablets twice a day,” said Birtwistle
“If you don’t know where you are sleeping or when you will be eating next, our priorities are very different, particularly once patients begin to feel better. Many of the patients in the DOT programme also struggle with substance abuse,” she concluded.
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