Tuberculosis in medical doctors in KwaZulu-Natal, South Africa : personal experiences and perceptions related to their diagnosis and treatment.

Abstract

Title: Tuberculosis in medical doctors in KwaZulu-Natal (South Africa): Personal experiences and reflections related to their diagnosis and treatment. Background: The high tuberculosis (TB) incidence and prevalence fuelled by the concomitant HIV epidemic in South Africa has resulted in a high rate of tuberculosis infection in health care workers. This is the first study to investigate the experiences and reflections of doctors who were diagnosed with active TB during their employment in high TB burden hospitals in KwaZulu-Natal, South Africa. Methods: Consecutive medical doctors working in both the public and private sectors and who were treated for active tuberculosis between 2007 and 2010 were contacted to participate in the study. Each participant completed an informed consent and a validated anonymous self-administered questionnaire. The study received ethical approval from the University of KwaZulu-Natal. Results: Forty doctors participated in the study. The mean age of participants was 33.67±10.63 years. The majority were between 21 and 40 years of age (males (52.5%), and employed in the public sector (95%). Four (10%) had MDR-TB. A number of participants were referred for costly special investigations which are not considered to be part of first line care in South Africa. For example, 15 participants (37.5%) underwent chest CAT scans during the diagnostic period. Eight doctors reported complications following invasive procedures. Nineteen (47.5%) of the 33 participants (82.5%) who had experienced sideeffects related to anti-TB drugs had considered defaulting on their treatment because of the side-effects of these drugs. Many participants expressed concerns about the uncaring attitudes of senior medical colleagues and hospital management. The majority of participants had introspected on their illnesses and experiences and committed themselves to become more caring and empathic towards their patients in future. Conclusions: All health care workers and particularly nurses and medical doctors working in environments with a high burden of infectious diseases such as HIV and TB, are at increased risk to TB infection. They encounter various personal and professional problems following contraction of TB infection. These experiences had impacted in many ways on their professional lives, and some doctors have since left the medical profession because of these experiences. The risks associated with TB must be minimised. Much more therefore remains to be done in the public health care system if these trends are to be reversed; this includes health policy changes, health system changes and attitudes of medical colleagues towards medical doctors who become “victims of illnesses acquired in the course of duty”.