44-year-old Kaizer Mahapa’s battle with MDR-TB shines a spotlight on TB as a major public health concern. Lesotho has the highest incidence of TB in the world, estimated at 614 cases per 100,000.

31 October 2023 by Limpho Sello

Kaizer Mahapa relaxes as his Ha Matala home after his 26 October 2023 release from Senkatana MDR-TB Hospital. Credit: Limpho Sello.

---

Though his body is feeble and gaunt, Kaizer Mahapa’s spirit remains unbroken.

In the depths of his sunken eyes, there still burns a spark of resilience and hope, personifying the strength of the human spirit that has endured the most formidable adversaries in the form of multidrug-resistant tuberculosis (MDR-TB).

Mahapa’s fierce battle with MDR-TB dates back to 2021 when he began experiencing recurrent hospital visits due to symptoms that were initially mistaken for a common cold.

During this time, Mahapa shocked his family when he coughed up blood clots that filled approximately a five-litre bucket in one instance.

As doctors searched for answers, Mahapa underwent testing for Covid-19 and was eventually diagnosed with tuberculosis. At the beginning of his TB treatment journey, he completed treatment and initially believed he had won the battle.

However, a year ago, clinicians at Queen Elizabeth II Hospital diagnosed him with MDR-TB and quickly transferred him to the Senkatana MDR-TB Hospital, the only facility equipped to treat extremely ill MDR-TB patients.

“There was a time when I wished death upon myself,” Mahapa revealed to Uncensored News on 26 October 2023.

The World Health Organization (WHO) defines MDR-TB as a form of TB caused by bacteria that do not respond to isoniazid and rifampicin, the two most effective first-line TB drugs. WHO emphasises that MDR-TB remains a public health crisis and a global health security threat.

“MDR-TB is treatable and curable using second-line drugs. However, these second-line treatment options require expensive and toxic medications,” as stated on the WHO website.

I faced death head-on

Mahapa’s struggle with MDR-TB is further complicated by the fact that his lungs have weakened to the point of developing a heart condition.

Dr Chase Yarbrough, a senior technical advisor to Lesotho’s Ministry of Health at Partners in Health, and his colleagues have been caring for Mahapa over the past year.

Dr Yarbrough explained that Mahapa suffers from Post-TB lung disease, an ailment that has received limited attention.

In addition to his lung condition, Mahapa has a heart disease caused by the compromised functionality of his lungs. Each time his heart attempts to pump blood into his lungs, the increased pressure strains his heart.

This heart condition makes it impossible for Mahapa’s lungs to supply oxygen on their own, necessitating oxygen support.

Due to his family home not being connected to the national electricity grid, Mahapa stayed in hospital months after his release. This is because he was not going to be able to use portable oxygen concentrators and the three oxygen cylinders stationed by his bedside.

The United Nations’ Sustainable Development Goal 3 aims to ensure health and well-being for all, making a bold commitment to end the epidemics of AIDS, tuberculosis, malaria, and other communicable diseases by 2030. In line with this goal, Lesotho launched a concerted effort in August to reduce new infections.

Just last month, a local weekly publication, Newsday, reported that the Ministry of Health mobilised clinicians from twelve communities in Maseru for a two-week campaign that concluded on August 11 of this year.

The report highlighted that the success of this campaign, which covered communities such as Ha Rapokolana, Ha-Ramabanta, Semonkong, Machache, Rothe, Ha Mokhalinyane, Ha Ntsi, Maama, Mahloenyeng, and Mpatana, was marked by the diagnosis and immediate treatment of 169 TB cases, representing a crucial step in breaking the transmission cycle of this infectious disease.

The TB and HIV Coordinator of the Maseru District Health Management Team, Michael Mohlouoa, stated, “Enrolling 169 people in treatment means that we have been able to cut the chain of transmission. In simple terms, these individuals will not be able to transmit TB to the next person,” according to the article.

However, a report titled Policy and Programmatic Directions for the Lesotho Tuberculosis Program: Findings of the National Tuberculosis Prevalence Survey 2019, published in March 2022, warns that Lesotho needs to update its screening and treatment algorithms to achieve the End TB targets.

“A major focus will need to be placed on finding the “missing cases” i.e., undiagnosed or under-reported TB cases, or ensuring that not only TB symptomatic but also those who do not present with typical TB symptoms are promptly identified to reduce further onward transmission,” highlights the report.

The survey reveals a significant gender disparity in TB burden and health-seeking behaviour related to TB care, showing greater reluctance among men to seek care when they are sick.

The survey further recommends that the national program develop targeted strategies to reach men in general. It also suggests the importance of identifying where people in age groups of 35-44 and above 55 years generally seek care.

“Although we highlight the limitations and barriers of certain subgroups seeking care, another critical factor is the level of service quality especially in public health sectors. The survey identified more than 80% of symptomatic participants diagnosed with TB that had visited a public health facility. An examination of the cascade of care is required to identify why most of these people, especially men, were not diagnosed.” 

In remembrance of Dr Paul Farmer

Mahapa longed to rejoin his family as weeks passed after his hospital release.

To make this dream a reality, Partners in Health decided to renovate Mahapa’s family home, connect it to electricity and provide a shack where he could continue his informal business, thanks to the memory of Dr. Paul Farmer, the founder of Partners in Health, who passed away in February 2022.

Mpho Marole, the head of PIH Lesotho, explained how the organisation provided Mahapa with a portable oxygen concentrator, enabling him to move around his yard and work in his shack without interruption.

“So, in the case of Ntate Mahapa, we provided him with a portable oxygen concentrator, allowing him to move around the yard and work in his shack without being disconnected from oxygen. This portable device is rechargeable and highly convenient to use. With this gesture, I believe that Paul is looking down from his resting place with a smile because we are executing his mission effectively,” Marole said.

Lesotho Director General, Dr Nyane Letsie, sits with Kaizer Mahapa. Credit: Limpho Sello.

Dr Nyane Letsie, the Director General of the Ministry of Health, urged the public to normalise access to primary healthcare services for early detection.

“Prevention is better than cure. So, when TB is diagnosed early, it can be effectively treated. I also want to believe that our patient, Mahapa, would not require oxygen if his TB had been diagnosed earlier. Nevertheless, we are moving in the right direction because even in challenging cases like MDR-TB, we have managed to treat and cure it,” Dr Letsie said.

In 2022, Senkatana MDR-TB Hospital treated 129 MDR-TB cases, with a death rate estimated at 15 percent among MDR-TB patients.

Meanwhile, Dr Yarbrough expressed hope that Mahapa could set an example for other patients who require oxygen support at home. 

He recommends, “The government can use this case as an example to demonstrate that it is possible (for patients to access modern treatment). We have grown accustomed to not having access to such services.”

While Mahapa acknowledges that reuniting with his family will not be without challenges, he deeply appreciates the second chance he has been given.

“TB consumed a significant portion of my time that I could have used to develop my street vending business. I am eager to return and make up for lost time,” Mahapa expressed.