Despite decades of investment and expanded access to free treatment, Bulawayo’s health system is grappling with a silent but dangerous crisis with reports that between one percent and five percent of thousands of patients under antiretroviral therapy (ART) and Tuberculosis (TB) medication default. Quarterly provincial review meetings and clinic audits repeatedly flag this trend, prompting the city’s health leaders to sound the alarm. In an interview with CITE, Bulawayo’s Provincial Medical Director (PMD), Dr Maphios Siamuchembu said the trend is as baffling as it is dangerous.
“I would estimate between one percent and five percent of our patients, give us this problem. One thing that happens is people feel better and they think, ‘I don’t need to continue this treatment.’ But that’s not the case,” said Dr Siamuchembu. “Patients think they’re cured” – the PMD’s warning The PMD said treatment of TB takes a minimum of six months while treatment of HIV is lifelong.
“When you interrupt that, you’re basically culturing resistance and it comes back stronger then we have no arsenal to treat you,” he said. “You get a patient who is admitted to Thorngrove Hospital, he has drug-resistant TB but then they abscond. They jump over the fence of the hospital, and they disappear.” He said the health system itself is not blameless as it has limited security at facilities where some patients literally evade care, even though nurses make follow ups to patients’ houses.
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“You enter the gate and they ask who’s there. You say, ‘it’s the health workers, we want to find out about your medicines.’ They say ‘wait for me outside, and then they jump the durawall,” he said. “Some pitch up months later in a worse condition. And you wonder why people do that, because as far as we’re concerned, we’re trying to help them get better, and also to control that they don’t spread TB to other people.” Dr Siamuchembu said defaulters often give false names, phone numbers and addresses.
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