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3Thandeka Moyo
WHEN tuberculosis patient Loyiso Nare decided to cross the border into Botswana in search of greener pastures, accessing treatment for his ailment was the least of his worries.

His desperate situation made him blind to the risk that came with leaving home without guarantee of accessing the crucial drug supply needed to fight TB.

The trauma that came with scavenging for food for his four children and members of his extended family convinced him to travel without the necessary documents.

Forgetting the dangers that come with non-adherence to TB medication for at least six months, Nare purposed it in his heart to secure a living in Botswana than succumb to drought-induced starvation facing many communities in Bulilima, Matabeleland South province.

“I managed to illegally cross over to Botswana thinking it would be my passport to a better life.

The first days went well as I adhered to my medication acquired from the hospital back home. With fresh and adequate supplies of nutritious food, I could tell my system would quickly respond to my medication and eventually flush out TB,” says Nare.

Misfortune struck when he eventually ran out of medication.

“I tried ignoring the reality that my system would resist medication as I could never let go of the pleasant life I led in Botswana.

Unfortunately I became too comfortable in that situation and slowly succumbed to the disease,” he said.

Many Zimbabweans like Nare who illegally cross over to TB high-burden countries like Botswana and South Africa find themselves stranded with no medication.

Most of them cannot access healthcare as they have no proper documents. They are forced to suffer in silence than seek medical attention and risk deportation or arrest.

Such incidents have fuelled not only the prevalence of TB but that of drug resistant TB in Zimbabwe, a strand more expensive to cure and more detrimental to health.

TB has become one of Zimbabwe’s top killer diseases.

Centre for Disease Control and Prevention (CDCD) defines TB as a disease caused by bacteria that are spread from person to person through the air.

“TB usually affects the lungs, but it can also affect other parts of the body, such as the brain, the kidneys, or the spine. In most cases, it is treatable and curable. However, people with TB can die if they do not get proper treatment,” says CDCD on its website.

Matabeleland South provincial Tuberculosis Coordinator in the Ministry of Health and Child Care, Norbert Muleya, says a person develops drug resistant TB when TB bacteria become resistant to the drugs used to treat it.

“Drug-resistant TB can occur when the drugs used to treat the disease are misused or mismanaged.

Examples of how this can happen are when people do not complete the full course of treatment; when health care providers prescribe the wrong treatment, the wrong dose, or wrong length of time for taking the drugs; when the supply of drugs is not always available; or when the drugs are of poor quality.

“There is a high prevalence rate of HIV and a significant number of patients being diagnosed with TB are coming from high risk countries like South Africa where TB is the top killer.

The Ministry has developed strategies like one stop shops for the management of TB/HIV and ensuring that all HIV positive patients are being screened for TB and vice-versa,” says Muleya.

He says the ministry is also rolling out the Isoniacid Preventive Therapy (IPT) that prevents HIV patients develop TB as well as the cross border collaboration.

“As Botswana and South Africa are considered high risk countries, it is natural and of great priority to ensure that health professionals near the borders are given priority in terms of diagnostics so that they have the capacity to identify TB cases coming into the country.

Quite a significant population of Zimbabweans stay in South Africa and Botswana thus the need for integrated interventions,” he said.

Muleya says Zimbabwe recorded 1,968 TB cases which slightly dropped to 1,843 cases in 2015.

A survey in Plumtree town shows that most TB patients who travel to Botswana rarely adhere to medication and end up being resistant to drugs.

This, says Muleya, presents a risk to the remaining citizens who from to time interact with their visiting spouses and relatives.

“I am a health professional who attends to about 15 or more deportees on a daily basis coming from Botswana.

What we have noted is that most TB patients abandon seeking medication as they fear identifying themselves and being deported for lack of travel documents.

All we need is to increase awareness campaigns or maybe craft a SADC policy on TB which will enable anyone from within the region to freely access TB medication from wherever they are regardless of travel documents or origin,” says one practitioner who preferred anonymity.

According to CDCD, the most important way to prevent the spread of drug-resistant TB is to take all TB drugs as exactly prescribed by the health care provider.

“No doses should be missed and treatment should not be stopped early.

People receiving treatment for TB disease should tell their health care provider if they are having trouble taking the drugs,” says CDCD.

The statement also says health care providers can help prevent drug-resistant TB by quickly diagnosing cases, following recommended treatment guidelines, monitoring patients’ response to treatment, and making sure therapy is completed.

The International Organisation for Migration, Zimbabwe says poverty and a poor understanding of TB disease can cause migrants to put off care seeking altogether.

“When cross-border Zimbabwean migrants live in neighboring countries such as Botswana and South Africa, they are particularly hard to reach.

This is because of the many challenges they encounter as they try to access health services.

For instance, irregular migrants often avoid using public health facilities in host countries out of fear of being intercepted and deported;  long distances between the health facilities and the main road network affects attendance; negative attitudes of health workers can impact turnout; lack of time, the cost of travel and health services, and opportunity cost also have a negative impact,” reads the statement.