May 21, 2009

Long Walk to TB Treatment

I’ve noted before that transportation is a crucial - and often neglected - part of health-care infrastructure. Good quality care might exist but if a person can’t get to it, they’re out of luck. That’s one reason why I spend a good chunk of my day behind the wheel, driving people places.

Here’s a picture of a neighbourhood called Mayden Farm. It consists entirely of low-income housing built by the government and distributed free to poor people. Several people who used to live in Itipini have now been moved here.
Mayden Farm is one of the biggest such communities in Mthatha (there are three or four). There are thousands of people living here. And in the entire community there is not a single clinic.

I’ve been thinking about this because there’s an older woman who lives in Mayden Farm with her daughter - an Itipini employee - and family. The older woman defaulted on TB treatment a few years back and is now re-starting. That’s good. She was getting pretty sick. But as a re-treatment patient she needs 56 doses of a drug called streptomycin that can only be given as an intra-muscular injection. If she only had to take pills, we might bend the rules a bit and give the pills to the daughter to give to her mother. But since she needs an injection, the mother has to go to a clinic every day for nearly three months.

We’ve all sat around and thought about this and concluded we are the closest clinic to their home. And we are about two miles away. On Tuesday, this mother left home at 8am and didn’t make it to the clinic until 10am. (I thought that was pretty fast.) She’s old and weak and has TB. She can’t go any faster. She shows up, gets her shot, and turns around and starts home again. That is basically her entire day.

There is another clinic about two miles in the other direction and the advantage is that taxis ply that route. But the taxi costs about five rand in each direction or a little more than a dollar for the round trip. That doesn’t sound like much but when you live on a dollar a day, well… This family earns more than a dollar a day but not by much and they need to stretch it pretty far. (She initially defaulted on her TB treatment when she was living in the rural areas because she couldn’t afford the daily taxi ride to the closest clinic for the pills.)

The reality is that Mthatha has experienced rapid growth in the past decade or so and the government hasn’t been able to keep up with infrastructure. (But churches and privately-run schools have. They dot communities like Mayden Farm.) This older woman’s condition should not be life-threatening. It’s serious, yes, but I’ve seen other people with similar symptoms make full recoveries. But because of a set of factors outside our control, this is a very serious situation.

The situation raises all kinds of questions for me. Should I just pick her up every day and drive her to the clinic? (It’s way out of the way on my daily commute.) Is that fair or right? Should we just pay for the taxi? One factor that distinguishes this situation from others is that this is an ongoing and consistent need for transportation whereas I usually provide emergency or one-time lifts places.

We did some more thinking and appear to have reached an acceptable solution that is too complex to explain here but won’t require her to do that walk every day. Still, there must be many other people like her in Mayden Farm and around Mthatha that we don’t know about. What will happen to them?

The title for this post is a corruption of the title of Nelson Mandela’s autobiography. He is famous for saying, “There is no easy walk to freedom anywhere.” Which is true. Fifteen years after he was elected, neither is there an easy walk to treatment.