Off a shrub-lined road on the outskirts of Maseru, Lesotho’s capital, a dirt path leads to Botšabelo Hospital. The single-story, 24-bed facility overlooks a plateau stretching to flat-topped mountains. A single notebook registers visitors at the entrance. White vans labeled “Ambulance” are parked outside.
Botšabelo is Lesotho’s only hospital for people with an advanced form of tuberculosis called multidrug-resistant tuberculosis, which is resistant to some, if not all, drugs for treatment. The TB incidence rate here is the highest in the world at 852 per 100,000 individuals. In other words, in the next year, one out of every 100 or so people will contract TB. A portion of these sufferers has MDR-TB.
Partners In Health and Lesotho’s Ministry of Health opened Botšabelo in 2007. Health professionals from around Africa come here to learn proper ways to manage MDR-TB, which is notoriously difficult to treat. Medications are toxic and cause many side effects, making treatment difficult to stick to. Full recovery takes two years, at least.
Everything at the hospital caters specifically to MDR-TB. Doctors, nurses, lab technicians, and other staff are specially trained. Wards separate patients according to their level of drug-resistance. Even the building is structured around the disease; glass ceiling panels let in UV light, which kills TB bacteria, and ceiling vents refresh the air 12 to 15 times per hour to prevent the disease from spreading.
There are signs the hospital is making a difference. In the last decade, 1,500 patients have been admitted for care. In 2014, 60 percent of patients completed treatment successfully—a far cry from perfect, but greater than the global rate of 50 percent in 2012.
More compelling than the numbers, though, are the stories of people receiving care at Botšabelo and the PIH clinicians working to make this possible. Meet some of them below.
Botšabelo’s Nurse in Charge
Nurses provide most of the care at the hospital. They’re managed by Mabatloung Mofolo, who has worked at Botšabelo since 2011 and in other managerial roles with PIH since 2009. Her favorite part of her job? Caring for patients at their bedside. “You can provide help to save a life when it is needed most.”
Botšabelo attracts clinicians from across the globe. Nigerian-born Dr. David Omotayo heads PIH’s TB and MDR-TB programs in Lesotho. The physician trained in Lagos and Pretoria, South Africa, and has brought more than 20 years of experience to the hospital. "I fell in love with TB," he says. When not helping Lesotho’s Ministry of Health craft TB policy, he’s at Botšabelo checking up on patients and monitoring their treatment regimens.
The Patients’ Lounge
MDR-TB can’t be cured quickly. It can be months before patients are well enough to go home. Between morning and evening doses, they fill long hours in each other’s company. Those who are well enough take a break from their beds, walk the corridors, and watch TV in the lounge.
Intensive Care for the Sickest
MDR-TB is debilitating, but the side effects of treatment can be worse. When 47-year-old Kubelo Manyeli was admitted to Botšabelo, he was so sick he couldn’t walk. The two-year regimen of daily injections and toxic pills can cause hearing loss, nausea, and diarrhea, and it was taking its toll. For months, he lay hooked up to an IV. Doctors carefully monitored his treatment, adjusting as necessary, and gradually he responded to medications. Now, they are confident he’ll be discharged soon.
Botšabelo is at the center of a wider national MDR-TB care network. If patients are well enough to live at home, their friends or neighbors bring them medication every day after receiving training at Botšabelo. Together, they report back to the hospital for monthly checkups. Makatleno Ntsasa is a 41-year-old “treatment supporter” who watches out for Mamohau Marumo, a 28-year-old accountant. Ntsasa visits her twice a day. Halfway through treatment, it’s hard to tell Marumo is sick. “I feel normal,” she says and shrugs.
A Deadly Combination
People with MDR-TB are often already sick with HIV. About 78 percent of patients registered at Botšabelo are infected with both, including 61-year-old Thabo Selia-Lia. At Botšabelo, Selia-Lia tells Dr. Daniel Puga that he has pain on his left side and is still coughing. He’s no longer feverish, but he is vomiting and has diarrhea. Puga adjusts his medication for both MDR-TB and HIV to help manage his symptoms and side effects until they next meet.
Testing for Resistance
It’s difficult to tell which drugs aren’t working for MDR-TB patients. When they arrive for appointments, they are asked to cough up mucus, which Sofonia Makhele collects for analysis. The samples are sent up the road to the National TB Reference Laboratory, where they’re tested for drug resistance. Depending on the results, clinicians at Botšabelo put patients on drugs that will be most effective for their particular strain of MDR-TB.
The Youngest Sufferer
A sign reading “Isolation” hangs on the first of two doors leading to Naleli Maimane’s room. Nobody is sure how the 11-month-old got infected with MDR-TB, but luckily it hasn’t spread to other parts of her body—a common issue with infants whose immune systems aren’t strong enough to contain the disease to their lungs. Fortunately, Naleli is not suffering side effects and is doing well.
A Recovered Patient Pays a Visit
Drug resistance develops when patients aren't taking the correct antibiotic for their strain of TB. This often happens in Lesotho, where many clinicians don't have the tools and training to accurately diagnose MDR-TB. Reitumetse Mahobela's drug resistance had built up for months before she enrolled at Botšabelo and made a full recovery two years later. She’s a believer in spreading the word about proper treatment: “There are so many people out there. They don’t know about TB, and I think [my story] would help them take their medication.”
Interviews were conducted in April 2016.