South African Community Chief Overcomes TB Stigma to Become an Agent for Change

 {Photo credit: MSH}Tshoeu, skeptical at first, now encourages others to access health care.Photo credit: MSH

The role of community leaders in the response to tuberculosis (TB) in South Africa cannot be overrated. Approximately 500,000 of the country’s residents acquire active TB every year. South Africa also faces treatment adherence challenges, partially due to the stigma associated with TB in communities: nearly one in five patients with multiple&;drug resistant TB do not complete their course of medication. Community leaders, as key personalities who shape public opinion, can play a central role in fighting TB&;related stigma and encouraging people to test for TB and adhere to treatment. Nkathalo Wellness (Nkathalo), a civil society organization supported by Management Sciences for Health (MSH) through the US Agency for International Development (USAID)&;funded Building Local Capacity for Delivery of HIV Services in Southern Africa Project, has established a partnership with a local chief, Oupa Brains Tshoeu, to fight that stigma. The relationship has not been a smooth one but demonstrates the importance of working with local leaders to address health challenges in communities.

Nkathalo met Tshoeu early in 2014 when one of its volunteers was conducting community visits in Majakaneng, a district in Rustenberg, South Africa. Initially Tshoeu was skeptical and unwelcoming to the organization working in the area. He looked unwell but insisted that he had a private family doctor whom he visited regularly and showed the team the medication he was taking for what he called “flu.”

Nkathalo team leader Oniah decided to approach the chief personally about screening for TB and HIV. She collected samples of his sputum and took it to the clinic for testing. Tshoeu’s results revealed that he had active TB. Tshoeu was reluctant to initiate treatment at the clinic, stating that he was very busy and feared the stigma. He said:

What will my community say if they find out I have TB?

Oniah spent time with Tshoeu, counseling him and helping him deal with his concerns. He finally agreed to meet the team leader at the clinic, where he began TB treatment. For the first two weeks, Oniah delivered the weekly treatment refill to his house. She spoke to Tshoeu about how he could use his influence as a chief to help others who faced similar health challenges.

Tshoeu is grateful for Nkathalo’s support. "I have started gaining weight, from 54kg to 68kg… I can see progress and my appetite is back. Nkathalo saved my life," said Tshoeu.

The organization’s care has transformed Tshoeu’s outlook and behavior. He began taking responsibility for his health and completed his treatment in September 2014. He has become a great supporter of Nkathalo’s efforts in the community. He is involved in community campaigns and invites people from the organization to his home to conduct information sessions during community gatherings.

Nkathalo Wellness provides communities with information on TB and HIV symptoms, diagnosis, prevention, and treatment. In 2014, the organization provided prevention messages to 9,330 people and referred 6,651 people for TB screening.