Kutama Sinthumule Correctional Centre : TB Treatment Pieter Jordaan, South African Custodial Management (SACM)
K
utama Sinthumule Correctional Centre is a maximum security correctional centre found in the Limpopo Province in the Vhembe district in the small town of Louis Trichardt. It is the largest prison in the Southern hemisphere with a population of three 024 offenders. The facility consists of three clinics, out patient department and hospital. Offenders visit the clinics on a daily basis as per schedule for consultation and screening of chronic as well as infections diseases, i.e.TB. TB is amongst the most infectious diseases found in the facility due to the cross transfers of offenders between the Department of Correctional Service and the Kutama Sinthumule Correctional Centre. The infection rate is about three offenders per month. TB screening takes place on the offender’s arrival at the facility. It is also an ongoing process to offenders who are in the facility. Sputum for AFBx2 is taken to the nearest private laboratory. Turn around time is excellent as we receive all results within 24 hours. Offenders whose smears test positive are start treatment
immediately as well as those offenders diagnosed as being positive through x-rays. Ongoing monitoring is done through Direct Observatory Treatment strategy and collection of sputum of those on treatment to monitor progress, compliance and non converters as well as drug resistant TB. Patient counselling on adherence, side effects of drugs and progress of the disease is an ongoing process until the offender finishes the treatment cycle. The facility has had six Monocular Diagnosis TB offenders. Three were referred to Sizwe Hospital between 2005 and 2006. In 2007 we had three offenders who were diagnosed with Ulti-drug Resistance TB. They were taken to the Modimolle MDR hospital to start treatment. They were all nursed in the facility in the isolated ward until they all converted and were discharged to their cells. Their cell mates were screened on numerous occasions but were found to be negative. The three offenders took their treatment from the clinics inside the facility and were seen every three months by an MDR TB doctor from
Modimolle. They took treatment for about 28 months until they were discharged during May 2010. Ongoing monitoring of sputum collection and x-ray continue even though they have completed their treatment. The facility is experiencing a number of challenges concerning TB of which the admission of new offenders it the most important. Offenders at times arrive without their TB patient cards as well as sputum results and transfer letters while their files indicate that they are on TB treatment. This is quite often confirmed by the offender himself. When an offender is transferred back to the Department Of Correctional Services the follow-up is hampered due to the fact that some offenders go to Gauteng and other provinces. The other challenge is HIV/AIDS, as these offenders are difficult to diagnose through Active Fast Bacilla. Most are diagnosed through x-rays and sputum culture which have a 4-6 weeks turn around time. The strength of combating TB in this facility is the follow up system and the team work of nurses as well as the offender support groups. The facility has not yet had a defaulter in the facility’s history, as it is easy for follow ups to be conducted due to fact that offenders are easily accessed. Ongoing health education also plays a significant role as it opens an opportunity for others to understand that the disease is curable only if one adheres to treatment. Support groups of offenders are also of assistance to the medical staff. After attending a training of trainers TB/MDR course, knowledge was shared amongst colleagues and security personnel by means of Onthe-Job training. Democratic Nursing Organisation of South Africa (DENOSA) with the partnership of International Council of Nursing are doing a huge job too by including correctional centres in their training as more TB infection is found in correctional centres. Offenders form part of the society after their release. Helping of offenders thus helps the society.
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