Lesotho Aids diary: Counselling co-ordinator

The BBC, in conjunction with Medecins Sans Frontieres, is following the lives of seven people from the community of St Rodrigue, in Lesotho, who will share their hopes and fears as they each struggle to live with and work through the country's HIV/Aids crisis.

Mececilia Makhetha Leche | MSF counselling co-ordinator | Morija

Mececilia counsels patients on multi-drug resistant TB

About 90% of TB patients here are also diagnosed with HIV. Last week I went to St Rodrigue to introduce a TB protocol to the lay counsellors.

Every time a patient comes for refills of their TB medication, they are supposed to be referred to a lay counsellor for coaching on the importance of taking their medication every day. We call this adherence counselling.

It's new because the counsellors were only doing adherence counselling with patients taking ARVs for HIV. But we felt it was necessary to do this counselling with TB patients as some were defaulting on their treatment, which means they will end up coming back with TB symptoms again.

TB patients are given masks in the waiting room so they don't infect other patients

If that happens, then patients can become resistant to the drugs, which is serious.

After two months of taking their treatment they start to feel better and just think they are cured.

That's why they need to be told time and time again that in new cases the TB medicine must be taken for a minimum of six months, and that it's only doctors or nurses who can take them off treatment or tell them if they are cured.

Drug-resistant TB

Across Lesotho patients were dying of TB. Recently it became clear that they were dying because they were resistant to the TB drugs.

Now there is this test called a drug-sensitivity test. It's given to people who still have TB even if they're at the end of treatment.

This test tells which drug the patient is resistant to. Generally each TB patient is on four medications. When they are resistant to two of the four drugs, they are said to be multi-drug resistant (MDR) and to have MDR TB.

In early 2008, we had many patients in Lesotho who died just a week after they were diagnosed with drug-resistant TB. Now the drug-resistant TB patients are sent immediately to Botsabelo for treatment.

Wearing masks

Like with regular TB, we need to be careful when someone is coughing as they could have drug-resistant TB, and they can then pass on that drug-resistant strain of TB to someone else.

In St Rodrigue, the problem is that the consultation room doesn't have good ventilation. So people working in St Rodrigue, like the nurses and lay counsellors, don't feel safe seeing these patients in their consultation room. They wear masks when they see the patients. I think the masks help.

MSF plans to renovate the clinic so they can improve the ventilation situation.

We are doing lots of things like this to improve what we call 'TB infection control'.

For the coughing patients, they are given surgical masks when they are in the waiting areas so they are not infectious to other patients.

We also give advice to people working in the clinics to make sure that they see coughing people first so that they can then leave the clinic quickly.

People on TB treatment need to take the counselling seriously - they must adhere really well to their treatment to try to make sure they don't become resistant. Maybe with the support of the lay counsellors, they will do it.