Eswatini: Everything for patients

For the past 15 years, Médecins Sans Frontières/Doctors Without Borders (MSF) has been operating in the Shiselweni region of Eswatini. Our teams are responding to the HIV/TB epidemics and recently the COVID-19 pandemic. Most standard activities and novel initiatives implemented have been motivated by the different needs of patients.

Bringing medical services closer to patients and their communities have been a constant ambition since the start of MSF activities. Following the outbreak of the COVID-19 pandemic, we modified how we provide medical care to our patients. For instance, one goal was to protect vulnerable patients with TB from being infected with the COVID-19 virus. So, instead of them visiting clinics to collect their monthly drugs and risk possible COVID-19 exposure, TB medications were delivered to patients’ doors.

"It really helps a lot that we get nurses visiting us, as we are used to going to the facility,” says Mrs Motsa*, a TB patient. “I understand there is a lot of similarity between COVID-19 and TB as they are both respiratory conditions, therefore I am vulnerable to it. My chances of surviving are compromised. Also, now I need not worry about money for transport or the time that it takes to go to the hospital. Instead, I get quality service right at my doorstep.”

Similarly, MSF adapted our care for people living with HIV, with many of them being able to receive their anti-retroviral medication right at their homes or in nearby communities.

With the recent developments in technology, the tasks of healthcare personnel have shifted to include digital systems. For the treatment of drug-resistant TB (DR-TB) in the community, a community member is usually responsible for monitoring a patient's daily treatment. However, triggered by COVID-19 restrictions, this responsibility was shifted to patients solely with the support of digital health technology. Using a smartphone and a special application, patients recorded videos of themselves swallowing their medications. These were then automatically sent to a healthcare facility where a health worker could review the video and check that the medication was taken correctly.

“Using the video observed therapy allows me to take my medication faithfully in the comfort of my own home. Also, I am a person who easily forgets, so the videos help me remember if I have or have not taken the medication,” says Tengetile Dlamini, an MSF patient. “I feel empowered as this has allowed me to be responsible for my own health whilst allowing me to take my medication at my own convenience.”

The novel approach of digitally supported HIV self-testing

Recently, a digital system called “Pocket Clinic” was introduced for patients wanting to perform HIV oral self-testing. This technology gives patients access to education sessions through a tablet and explains how to perform the tests themselves following electronic guidance. More than 200 patients have benefitted from this digital platform, which provides more convenient and private conditions for HIV testing.

Providing quality medical care is considered a basic duty of MSF. For the past decade and a half, patients with DR-TB disease were subjected to a two-year treatment regime, with painful daily injections for at least six months. Some patients would experience severe side effects, like permanent loss of hearing. In 2021, treatment was made easier for patients by introducing a shorter treatment regime of nine months with newly developed oral drugs, meaning no injections and fewer side effects. Around 150 DRTB patients started the short treatment and the first results showed good health outcomes with high cure rates.

Similarly, the treatment of hypertension was simplified with a new approach that only requires one pill per day instead of multiple pills, creating a much friendlier way to manage this chronic disease. More than 150 patients have received this treatment so far through primary care clinics.

Patients-centric & environment-friendly measures

Finally, MSF invested in the set up of oxygen plants in Hlathikulu hospital and Nhlangano health centre. Patients now have easy access to oxygen therapy which is much needed for the treatment of COVID-19 and other lung diseases.

Several of these patient-friendly measures have become the standard of care practised in healthcare facilities and programmes in the region and beyond. Others are gaining popularity. MSF will continue introducing more innovative and convenient ways to access healthcare services to ensure that patients receive the quality care they deserve.

Apart from being patient-centred, MSF follows environmentally friendly measures to minimise our impact on the climate and the planet in general. For instance, solar power is used to provide electricity in a remote clinic in Gege, and cars using hybrid energy sources are being used more often in our projects, thus reducing carbon emissions.