A young boy with spinal TB at MSF's healthcare clinic in Lankien, Jonglei State, southern Sudan.April 2008.
Photo by Susan Sandars / MSF
This small village in southern Sudan looks like many others in Africa. Women sit outside their ‘tukuls’ chatting and children jump rope and play. Yet one thing is different about this place, most of the people living here have tuberculosis (TB) and are staying here while they receive treatment. Tuberculosis kills around 1.6 million people every year, almost all of them living in the developing world. For the most part, it’s a curable disease which is treated with a combination of antibiotic drugs. However, the treatment is long, stretching over six months at least. Although some patients might start to feel better after as little as two weeks on treatment, they must be encouraged to complete the entire treatment course. If people do stop taking their drugs, or default, before they finish their treatment, they will not be cured and there is a real risk that they could spread the disease or develop a strain of TB that is resistant to the drugs.
In countries where TB is rife and free health facilities scarce, MSF has built special ‘TB villages,’ where patients can stay for six to eight months and receive round the clock care, supplementary food, bed nets to protect them from malaria, blankets and clean drinking water. This setup greatly increases the chance that patients will finish their treatment course and be cured. As medical coordinator Ronald Kremer explains: "TB drugs must be taken every day under the direct observation of health staff to ensure that patients complete their treatment. In rural southern Sudan, where patients often have to walk for hours or days just to get to a clinic, daily visits are simply not possible."
This treatment method is used by MSF in a number of countries in the Horn of Africa, where nomadic populations are common or where conflict and insecurity have prevented medical centres and roads from being built. In Sudan, where over 90,000 new cases of the disease were diagnosed in 2006 , MSF has been treating people using this ‘village approach’ for over ten years.
Innovative and flexible approaches, like TB villages, have shown that it is possible to successfully treat TB in countries such as Sudan. However, what is really needed to tackle this global emergency are new diagnostic tools that are simple, reliable and adapted for use in remote, resource-poor settings; together with more potent drugs to shorten the length of treatment and to address drug-resistant TB. With these, thousands, rather than hundreds, of lives can be saved.