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Meet the people whose lives have been torn apart by tuberculosis

Emma Page reviews a film that discusses medicines adherence, antibiotic resistance and polypharmacy — but centres on the stories of the people involved

TB: return of the plague

TB: return of the plague

Swaziland has the highest rate of tuberculosis in the world. In Jezza Neumann’s documentary “TB: return of the plague”, we meet the people who have suffered in so many ways from the effects of the illness and the medicines used to treat it — from the mother who cares for her two adult children to the nurses who risk infection themselves to look after the sick.

Mr Neumann chooses his cast well. It is impossible not to fall in love with Nokubhega (pictured), the charming young girl who had lost her mother to the disease just two weeks before filming began. We watch as she and her brother, Melusi, are told that Nokubhega herself has the multi-drug resistant form of the disease (MDR-TB) and will have to receive treatment for almost two years, with the first six months spent isolated in the TB hospital.

Bheki, a builder in his late thirties, is struggling to come to terms with his own diagnosis, as well as that of his sister Zabile. Through Zabile’s struggle, we learn of the devastating side effects of the medicines, including vomiting and diarrhoea leading to serious weight loss. Her doctor explains that she has taken the difficult decision to suspend treatment temporarily, despite the risk of Zabile succumbing to TB, because otherwise she would die from the effects of the medicines.

Although Bheki’s condition is less serious, his health deteriorates in other ways. He becomes frustrated with the number of tablets he has to take twice a day: eight to treat the MDR-TB and two to try to alleviate the side effects, which he describes as “just too much”. We watch him struggle to cope with being no longer able to work or play football, which he blames on the medicines he is losing faith in. He shares thoughts of suicide and repeats his mantra: “this life I am living is terrible”.

Bheki’s case highlights the problems of polypharmacy and the difficulties in encouraging people to adhere to medicines that have serious side effects and no guaranteed benefit.

Less than half of those diagnosed with MDR-TB successfully complete the course of medicine. MDR-TB originally arose because of lack of adherence to TB treatment — and in some cases MDR-TB can mutate into the even more serious extremely drug-resistant TB (XDR-TB), from which 70 per cent of patients die within a month of diagnosis. The message here is clear: not only will patients die if they stop taking their medicines, they perpetuate the problem.

TB is a particular concern in Swaziland. The illness is more easily contracted with a lowered immune system, and one quarter of people there have HIV. Additionally, because people know how easily the condition is spread through the air, those who contract TB can be ostracised from society. We hear that people are so afraid of becoming infected with the disease that they will not even stop on the main road near the hospital. The stigma is such that it can lead to people hiding their diagnosis and not taking their medicines, allowing the infection to spread. Poor and often close living conditions amplify the problem.

However, the film is keen to stress that this is a global issue. As Nokubhega says: “Anyone can catch TB. It’s not choosy.” In the infectious diseases category, TB is the second biggest killer worldwide, and London has the highest prevalence in Europe. It would be easy to portray the problem as remote, but throughout the film a feeling of familiarity pervades. Images of the children dancing and Bheki supporting the local football team make us able to relate to them. The matter-of-fact delivery of the diagnoses adds to this sense of the everyday.

When characters do reveal their emotions, the filmmakers handle it sensitively. Melusi tenderly describes how much he misses his sister while she is away in isolation; Nokubhega is given time to express herself slowly in English, so that the audience can connect more easily with her.

At times, the film feels jarring and intrusive; images of stunning scenery are juxtaposed with close-up shots of the interviewees at moments of extreme misery. The film-makers somehow left me feeling both privileged to have witnessed these encounters and uncomfortable at having done so. This feeds into the overall message that the film shamelessly presses: the drugs being used to treat these patients are between 40 and 70 years old and take years to work. The side effects can be ghastly and in some cases life-threatening. The plea comes from Nokubhega herself: “We need better medicines.”

With such a clear agenda, “TB: return of the plague” might have felt contrived. Although some moments seem overly twee, the characters are so remarkable and their humanity so raw they inspire empathy and a sense of injustice rather than pity in the viewer. Their stories linger with me long after the credits have rolled.

“TB: return of the plague” is due to air on BBC4 on 19 March 2014.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2014.11135796

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