Kungani “Izifo Ezelaphekayo” Zibuya?

IKHAYA lisanda kuhlanzisiswa. Nokho, njengoba kudlula izinsuku, amasonto, nezinyanga, kancane kancane uthuli nokungcola kuyabonakala futhi. Ngakho-ke, akwanele ukuhlanzisisa kanye nje kuphela. Kudingeka ligcinwe libukeka njalo.

Okwesikhashana kwabonakala sengathi imithi yesimanje yayiwuqede ngokuphelele umalaleveva, i-TB (isifo sofuba), nogcunsula. Kodwa izindlela ezidingekayo zokuvimbela lezizifo ngokucwaninga nangokwelapha ngokuvamile zazinganakwa kakhulu. Manje “uthuli nokungcola” kuye kwabonakala futhi. “Embulungeni yonke, isimo sikamalaleveva singesingathi sína futhi siba sibi kakhulu,” kusho uDkt. Hiroshi Nakajima we-WHO (World Health Organization). “Abantu kumelwe baqaphele ukuthi i-TB ibuyile—futhi ibuye ngezinkani,” kuxwayisa isazi sesifo sofuba uDkt. Lee Reichman. Futhi i-New York Times yamemezela ekuqaleni kwalelishumi leminyaka: “Kusukela ngo-1949 iziguli ezintsha ezinogcunsula zingamanani aphakeme kunawo wonke.”

Umalaleveva—Usongela Cishe Ingxenye Yomhlaba

Manje, eminyakeni ecishe ibe ngu-40 kusukela kwamenyezelwa ukuthi cishe wawuqediwe, umalaleveva ubeka usongo olungathi sína e-Afghanistan, eBrazil, eCambodia, eChina, e-Indonesia, eNdiya, eSri Lanka, eThailand, eVietnam, nasezingxenyeni ezihlukahlukene ze-Afrika. “Umzuzu ngamunye kufa abantwana ababili ngenxa yalesifo,” kubika iphephandaba laseFrance i-Figaro. Isibalo sabafayo ngonyaka siyizigidi ezimbili—abangaphezulu kakhulu kunababulawa ingculaza.

Abantu abacishe babe izigidi ezingu-270 bangenwa igciwane elithwala umalaleveva, kodwa abayizigidi eziyizinkulungwane ezingu-2,2 babhekwa njengabasengozini. “Kwenzeka kanjani ukuba umalaleveva, owawuqediwe ngaphambili noma owawulawulwe ngezinga elikhulu emaphesentini angu-90 enani labantu abasemhlabeni, manje usongele amaphesenti angaphezu kuka-40 kithina?” kubuza uPhyllida Brown kuyi-New Scientist. Izizathu ziningi.

Ukugawulwa kwamahlathi nokwenziwa kwamakoloni. Ukuhlala kwabantu ezindaweni ezinamahlathi emvula anomiyane kuye kwabangela ukubheduka kukamalaleveva eBrazil. “Esasinakho kwakuwukuhlaselwa kwendawo ezungezile yomiyane,” kusho isazi sesimiso sokuzivikela komzimba ezifweni uClaudio Ribeiro. Wathi abafuduki “babengenakho okuhlangenwe nakho ngomalaleveva futhi babengakwazi ukulwa nalesisifo.”

Ukuthuthela kwamanye amazwe. Ababaleki abafuna umsebenzi baseMyanmar bathutheleka ezimayini zamatshe ayigugu zaseBorai, idolobhana laseThailand. “Ukuthutha kwabo ngaso sonke isikhathi kwenza ukuba umalaleveva ungalawuleki,” kubika i-Newsweek. Ezinye iziguli ezingu-10 000 ezinomalaleveva ziyabikwa inyanga nenyanga—phakathi kwezisebenzi zasemgodini nje kuphela!

Uhambo lokubuka amazwe. Abaningi abavakashela izindawo ezinomalaleveva babuyela emakhaya sebengenwe yilesisifo. Ngakho, ngo-1991 abangaba ngu-1 000 baxilongelwa lesisifo e-United States, nabangu-10 000 eYurophu. Minyaka yonke amakhulukhulu ezivakashi nezisebenzi zaphesheya zibuyela eCanada zinalesisifo. Esenzakalweni esidabukisayo, abantwana ababili baba nemfiva ngokushesha nje ngemva kokuba umkhaya wakubo ubuya e-Afrika. Udokotela akazange awusole umalaleveva. “Ngesikhathi abazali bebayisa esibhedlela, kwase kwephuze kakhulu,” kubika i-Globe and Mail yaseToronto. “Bafa belandelana ngamahora ambalwa.”

Izinhlobo ezimelana nemithi. I-WHO ibika ukuthi izinhlobo zikamalaleveva ezimelana nemithi ziye zasakazeka kuwo wonke amazwe ase-Afrika ashisa kakhulu. E-Asia eseNingizimu-mpumalanga, kusho i-Newsweek, “ukumelana nemithi kwanda ngokushesha kakhulu kangangokuba ezinye izinhlobo ngokushesha zingase zingelapheki.”

Ukuntuleka kwemali. Kwezinye izindawo imitholampilo intula izinto zokwenza ukuhlola okulula nje okubizwa ngokuthi yi-blood smear. Kwezinye izindawo ingxenye enkulu yemali yezempilo idingeka ngenxa yezinye izimo eziphuthumayo, okuphumela ekuntulekeni kwemithi yokubulala izinambuzane nemithi yokwelapha. Ngezinye izikhathi kuba yindaba yokwenza inzuzo. “Ayikho inzuzo ngezifo zasemazweni ashisa kakhulu,” kuvuma i-New Scientist, “ngoba, ngokuvamile, labo abahlaselwa yizifo abakwazi ukukhokhela imithi.”

Isifo Sofuba—Umbulali Omdala Kodwa Onezimbangela Ezintsha

I-streptomycin, umlaliso owathembisa ukulawula isifo sofuba, yaqala ukusetshenziswa ngo-1947. Ngalesosikhathi, kwakucatshangwa ukuthi isifo sofuba sasiyoqedwa unomphela. Kodwa kwamanye amazwe kuye kwaqapheleka ngokushesha ukuthi isimo sibi: amazinga e-TB aye anda ngokuphawulekayo eminyakeni yamuva nje. “Ezindaweni ezikhungethwe ubumpofu eMelika,” kubika i-Washington Post, “amazinga e-TB mabi ngaphezu kwalawo asemazweni ampofu kakhulu aseningizimu yeSahara e-Afrika.” ECôte d’Ivoire kunalokho elinye iphephabhuku elikubiza ngokuthi “ukubuya kwesifo sofuba okunonya.”

UDkt. Michael Iseman uzwakalisa ukukhathazeka: “Sasiyazi indlela yokuselapha. Sasikwazi ukusilawula. Kodwa sahluleka ngandlela-thile ukusiqeda.” Yini eyaphazamisa impi yokulwa nesifo sofuba?

Ingculaza. Njengoba ishiya umuntu engavikelekile ekungenweni izifo, ingculaza ibhekwa njengembangela eyinhloko yokubuya kwe-TB. “Uma engabulawa enye imbangela kuqala,” kusho uDkt. Iseman, “cishe amaphesenti ayikhulu eziguli eziphethwe ingculaza athwele amagciwane e-TB ayoba nesifo sofuba.”

Indawo ezungezile. Amajele, amakhaya abagugile, izindawo zokukhoselisa abangenamakhaya, izibhedlela, nezinye izikhungo kungaba imithombo yesifo sofuba. UDkt. Marvin Pomerantz ulandisa ukuthi ukusebenzisa kwesinye isibhedlela indlela yokwelapha ngezifutho kwandisa ukukhwehlela ezigulini ezazine-pneumonia futhi ngalokho kwadala ngandlela-thile umqedazwe we-TB phakathi kwezisebenzi zalesosibhedlela.

Ukuntuleka kwemali. Lapho nje kwase kubonakala sengathi isifo sofuba sase silawuleka, imali eyayisetshenziswa yancipha, futhi ukunakekela komphakathi kwabhekiswa kwenye indawo. “Kunokuba siqede i-TB,” kusho uDkt. Lee Reichman, “saqeda izinhlelo zokwelapha isifo sofuba.” Isazi sokusebenza kwamakhemikhali ezintweni eziphilayo uPatrick Brennan sithi: “Ekuqaleni kwawo-1960 ngangicwaninga ngokuphathelene nemilaliso yokulwa ne-TB kodwa nganquma ukuyeka ngoba ngacabanga ukuthi i-TB yase yelaphekile.” Ngakho, ukubuya kwesifo sofuba kwabazuma odokotela abaningi. “Phakathi nesonto elilodwa [ekupheleni kuka-1989],” kusho omunye udokotela, “ngabona iziguli ezine ezintsha ezinalesifo uthisha owayengifundisa esikoleni sezokwelapha ayethé ngangingasoze ngiphinde ngizibone.”

Ugcunsula—Ibuya Elibhubhisayo

Naphezu kokusebenza ngokuphumelelayo kwe-penicillin, ugcunsula usasakazeke kabanzi e-Afrika. E-United States, wenza ibuya elinamandla kakhulu emva kweminyaka engu-40. Ngokwe-New York Times, manje ugcunsula “udlala ngesizukulwane sodokotela abebengavamile, uma kwake kwenzeka, ukubona isiguli esinalesisifo.” Kungani ubuyile?

I-crack. Ukuluthwa yi-crack kuye kwaqhubekisela phambili lokho omunye udokotela akubiza ngokuthi “ukuzitika kokuncintisana kokusebenzisa i-cocaine nobulili.” Njengoba ngokuvamile abesilisa bentshontsha ukuze basekele ukuba kwabo yimilutha, abesifazane ngokunokwenzeka badayisa ngobulili ukuze bathole izidakamizwa. “Ezikhungweni ze-crack,” kusho uDkt. Willard Cates, Jr., we-U.S. Centers for Disease Control, “kukhona ubulili nabantu abaningi okuhlanganyelwa nabo ubulili. Kungakhathaliseki ukuthi yisiphi isifo esisakazeka kulezozindawo siyoba esithathelwanayo.”

Ukuntuleka kwesivikelo. “Naphezu komkhankaso ‘wobulili obulondekile,’” kubika i-Discover, “abevé eshumini nambili basemadolonzima ukusebenzisa ama-condom ukuze bazivikele kulesisifo.” Ukuhlola okwenziwa e-United States kwambula ukuthi amaphesenti angu-12,6 kuphela alabo abahlanganyela ubulili nabantu abayingozi awasebenzisa njalo ama-condom.

Imali elinganiselwe. I-New York Times iyaphawula: “Ukwehla kwemali kuye kwathiya imitholampilo yomphakathi lapho ingxenye enkulu kagcunsula nezinye izifo ezithathelwana ngobulili kuxilongelwa khona.” Ngaphezu kwalokho, izindlela zokuhlola azinembile ngaso sonke isikhathi. Kwesinye isibhedlela omama abaningi babeletha abantwana abangenwe yilesifo, nokho ukuhlolwa kwangaphambili kwegazi lalabomama akuzange kunikeze bufakazi bukagcunsula.

Ingabe Ukuphela Kwazo Kuseduze?

Impi yomuntu yokulwa nezifo iye yaba ende futhi ekhungathekisayo. Ngokuvamile impumelelo ekulweni nezinye izifo iphazanyiswa ukwehluleka lapho kuliwa nezinye. Ingabe umuntu ulahlelwe empini ewumlibe angasoze ayinqobe? Ingabe liyoke libe khona izwe elingenazo izifo?

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Ukubhubhisa Kukagcunsula

UGCUNSULA ubangwa i-Treponema pallidum, igciwane elisontekile, futhi uvame ukutholakala ngezitho zobulili. Khona-ke leligciwane elisontekile lingena emgudwini wegazi bese lisakazeka kuwo wonke umzimba.

Ngemva kwamasonto ambalwa leligciwane lingenile, kuvela isilonda esibizwa ngokuthi i-chancre. Ngokuvamile sakheka ezithweni zobulili kodwa kunalokho singase sivele ezindebeni zomlomo, ezindlaleni, noma eminweni. Ekugcineni lesisilonda siyaphola singashiyi sibazi. Kodwa amagciwane ayaqhubeka esakazeka emzimbeni wonke kuze kube yilapho sekuvela izimpawu zesibili: ukuqubuka esikhunjeni, umphimbo obuhlungu, amalungu abuhlungu, ukuqothuka kwezinwele, izilonda, nokuvuvuka kwamehlo.

Uma ungelashiwe, ugcunsula uyahlala uzifihle okungase kuthathe sonke isikhathi sokuphila komuntu. Uma owesifazane ekhulelwa phakathi nalenkathi, umntwana wakhe angase azalwe eyimpumputhe, ekhubazekile, noma efile.

Amashumi eminyaka kamuva, abanye baqhubekela ezingeni lokugcina likagcunsula, lapho leligciwane elisontekile lingase lizinze enhliziyweni, ebuchosheni, emfunkulwini, noma kwezinye izingxenye zomzimba. Uma leligciwane elisontekile lihlala ebuchosheni, kungase kuphumele ekuqhakanyekeni komzimba, ukukhubazeka okuvamile, ngisho nasekusanganeni. Ekugcineni, lesisifo singaba esibulalayo.

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Biophoto Associates/Science Source/Photo Researchers

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“Umlingisi Omkhulu”

YILEYONDLELA uDkt. Lee Reichman abiza ngayo isifo sofuba. “Singase sifane nomkhuhlane, i-bronchitis, i-flu,” esho. “Ngakho, ngaphandle kwalapho udokotela ecabanga nge-TB, angase angaxilongi ngokunembile.” Ukuhlolwa kwesifuba nge-X ray kuyadingeka ukuze kuqinisekwe ngalesifo.

Isifo sofuba sidluliselwa ngomoya sisuka komunye umuntu siya komunye. Ukukhwehlela kungase kwenze izinhlayiyana ezincane ngokwanele ukuba zingangena emaphashini. Nokho, ngokuvamile izivikela-mzimba zinamandla anele okubhekana nalesifo. UDkt. Reichman uyachaza: “[Yilabo] kuphela abanamagciwane amaningi kakhulu ezifubeni zabo—ayizigidi eziyikhulu uma kuqhathaniswa nangaphansi kwezinkulungwane eziyishumi ezikubathwali bawo abangaqhamile—[abanga]sakaza lesisifo.”

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SPL/Photo Researchers

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Ukufudumala Kwembulunga Yonke Nomalaleveva

UMALALEVEVA awunakuqala ngaphandle komiyane obizwa ngokuthi i-Anopheles gambiae onaleligciwane. “Shintsha inani labathwali baleligciwane [isinambuzane] futhi uyoshintsha nembangela yalesisifo,” kuphawula i-Economist.

Ukuhlola kwasezindlini zesayensi zokucwaninga kuye kwabonisa ukuthi ukukhula okuncane kwezinga lokushisa kungalithinta kakhulu inani lalezinambuzane. Ngakho, abanye ochwepheshe baphetha ngokuthi ukufudumala kwembulunga yonke kungenzeka kunethonya elikhulu embangeleni kamalaleveva. “Uma ingqikithi yezinga lokushisa koMhlaba ikhula ngisho nange-degree Celsius eyodwa noma amabili,” kusho uDkt. Wallace Peters, “ingase yandise izindawo zokuzalela zomiyane kanjalo umalaleveva ungase usakazeke ngaphezu kokuba kunjalo manje.”

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Dr. Tony Brain/SPL/Photo Researchers

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Izindawo zokukhoselisa abangenamakhaya zingaba imithombo yesifo sofuba

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Melchior DiGiacomo