A patient in Malawi struggles to overcome poverty, access to health care, and tuberculosis.

TB CARE II District Coordinator Patrick Gomani adjusts a mask on tuberculosis patient Zefa Charles to prevent transmission of the disease during an ambulance ride.

By Robbie Flick

Zefa lives more than two hours away from the district hospital and 20 kilometers from the nearest health center. She lives at the end of a road that quickly degrades into little more than a muddy footpath. Her home is a small mud-walled hut that she shares with her grandmother, sisters, and children.


Zefa lives in a small mud hut far from the closest hospital.


To help monitor her treatment and speed her recovery, PIH made arrangements for her to live at the hospital for six weeks.

Over a year ago, Zefa tested positive for HIV at the health center. Her CD4 count — an indicator of immune system strength — was too high to begin antiretroviral therapy, and the tuberculosis bacteria in her lungs went unrecognized, presenting a constant risk of infecting her family. Sick and failing to get better, she spent many days traveling to the health center, only to receive bactrim, an antibiotic to prevent opportunistic infections.

“Bactrim, bactrim, bactrim,” she said, “until the day I was diagnosed with tuberculosis.” She received first-line drugs, but did not get any better; tests confirmed she had multi-drug resistant tuberculosis (MDR-TB), a deadly manifestation that does not respond to first-line treatments. 

MDR-TB made an already difficult life much more challenging. “I don’t have food. I have no money. My children have no notebooks for school. The only food I eat is what these children have found,” she explained to staff from PIH's sister organization in Malawi, APZU. Gaunt with sunken eyes, it was clear how significant a toll the difficult access to health services and lack of appropriate treatment options had taken on her.

Thanks to a partnership with USAID, TB CARE II, and the Malawian government, APZU/PIH had the tools and resources to help Zefa. Malawi's National TB Programme supplied the rare second-line drugs to treat Zefa, while APZU/PIH specially outfitted a room at Neno District Hospital so she could benefit from the close oversight of clinicians.

“I’m feeling better because I will finally find the right treatment there,” she said, as APZU/PIH staff readied her for the long journey back to Neno to be admitted.

Now, after six weeks of treatment and monitoring, she is finally getting better and looking forward to returning home to finish her treatment, finally on her way to being free of tuberculosis.

Learn more about PIH's work to fight tuberculosis.


TB CARE II is a five-year project from the United States Agency for International Development designed to provide global leadership and assist National Tuberculosis Programs in high burden countries around the world to accelerate the implementation of programs for TB DOTS, TB/HIV and Programmatic Management of Drug Resistant TB (PMDT). Led by University Research Co., LLC (URC), the TB CARE II Project team is comprised of leading organizations involved in building TB service delivery systems worldwide, including Partners In Health, Jhpiego, Project HOPE, and many others. TB CARE II programs work with a wide segment of stakeholders, including policy planners, public sector providers, communities, and patients to scale up evidence-based interventions and improve outcomes in tuberculosis prevention and control.