Ukunqoba Kanye Nenhlekelele
“Umlando wesifo sofuba kuleminyaka engu-30 edlule uye waba owokunqoba kanye nenhlekelele—ukunqoba kososayensi abavela nendlela yokulawula nokuqeda lesi sifo ekugcineni, kanye nenhlekelele yokuhluleka okukhulu ukusebenzisa izinto abazitholile.”—J. R. Bignall, ngo-1982.
ISIFO SOFUBA (TB) sekuyisikhathi eside sibulala abantu. Sahlasela ama-Inca asePeru esikhathini eside ngaphambi kokuba abeLungu bafike ngemikhumbi eNingizimu Melika. Sahlasela abaseGibithe ngesikhathi sokubusa kofaro. Imibhalo yasendulo ibonisa ukuthi i-TB yayihlasela kokubili abantu abavelele nabantukazana eBabiloni lasendulo, eGreece naseChina.
Kusukela ekhulwini le-18 kuze kube sekuqaleni kwekhulu lama-20, i-TB yayiyimbangela eyinhloko yokufa kwabantu emazweni aseNtshonalanga. Ekugcineni, ngo-1882, udokotela waseJalimane uRobert Koch wamemezela ukuthi ulitholile igciwane elibangela lesi sifo. Eminyakeni engu-13 kamuva uWilhelm Röntgen wathola ama-X ray, okwavula indlela yokuxilonga amaphaphu abantu abaphilayo ukuthi awanazo yini izimpawu zesifo sofuba. Ngokulandelayo, ngo-1921, ososayensi baseFrance bathaka umuthi wokugomela i-TB. Njengoba yethiwa ngososayensi abayithaka, i-BCG (Bacillus Calmette-Guérin) isewukuphela komuthi okhona wokugomela lesi sifo. Noma kunjalo, i-TB yaqhubeka ibulala abantu.
Ikhambi Ekugcineni!
Odokotela bathumela abantu abaphethwe i-TB ezindaweni ababezolulamela kuzo. Lezi zibhedlela zazivame ukuba sezintabeni, lapho abagulayo babengaphumula khona futhi bathole umoya ohlanzekile. Khona-ke, ngo-1944, odokotela base-United States bathola i-streptomycin, okuwumuthi wokuqala owaphumelela ekwelapheni i-TB. Ngokushesha kwenziwa neminye imithi enqanda i-TB. Ekugcineni, abaphethwe i-TB babengelashelwa ngisho nasemakhaya.
Njengoba ukusakazeka kwalesi sifo kwakuncipha, ikusasa lalibonakala liqhakazile. Izindawo zokululama zavalwa, futhi ukuxhaswa ngokwezimali kocwaningo lwe-TB kwanqamuka. Izinhlelo zokugoma zayekwa, futhi ososayensi nodokotela bafuna izinto ezintsha eziyinselele kwezokwelapha.
Nakuba i-TB yayisabulala abantu emazweni asathuthuka, kwakuqinisekwa ukuthi isimo sasiyoba ngcono. I-TB yayisiqediwe. Abantu babecabanga kanjalo, kodwa babeshaye phansi.
Ukubuya Ngezinkani Okubhubhisayo
Maphakathi nawo-1980, i-TB yaqala ukubuya ngezinkani ngendlela esabekayo nebhubhisayo. Khona-ke, ngo-April 1993, i-World Health Organization (WHO) yamemezela ukuthi i-TB “iyisici esiphuthumayo embulungeni yonke,” inezela ngokuthi “lesi sifo sizobulala abantu abangaphezu kwezigidi ezingu-30 eminyakeni eyishumi ezayo uma kungathathwa isinyathelo esiphuthumayo sokunqanda ukusakazeka kwaso.” I-WHO yayiqala ngqá ukwenza isimemezelo esinjalo.
Kusukela ngaleso sikhathi, akukho ‘sinyathelo esiphuthumayo’ esiye sanqanda ukusakazeka kwalesi sifo. Eqinisweni, isimo siye saba sibi kakhulu. Muva nje, i-WHO yabika ukuthi i-TB yabulala abantu abaningi ngo-1995 ukwedlula noma yimuphi unyaka emlandweni. I-WHO yaxwayisa nangokuthi abantu abangaba izigidi ezingu-500 bangase baphathwe yi-TB eminyakeni engu-50 ezayo. Abantu babezoqhubeka beba izisulu ze-TB engelapheki, emelana nemithi enhlobonhlobo.
Kungani Yabuya Ngendlela Ebhubhisa Kangaka?
Isizathu siwukuthi phakathi neminyaka engu-20 edlule, izinhlelo zokulawula i-TB ziye zancipha noma zaphela ezingxenyeni eziningi zomhlaba. Lokhu kuye kwabangela ukwephuza ukuxilonga nokwelapha labo abanalesi sifo. Lokho-ke kuye kwaphumela ekufeni kwabantu abengeziwe nasekusakazekeni kwalesi sifo.
Esinye isizathu sokuqubuka kabusha kwe-TB inani elandayo labantu abampofu, abangondlekile abahlala emadolobheni aminyene, ikakhulukazi emadolobheni amakhulu emazweni asathuthuka. Nakuba i-TB ingahlaseli imiphakathi empofu kuphela—noma ubani angaba nayo—izimo zenhlalo ezingahlanzekile neziminyene zenza kube lula ukusakazeka kwesifo phakathi kwabantu. Lezi zimo zandisa namathuba okuba izimiso zemizimba yabantu zokuzivikela ezifweni zibe buthaka kakhulu ukuba zimelane nalesi sifo.
I-HIV Ne-TB—Inkinga Ekabili
Inkinga enkulu iwukuthi i-TB ne-HIV, igciwane lengculaza, sekwakhe ubuhlobo obubulalayo. Phakathi kwabantu abalinganiselwa esigidini esisodwa ababulawa izifo ezihlobene nengculaza ngo-1995, ngokunokwenzeka abayingxenye eyodwa kwezintathu babulawa yi-TB. Lokhu kungenxa yokuthi i-HIV iwohloza amandla omzimba okumelana ne-TB.
Kubantu abaningi igciwane le-TB alikubangeli ukugula. Ngani? Ngoba amagciwane e-TB abanjwe amangqamuzana okuthiwa ama-macrophage. Lapho, avalelwe isimiso somuntu somzimba sokuzivikela ezifweni, ikakhulukazi ama-T lymphocyte, noma ama-T cell.
Amagciwane e-TB anjengezimfezi ezivalelwe kobhasikidi abavalwe ngcí. Labobhasikidi bangama-macrophage, kanti izivalo zabo zingama-T cell. Nokho, lapho kufika igciwane lengculaza, likhahlela labobhasikidi kuvuleke izivalo. Lapho kwenzeka lokho, amagciwane ayabaleka futhi ahlasele noma iyiphi ingxenye yomzimba.
Ngakho-ke, abantu abanengculaza basengozini enkulu yokuba ne-TB kunabantu abanezimiso zokuzivikela ezifweni ezisebenza kahle. Uchwepheshe we-TB eScotland wathi: “Abantu abane-HIV basengozini enkulu kakhulu. Abantu ababili abanengculaza emtholampilo waseLondon bangenwa yilesi sifo ngemva kokuba babekade behleli ephasishi lapho kudlula umuntu owayephethwe yi-TB esunduzwa ngenqola.”
Ngakho, ingculaza iye yabhebhethekisa ubhadane lwe-TB. Ngokwezinye izibalo, ngonyaka ka-2000, isifo sengculaza siyobangela i-TB kubantu abayizigidi ezingu-1,4 abebengeke bagule ukube bebengenaso isifo sengculaza. Isici esibalulekile ekusakazekeni kwe-TB asikhona nje ukuthi abaphethwe yingculaza basengozini enkulu yokungenwa yilesi sifo kuphela kodwa futhi nokuthi bangadlulisela i-TB nakwabanye abantu, kuhlanganise nalabo abangenayo ingculaza.
I-TB Emelana Nemithi Enhlobonhlobo
Isici sokugcina esenza ukulwa ne-TB kube nzima kakhulu ukuqubuka kwe-TB emelana nemithi. Lenhlobo yesifo sofuba ingase yenze lesi sifo singelapheki, njengoba kwakunjalo nasesikhathini sangaphambi kokutholakala kwemithi.
Kuyindida ukuthi ukusetshenziswa kabi kwemithi yokunqanda i-TB kuyimbangela eyinhloko ye-TB emelana nemithi enhlobonhlobo. Inqubo ephumelelayo yokwelapha i-TB ithatha okungenani izinyanga eziyisithupha futhi idinga ukuba abagulayo baphuze izinhlobo ezine zemithi njalo. Kungase kudingeke ukuba ogulayo aphuze amaphilisi angaba ngu-12 ngosuku. Uma abagulayo bengayiphuzi njalo imithi noma bengayiqedi, kuqubuka uhlobo lwe-TB okunzima noma okungenakwenzeka ukulunqanda. Olunye uhlobo lwalesi sifo lumelana nemithi ye-TB evamile engaba ngu-7.
Ukwelapha abantu abane-TB emelana nemithi enhlobonhlobo akunzima nje kuphela, kodwa futhi kuyabiza. Izindleko zingaphindeka cishe kayikhulu kunezindleko zokwelapha abanye abantu abane-TB. Ngokwesibonelo, e-United States, izindleko zokwelapha umuntu oyedwa zingase zibe ngaphezu kuka-R1100 000!
I-WHO ilinganisela ukuthi kungenzeka ukuthi abantu abangaba izigidi eziyikhulu emhlabeni wonke banezinhlobo ze-TB ezimelana nemithi, ezinye ezingenakwelapheka nanganoma imiphi imithi ye-TB. Lezi zinhlobo eziyingozi zisakazeka njengohlobo oluvamile.
Ukugoma Nokwelapha
Yini eyenziwayo ukuze kunqandwe lesi simo esiphuthumayo embulungeni yonke? Indlela engcono kakhulu yokulawula lesi sifo iwukusithola nokwelapha esibaphethe lapho sisaqala. Lokhu akusizi labo asebegula kakade kuphela kodwa kuvimba isifo singasakazekeli kwabanye.
Uma i-TB ingelashwa, ibulala izisulu zayo ezingaphezu kwengxenye. Nokho, uma yelashwa ngendlela efanele, i-TB iyelapheka cishe kubo bonke abantu uma ingabangelwa igciwane elimelana nemithi ehlukahlukene.
Njengoba sesibonile, ukwelapha okuphumelelayo kudinga ukuba abagulayo bayiphuze bayiqede yonke imithi. Ngokuvamile, abakwenzi lokho. Ngani? Phela, ngokuvamile ukukhwehlela, imfiva nezinye izimpawu kuyanyamalala ngemva kwamasonto ambalwa kuqalwe inqubo yokwelapha. Ngakho, abaningi abagulayo baphetha ngokuthi baluleme bese beyeka ukuphuza imithi.
Ukuze ilwe nalenkinga, i-WHO igqugquzela uhlelo olubizwa ngokuthi i-DOTS, okumelela amagama athi “directly observed treatment, short-course [inqubo yesikhashana yokwelashwa ugadiwe].” Njengoba igama libonisa, izisebenzi zezokwelapha ziqapha isimo ukuze ziqiniseke ukuthi abagulayo bayawuphuza umuthi ngamunye, okungenani izinyanga zokuqala ezimbili zokwelashwa. Nokho, lokhu akulula ukukwenza ngaso sonke isikhathi ngoba abaphethwe i-TB bahlala ezindaweni eziqhelile emphakathini. Njengoba ukuphila kwabo ngokuvamile kugcwele usizi nezinkinga—abanye baswele ngisho namakhaya—inselele yokuqikelela ngaso sonke isikhathi ukuthi bayayiphuza imithi yabo ingathena amandla.
Ngakho, ingabe akhona amathemba okunqoba lolu bhadane lwesintu ekugcineni?
[Ibhokisi ekhasini 5]
Amaqiniso Nge-TB
Incazelo: I-TB iyisifo esivame ukuhlasela futhi sonakalise amaphaphu, kodwa singadlulela nakwezinye izingxenye zomzimba, ikakhulukazi ebuchosheni, ezinsweni, nasemathanjeni.
Izimpawu: I-TB ehlasela amaphaphu ingabangela ukukhwehlela, ukuzaca nokuphelelwa uthando lokudla, ukujuluka ube manzi ebusuku, ubuthakathaka, iphika nobuhlungu besifuba.
Indlela exilongwa ngayo: Ukuhlolwa kwesikhumba kungabonisa ukuthi umuntu ungenwe yigciwane yini. I-X ray yesifuba ingabonisa umonakalo emaphashini, ongase ube uphawu lokuthi i-TB isiqalile. Ukuhlolwa kwesikhwehlela sogulayo endaweni yocwaningo kuyindlela ethembeke kakhulu yokuthungatha amagciwane e-TB.
Labo okufanele bahlolwe: Yilabo abanezimpawu ze-TB noma abaye basondelana ngokuphindaphindiwe nomuntu one-TB—ikakhulukazi emagumbini angenamoya owanele.
Imithi yokugoma: Kunomuthi owodwa vó wokugoma—owaziwa ngokuthi i-BCG. Unqanda i-TB ebhubhisayo kubantwana kodwa awulona usizo entsheni nakubantu abadala. Okukhulu okwenziwa yilomuthi wokugoma ukuvikela umuntu iminyaka engaba ngu-15. I-BCG ivikela abangakangenwa yilesi sifo kuphela; ayibasizi abantu asebenaso kakade.
[Ibhokisi ekhasini 6]
I-TB Nemfashini
Nakuba kungase kubonakale kuyinqaba, phakathi nekhulu le-19, i-TB yayidunyiswa, njengoba abantu babecabanga ukuthi izimpawu zalesi sifo zazigqamisa imibono yobungcweti, enokuqonda.
Cishe ekuqaleni kwawo-1820, u-Alexandre Dumas, umlobi wemidlalo yaseshashalazini namanoveli waseFrance, wabhala encwadini yakhe ethi Mémoires: “Kwakuyimfashini ukukhala ngesifuba; bonke abantu babezaca, ikakhulukazi izimbongi; kwakuyinto enhle ukufa ngaphambi kokuba neminyaka engamashumi amathathu.”
Kubikwa ukuthi imbongi yaseNgilandi uLord Byron yathi: “Ngingathanda ukubulawa ukuzaca [TB] . . . ngoba zonke izintokazi beziyothi, ‘Ake nibheke uByron bandla, indlela amuhle ngayo njengoba efa!’”
Umlobi waseMelika uHenry David Thoreau, okubonakala sengathi wabulawa i-TB, wabhala: “Ukuwohloka nokugula komzimba kuvame ukuba kuhle, . . . njengokuzaca okubabazekayo.”
Siphawula indlela i-TB eyayibahlaba umxhwele ngayo abantu, isihloko esithile kuyi-Journal of the American Medical Association sathi: “Ukuthandwa kwalesi sifo okuyindida kwakuthonya imibono yemfashini; abesifazane babeshisekela ukuba babukeke bephaphathekile futhi bezacile, babesebenzisa izimonyo ezikhanyisa ibala, futhi bethanda izingubo ezinde eziveza ubuncane bomzimba—njengalobo obuthandwa onobuhle banamuhla ababukeka sengathi babulawa indlala.”
[Ibhokisi ekhasini 7]
Ingabe Kulula Ukungenwa Yi-TB?
“Ayikho indawo yokucashela amagciwane esifo sofuba,” kuxwayisa uDkt. Arata Kochi, umqondisi we-Global TB Programme ye-WHO. “Noma ubani angangenwa i-TB ngokumane ahogele igciwane le-TB elisemoyeni elikhishwe othile lapho ekhwehlela noma ethimula. Lamagciwane angahlala emoyeni amahora amaningi; ngisho neminyaka. Sonke sisengozini.”
Nokho, ngaphambi kokuba umuntu aphathwe yi-TB, kumelwe kwenzeke izinto ezimbili. Okokuqala, kumelwe angenwe amagciwane e-TB. Okwesibili, lamagciwane kumelwe abangele isifo.
Nakuba ungase uyithole ngokuthintana isikhashana nomuntu onayo, i-TB cishe ingasakazeka ngokuthintana ngokuphindaphindiwe, njengaphakathi kwamalungu omkhaya ahlala endaweni eminyene.
Amagciwane ahogelwe umuntu ongenwa yilesi sifo ayanda esifubeni. Nokho, kubantu abangu-9 kwabayishumi, isimiso somzimba sokuzivikela ezifweni siyawavimba, kanjalo umuntu ongenwe amagciwane angaguli. Nokho, ngezinye izikhathi amagciwane asefile angavuswa ukuba buthaka kwesimiso sokuzivikela ezifweni ngenxa ye-HIV, isifo sikashukela, ukwelashwa komdlavuza ngamakhemikhali, noma ezinye izimbangela.
[Umthombo Wesithombe ekhasini 4]
New Jersey Medical School—National Tuberculosis Center
[Isithombe ekhasini 7]
Amagciwane e-TB adedelwa igciwane lengculaza anjengezimfezi eziphuma kobhasikidi