Years of war and a fragile health system have left many people without access to treatment for chronic infectious diseases such as tuberculosis (TB) in South Sudan, where about 14,000 cases are reported every year, according to WHO. In the neighboring country, Sudan, the number of detected cases is higher, 20,000, although the population is about four times bigger. If left untreated, TB severely weakens people and can be fatal. TB is one of the top ten causes of death worldwide.
Over recent years, MSF has integrated the diagnosis and treatment of TB into some of its medical programmes in Sudan and South Sudan in order to help tackle this disease, treating refugees, internally displaced people and local communities. New and innovative tools, such as the point-of-care-ultrasound (Pocus) and GeneXpert, are making it easier to diagnose TB better and faster.
Without a proper diagnosis, people with TB may be given the wrong treatment, with the result that they fail to recover from the disease. The volatile situation in the region, where conflict frequently results in people moving from one place to another, can also result in TB patients interrupting their treatment, raising the risk that they will develop resistance to anti-TB drugs.
MSF patients and medical staff in South Sudan’s Upper Nile region and Sudan’s White Nile state describe the challenges and successes of treating TB in this difficult context
“Now I have recovered. I can walk easily and I am fit again”
John Jimis, 28, is from Malakal in South Sudan. He arrived in Sudan as a refugee in 2017, rejoining his family who had already fled the war in their country. According to UNHCR, there are about 250,000 South Sudanese refugees in White Nile state, most of them living in camps like Al Kashafa.
“I was coughing all the time and I wasn’t sleeping well. I kept going to the health centre in Jorey refugee camp. They gave me medication but I wasn’t getting any better. I saw the doctor three times or more, but my weight kept on dropping.
My relatives took me to MSF’s hospital in Al Kashafa. When I arrived I was very sick and I couldn’t sleep at night. I was brought into the hospital unconscious, weighing just 45 kg. They took a sputum sample and confirmed I had TB.
Now I have recovered. After two months I went back to the hospital and they took my sputum again. When I went back, my weight was 54 kg and it continues to increase.
The doctor has changed my medication to start the next phase of treatment. I’m taking the medication now. I can walk easily and I’m fit and healthy, thanks be to God. I am very happy as I didn’t expect such a quick recovery.”
“Due to the conflict, many TB patients had their treatment disrupted”
Yumo Arop is MSF’s TB and HIV supervisor in White Nile state, Sudan.
“In Sudan, there were cases of TB before the arrival of refugees from South Sudan, but he refugees’ basic and congested living conditions – the lack of clean water and the poor sanitation – create the perfect environment for some diseases to spread.
When a new crisis broke out in 2017 in northeast South Sudan, with violent combats, thousands of people crossed to neighbouring White Nile state in Sudan. Most of the new arrivals settled in Khor Waral refugee camp.
We screened the health of the newcomers and confirmed that some had TB. Some had been receiving treatment already in South Sudan, but due to the conflict and their displacement, many had their treatment disrupted. Some people had gone six or eight months without being treated. Health promoters helped identify possible patients and referred them to our hospital in Al Kashafa refugee camp.
It was important to restart their treatment to prevent the expansion of the disease, as an infected person sitting in an overcrowded place can spread the disease to others, sometimes to their whole family. Prophylaxis [preventive treatment] needs to be distributed to the relatives.
If not treated properly, TB can lead to many issues, such as not being able to walk, loss of appetite, cough, body weakness, fever and death. The misuse of antibiotics can also lead to patients developing resistance. Luckily we only detected one case of resistant TB in 2018.”