On the surface, the series of recent dramatic escapes of patients with drug-resistant tuberculosis from a hospital in the Eastern Cape indicates that South Africa is grappling with how to balance the liberty of patients against the need to protect wider society.

In the light of the wrenching human costs of the patients' confinement, their rebellious feelings about being cut off from their loved ones is only too understandable. But so is the danger they pose to the rest of their communities if they abandon their treatment and the (often inadequate) facilities that provide it.

This debate, as muted as it has been, is, however, only confined to the Eastern Cape. Across South Africa, the XDR-TB crisis has been complicated further by the different provinces taking different approaches to deciding how long to hospitalise people with drug-resistant TB.

In KwaZulu Natal, the province with the most recorded cases, the main hospital is routinely discharging patients after six months of treatment, even if they remain infectious, to make room for new patients who, presumably, have a better chance of being cured.

The province is reportedly rapidly adding hospital beds, part of a national expansion of hospital capacity for XDR-TB. At the same time, by discharging patients who are potentially infectious, the provincial government may inadvertently be helping to spread the often deadly virus in the communities where the uncured patients return.

The treatment for XDR-TB is notoriously cumbersome, long and costly.  Patients sometimes require uninterrupted treatment for as long as two years - a considerable length of time to be spent in an often ill-equipped hospital ward. Rather than seek counter-productive quick fix solutions like it does, the provincial government needs to address the XDR-TB crisis holistically - that is sensitively to the existing patients and preventatively to the rest of our society. 

Dr Lionel Mtshali

Leader of the Official Opposition 

Contact: Dr Lionel Mtshali, 083 256 4902