Enforced quarantine is controversial

Clare Nullis

Clare Nullis

Behind high wire fences patrolled by security guards to prevent escape, a drab building used more than a century ago for smallpox victims houses patients with the latest virtually incurable disease: super drug-resistant tuberculosis.

Among them is a minibus taxi driver who reluctantly agreed to be admitted after exposing hundreds of people every day to his potentially lethal germs.

Enforced quarantine is highly controversial. Critics say it is a violation of medical ethics and individual human rights.

Health authorities, who earlier this year resorted to the courts to compel four patients to stay at the hospital, say they have no choice.

"There are challenges without answers," said Simon Moeti, medical superintendent of the Brooklyn Chest Hospital.

"There are people who refuse treatment, people who want to abscond," he told journalists visiting the clinic on the sidelines of an international TB conference .

Moeti and other health professionals say that facilities like Brooklyn are much like a Band-Aid to a gaping wound, given the spread of Aids and the related upsurge in TB cases, including multi-drug-resistant (MDR) and the untreatable extremely drug-resistant (XDR) strains.

South Africa reported 343000 TB cases last year, of which about 6000 were MDR. The government says that there have been about 400 cases of XDR-TB, but groups like Medecins Sans Frontieres say this is a vast underestimation.

Testing methods are hopelessly slow and out of date - and it is very difficult to diagnose TB in HIV-positive people.

Nearly 60percent of TB patients have the HI virus, and many people with drug-resistant TB die before they are tested and treated - having probably infected other people in the meantime.

The drugs are also woefully outdated and inadequate. The Global Alliance for TB Drug Development told the conference that trials of two possible drugs were promising. One of them, antibiotic moxifloxacin, could shorten treatment time and the other, PA-824, had potential for drug-resistant strains.

But even if clinical trials are successful, it might take years for the drugs to reach the market.

"We can't wait that long. We need new drugs now," said Winston Zulu, a Zambian Aids and TB activist who lost four brothers to TB.

Drug multinational Eli-Lilly is offering hard-hit TB countries the technology and know-how of two of its antibiotics used in a four-drug cocktail for drug-resistant strains, and is training health workers.

But experts worry that the drug-resistant strains will continue to spread - largely because people are not sticking to the six-month treatment course.

In the Western Cape, including Cape Town, 64 cases of XDR-TB have been identified this year, according to local health officials.

Twenty of the patients have died and 39 of the survivors are currently being treated at Brooklyn, some in the fenced-off ward and others elsewhere in the hospital.

The youngest is just a year old. Her mother died last year before local authorities started testing for XDR-TB though that was most likely the cause, said Moeti.

"But she's doing OK," he said, picking up the child who was sitting with other infants.

He refused to divulge identities because of confidentiality, and journalists were not allowed to speak to patients in the 308-bed clinic.

The clinic - a collection of small scattered buildings - was purchased from a farmer in 1872 because of its isolated location.

It was initially used for smallpox, then for the big influenza epidemic and now for TB.

Structurally, there have been few changes in the past century. Though the clinic is in dire need of a coat of paint, Moeti says its design allows for good ventilation - TB thrives in closed spaces. - Sapa-AP