The experience of 42-year-old Mrs Adebola Temitope-Adams, a tuberculosis survivor, tells it all. Tuberculosis (TB) is no respecter of person, age, or social status. For seven years, she battled TB. Even when the drugs seemed not to work, she stood on the side of hope that it would not be her end because of her mother and husband. Eventually, respite came with the opening of a multi-drug-resistant ward at the University College Hospital (UCH).
Mrs Temitope-Adams got diagnosed with TB in March 2004; that was in her final year at the university. And all through the National Youth Service Corps (NYSC) years, and later a Master’s degree programme, she was moving from private clinics to public health facilities in search of a cure.
Mrs Temitope-Adams is the national coordinator of TB People in Nigeria, and she covers southern Nigeria. She spoke at the World TB Day 2024 Media Roundtable on Shorter TB Regimens, organised by the Plan Health Advocacy and Development Foundation, in Ibadan, Oyo State.
“I don’t know where I got it from because prior to the test I was not coughing. We went for cloth-fitting in preparation for my sister’s wedding. Even though it was during an ASUU strike that I should have gained weight, I noticed that I had lost a lot of weight,” recounted Mrs Temitope-Adams.
She developed a persistent cough a few months later, and at a private hospital, she took an X-ray and sputum tests, which came back positive for TB. She began treatment; and, instead of returning to school, her mother wanted her to stay back at home to complete her treatment.
“I couldn’t afford to postpone my studies, so I would be able to graduate with my friends. So I insisted that I was going back to school. Therefore, they had my drugs sent to me. Unfortunately, I couldn’t take the drugs on time. Because I was not adhering to my medication, I had a relapse, so an injectable antituberculosis drug was given in addition to the other TB medication,” she stated.
Today, there are several drugs approved for use against tuberculosis. The drugs used and the length of treatment are the same for both adults and children, but the dosage is based on a person’s weight.
People with active TB are generally treated with a combination of four drugs. Drug treatment typically lasts at least six months and sometimes longer. Stopping treatment too early can result in the infection coming back and lead to the development of drug-resistant tuberculosis.
Due to the relapse, Mrs Temitope-Adams’s test after the eighth month came back positive for TB. So she starts to shuttle between both private and public health facilities because some days she feels strong, and on other days she is tired.
Also, she couldn’t proceed to work after graduation because no employer would want someone who is always sick. That was the reason she pleaded with her mother to support her going back to school for her Master’s degree in 2006, which she finished in 2009.
“I kept going in and out of DOT centres. In all, I went to four DOT centres and, in between, about three private facilities. Because of the stigma, I did not go to nearby hospitals where I could meet someone who would know me. I even went to an herbal doctor when I was almost losing it,” she declared.
She kept moving from one centre to another where she was not known, and an injectable antituberculosis drug was given in addition to other TB medications, with the faith that probably one of the drugs would still work for her.
“After taking the treatment twice and it was not going well, my widowed mother had to sell a parcel of land for N4 million to be able to continue supporting my treatment. The health centres insisted I not repeat the drugs.
“For four months in 2009, I was given the injectable antituberculosis drug at the private hospital and spent about N120,000 just on this. Each ampoule of the injection cost N400. Still, it persisted. I just knew that I was still breathing because by then I was so thin.”
For her, death was not an option. Being the last born in the family with four girls and a mother who recently lost her husband, she kept encouraging herself to keep pushing on. She couldn’t proceed to work after graduation.
Her mom, a school teacher, is educated and understands the importance of treatment adherence. It was difficult for her to see her daughter down with TB months after her husband died in a road accident.
In 2008, she met with a man who showed interest in her and wanted to marry her. He did not consider someone with TB as one to run away from.
In fact, he took her to the hospital, and his love remained resolute even when people tried to discourage him. He also knew marriage could only happen after the completion of her treatment.
But repeating the TB drugs, she was told, was useless. This continued until, during her studies for a higher degree in urban and regional planning at the University of Ibadan. She went to the chest clinic of the University College Hospital to plead for help. Then her sputum sample was again taken alongside others and sent to Belgium for testing.
The results of her test came back from Belgium and said that she had multidrug-resistant TB. So she was among the first set of individuals with MDR-TB that the hospital took into their new ward for a treatment that lasted for 24 months.
“At the ward, we were given injectable antituberculosis drugs alongside other TB medications. The side effects of these drugs were terrible: changes in eyesight, pins and needles, noise in the ear, hearing loss, and a severe headache. For me, it affected my hearing and vision,” she recalled.
Eventually, after the third time of testing, the result came back negative, and the injectable antituberculosis drugs were stopped. That was after she had been on the injection for seven months. She later continued with the other antituberculosis drugs for another 14 months, after she was discharged from the UCH’s MDR ward.
To fill the time, she learned a trade, She learnt interior decoration and hat- making. She just didn’t want to stay at home doing nothing.
Through it all, the man she later married remained strong in her support. Of course, marriage happened afterwards.
“I was on my medications, so I couldn’t get pregnant because of the toxic effects of the drug on unborn babies. But thankfully, immediately after I finished my drugs, the following month, I got pregnant,” she added.
The mother of five, who had normal deliveries, added: “In fact, my pregnancies were smooth. Pregnancy was easy for me; in fact, my last baby born in 2023 was the easiest of them all.”
Mrs Temitope-Adams said for her, it was a wild experience: “I took over 5000 anti-TB tablets and over 600 injectable antituberculosis drugs in over eight months.
“I don’t know what kept me going. But I just know that I didn’t want to die because of my mother and then because my husband stood by me. I know that if anything, he too deserves to be happy.”
She, however, said it is important that people know that TB is not the end of the world.
“With TB, you only need to take drugs for four months based on the short-course therapy for TB, and it will go. It is not like hypertension; you will need to take the medications for life. So we need to encourage people not to default on their medication,” said Mrs. Temitope-Adams.
Shorter regimens will not only reduce the burden on patients but also enhance treatment adherence and completion rates. Its other advantages include improved adherence, reduced treatment failure, enhanced patient experience, and cost savings.
Interestingly, the person on treatment within four weeks cannot infect people around them. After about two months of its use, the person feels very strong and believes that he is okay. As such, people at this time default. However, the medications must not be stopped so that the TB germs can eventually sleep to death.
Also, individuals with TB shouldn’t be stigmatised by people, including health workers.
“I have gone through stigma. The healthcare worker who tells you that you have TB even tries to drive you away from moving close to him, forgetting that TB somewhere is TB everywhere. When we don’t stigmatise, a lot of people can easily come out to say they have TB and get treated,” she advised.
Even so, she said ending TB by 2030 also required that individuals be adequately informed about the signs and symptoms of TB to look out for. And thankfully, there are shorter TB treatment regimens to prevent and treat TB.
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