Change Agents Advocate for Tuberculosis Testing and Treatment in Swaziland Communities

Rosa, a 35-year-old ex-miner’s widow and mother of three has been breastfeeding her six-month-old baby despite suffering from Multi Drug Resistant-Tuberculosis (MDR-TB). “I cannot stop breastfeeding my baby, my mother-in-law forbids me,” says Rosa. Change agents who live in the community in Swaziland visited Rosa’s homestead to persuade her to change living environment with her children and seek medical attention. It took a couple of visits to Rosa’s mother-in-law for them to agree for the children to be isolated.

I am the head of the family now since my husband died and my son passed on as a result of HIV and the extreme case of TB, so this is how my husband used to do things around here. My daughter-in-law remains here as she was married to this homestead and she does not question my judgement around here, but after your frequent visits I am slowly beginning to understand this whole TB and HIV thing and how my son died, and I thought that I should give your advice a chance to save my grandchildren,” said Rosa's mother-in-law.

In most parts of Swaziland the mother-in-law has a strong voice in the running of homesteads. This is why it was important for the change agents to get her buy-in. The agents then contributed for the children to visit the clinic, which is about 30km away, for them to be tested. Results later came and the children tested negative.

Swaziland National Network of People Living with HIV and AIDS (SWANNEPHA) with support from the International Organization for Migration (IOM) is implementing the HIV and TB co-infection project. This project is based in the southern part of Swaziland where there is a significant number of migrant workers, both active and retired. The project has trained 250 change agents and 3 facilitators who are placed in the field to implement this project.

Prayer is All We Do, God Will Heal My Son

“Listen, in this homestead we believe in God. All my life, I have never been to hospital, neither has the rest of my family. When we have a problem, we pray, nothing else, so please do not try and divert my family in our beliefs. My son will be okay, we are praying; if he dies, he will die with dignity having died in the hands of God.”

These are the words echoed by Elphas Dlamini of Matsanjeni community. His son, Bheki Dlamini suffers from MDR-TB and is facing adherence issues especially now that he is back home and under a highly religious environment that does not allow for any drugs to be administered in the body as the beliefs are that prayer and believing in God is the only solution. Bheki has defaulted on medication because he is always in the company of his family members who are taking care of him and fears that should his father find out that he is taking medication, he may face a tough decision to the extent of being disowned. He started his medication whilst in South Africa after numerous visits and teachings from a local NGO; however, trouble started when he had to come home as he knew the religious stance in his family.

Change agents have been visiting the homestead for some time and his father, Elphas, finally had a change of heart albeit after much persuasion. He allowed his son to get medical assistance for TB but will not allow the change agents to provide health education on other diseases. This is a positive step for the family and Bheki hopes that upon recovery his father will allow the rest of the family to seek health assistance.