[This entry is co-authored by doctors Elisa López Varela and Alberto García-Basteiro, ISGlobal researchers at the Manhiça International Health Research Centre (Mozambique)]
Dawn is breaking in the district of Manhiça, in southern Mozambique. The temperature will reach a sweltering 32-33ºC today. The district hospital starts bustling with activity first thing in the morning. At 7:30 a.m. in the sample collection room, people start queuing up to give sputum samples. Some of them have walked for more than an hour to reach the hospital. Others have hiked long distances to catch a chapa—a typical Mozambican form of collective transport that serves areas beyond the reach of paved roads. It is a formidable trek under any circumstances, but more so for those afflicted by an incessant cough, an overpowering feeling of weakness, and a month or two of steady weight loss.
In Manhiça, this is the usual journey for anyone suspected of having tuberculosis (TB). But these patients are luckier than people in other districts. Samples from the district hospital are analysed at the Manhiça Health Research Centre (CISM), which has a GeneXpert machine. This new diagnostic tool can detect more cases of TB than conventional microscopy. It makes immediate treatment possible for many patients who, until one year ago, were drifting from clinic to clinic, taking antibiotics that were powerless against their disease. For lack of suitable tools, many of these patients died of TB before they could be diagnosed. Throughout most of Mozambique, GeneXpert machines are not available and it remains impossible to diagnose a large percentage of patients with TB. Still, the number of patients who go undiagnosed for lack of access to the latest technology is small compared to the number of Mozambicans who never have any contact with the country’s fragile health care system. The World Health Organisation estimates that, for every case of TB diagnosed in Mozambique, another two cases go undetected. This year’s slogan for World Tuberculosis Day,‘Reach the 3 Million’, refers to the three million people with TB who are forgotten by health care systems around the world.
Mozambique has one of the highest rates of TB in the world. The medicines needed to fight the disease routinely run out, and the available diagnostic tools are antiquated and inefficient. With more than half of the population living on less than $1 per day, the country faces a pervasive shortage of health care resources that amplifies the difficulty of combating TB. In Manhiça, where we work, three out of four patients with TB are also infected with the human immunodeficiency virus (HIV), compounding the challenge of diagnosing and treating these patients. Patients with both diseases must take so many pills each day that it is naïve to expect that they will adhere to treatment. In children, the situation is even more difficult: paediatric formulations of drugs are not always available, and we have to work miracles to provide the proper dose. We often reflect on the fact that, for many Mozambicans, 15 years of war have led not to the blessings of peace and independence but rather to TB and HIV.
In the short term, there is no clear answer to the recurring question of whether the situation will ever improve. We think it will—the trend in the number of TB cases will eventually reverse in Mozambique, as it has in most countries. That’s why we’re here. In addition to our day-to-day support role at the hospital, we have the opportunity to address the huge challenge of finding tools and answers for the fight against TB. It is incredibly stimulating to carry out research on poverty-related diseases—TB being a major example—because of the potential to generate sweeping changes in society and health care. Today, as we mark yet another anniversary of the discovery of the TB bacterium, we remember the historic words of the Mozambican leader Samora Machel: “The struggle continues.”