Why patients default

When a patient is being treated for TB it is vital that they complete their treatment, which can take 6 or 8 months.  If they don’t carry on taking their medication the TB can return in a drug resistant form (MDR-TB) – difficult and complicated to treat in the UK, but practically a guaranteed death sentence in poor countries where the treatment is prohibitively expensive.

Yet in poor countries there may be many more reasons why patients end up not completing their treatment.  When Emmanuel Manomano (the TB Clerk appointed by TB Alert working at Murambinda Mission Hospital in Buhera District, Zimbabwe) did an analysis of the patients who did default from their treatment he found there were several reasons why this happened. 

• Lack of transport to and from hospital.  The government supplies bus warrants, but then they don’t pay the bus companies – so most bus companies ask for cash to meet immediate costs like fuel and spare parts.
• If the patient gets adverse drug reactions they may think the drugs aren’t working and stop taking them.
• Sometimes local clinics run out of drugs – they tell the patients to come to Murambinda Hospital to get more but without transport they don’t always come.
• TB patients lose their appetite – once on drugs they regain it.  But if there is no food available they sometimes stop taking the tablets to stop feeling so hungry.
• Feeling better within a few months means patients think they are cured and stop treatment.  Once they are better, family breadwinners might leave home to go to the nearest towns looking for work.
• Treatment is free but patients have to pay for x-rays - (fifty thousand dollars [yes thousand] or about £1.20). Some don’t turn up because they can’t afford it.

Emmanuel told us about one of the patients he visited:

"Jonah had TB but he hadn’t been to the clinic for check-ups and to get his tablets for the last three months. The day I visited, he was herding cattle and it took me a while to find him.  I asked him why he had stopped coming for his medicine.  He told me:

“Before I was diagnosed with TB I was very scared due to chest pain, having sleepless nights, shortness of breath, losing weight and loss of appetite, thinking that I was about to die. But the treatment and special care I was given from hospital staff made me feel much better.  When they discharged me they referred me to a local clinic to get more drugs but they ran out and told me to go back to the hospital each month.  It is too far to walk [24km each way] and I couldn’t afford the bus fare.  The thing is I feel fine now and I have to work to make some money, and so I don’t need to come back for tablets.  I have been taking them for so long I am sure that the TB is gone because I don’t feel it at all.”

I explained to Jonah that even though he felt better, the TB was still there and could come back stronger if he didn’t keep taking the medicine, and he agreed to come back if we gave him a transport allowance each time he came.  "