Tuberculosis (TB)

Interview with Dr Mphu K. Ramatlapeng, Health and Social Welfare Minister, Lesotho

Dr Mphu K. Ramatlapeng, Health and Social Welfare Minister of Lesotho.
WHO/Dominic Chavez

Lesotho Health and Social Welfare Minister, Dr Mphu K. Ramatlapeng, who has held her job since 2007, practiced general medicine and headed the Clinton Foundation’s office in Lesotho. In her Ministry office recently, John Donnelly interviewed her about a threat that gives her great concern – the spread of multidrug-resistant TB (MDR-TB).

John Donnelly Q: What motivated you to accelerate the response to the MDR-TB threat?

Dr Mphu K. Ramatlapeng A:It was when we had the scare from South Africa, with their cases of XDR-TB (extensively drug-resistant TB). The cases were very near the border with Lesotho. We became aware from this that we, too, might have the same problem, and might find some XDR-TB cases.

Q: What was the initial goal?

A: To find out who has it – MDR-TB and XDR-TB. The problem of treatment failure was evident throughout our country. We applied to the Green Light Committee so that we could start treatment. At that point, we received the help of many partners – the World Health Organization, Partners In Health, and the Clinton Foundation. These partners helped us to work out a strategy to find people who had the disease.

Even then, we knew it would not be easy. People are deceived by the size of Lesotho. Outsiders especially feel they can make an impact here because Lesotho looks small on the map and because our population is just 1.8 million. They think it will be a breeze, but it is not. The terrain is unbelievable. The challenges of Lesotho – with the sparse population, the mountains, the bad roads, the lack of infrastructure, the poverty – are equal to a medium-sized country with 10 million population.

Q: So what did you do?

A: We went into an emergency mode. In six months, this is what we did: we put a new laboratory in place (actually that took two months); trained staff; refurbished a hospital and turned it into an MDR-TB hospital. You have to deal with this problem in the immediate moment. Our reaction was not typical of the way that most governments or organizations work.

Q: Your national TB laboratory is now regarded as one of the most advanced in Africa – including the use of a new technology that within 48 hours can detect whether a person has MDR-TB. How did you arrange this?

A: We had a lot of help from one of our partners, the Foundation for Innovative New Diagnostics – FIND. That is a huge step. I have never seen technology regarding TB that is so advanced. We now have this platform that can help us not only with MDR-TB or XDR-TB cases, but also for other things, such as identifying whether children born to HIV-positive mothers are positive themselves. I wish I was still young – if I was, I would go to work in this area.

Q: Lesotho, and many other countries, especially in Africa, are facing many cases of HIV-TB coinfection. What are you doing about it?

A: It is a huge challenge for us. The two epidemics are treated almost as one entity. When patients have HIV, we immediately test them for TB – we almost expect that they will have it. Even if they are negative with TB, we tell them that they can expect to have it, and they should look for any warning signs.

Q: Many of your TB cases originate from miners who work in South Africa and bring back TB to Lesotho. How do you stop the flow of TB coming into Lesotho?

A: We are enclosed by one country – South Africa. People move across the border very, very easily. One of the main problems here is that if someone gets TB in South Africa and then they move back to Lesotho, they do not often continue treatment, meaning that ordinary TB develops into MDR-TB. We have not harmonized our TB control programme with South Africa. We have started to talk about this with all the regional countries, but we have not made much advancement so far. Until we do, if one country has a problem with TB, all the countries will have a problem.

Q: What is your advice to other Ministers of Health regarding tackling MDR-TB?

A: They have to act really fast. They have to know that treating MDR-TB can be very, very expensive – so they have to look for help from the Green Light Committee in securing the second-line drugs.

Also, if you have a problem with MDR-TB, admit you have a problem. If your people are dying from this, do not put this behind closed doors. Go save them. That means not only saving the people with MDR-TB but also the general population. You have to protect the population. You have got to stop it.