They scurry for cover at the sight of a blue and white police van and their women line up the streets at night in mini skirts trying to catch the eyes of randy motorists who think nothing of paying P20 for a “quickie” with a stranger.
The close to 100, 000 economic refuges, mostly from Zimbabwe, come to Botswana to seek their fortune, but for a growing number, such as Mthandazo Sibanda, it’s going painfully wrong. Exploitation by cash-in-hand bosses and discriminatory government health services have condemned them to the squalor of overcrowded shacks – and a serious illness that could kill them and become a serious public health threat.
Zimbabwean immigrants can work legally in Botswana. Most, however, do not have work permits. They do casual labouring work when they can get it. They live underground, fearful of being forcefully returned to Zimbabwe if found out by immigration officers. They cannot access government free medical support.
The rules cannot be bent, it seems, even when they are suffering from tuberculosis, the highly infectious disease for which medication, along with housing, food and clean clothes, can mean the difference between life and death.
Mthandazo Sibanda has chronic TB. Before he was bundled into a police van and dumped in a Gaborone Prisons clinic, he was adrift somewhere in Mahalapye. For a while he was treated for chronic TB at Princess Marina Hospital in Gaborone but later discharged back to Mahalapye where the treatment was discontinued. It is feared that he may have infected others.
Until he was arrested by police for failing to take treatment and put in a prison clinic, he was staying at home in Mahalapye waiting to sort out his medication problems.
He was diagnosed with the disease on 6th August 2007 and tried to adhere to the treatment regimen prescribed by doctors at his own cost. He says government medical personnel “failed to exercise due care and skill in administering treatment for TB”. He was prescribed the wrong medication which adversely affected his health. Health personnel left him to manage his own dosage which is in violation of the guidelines outlined in the Direct Observation Treatment, the standard and practice for persons afflicted with TB.
He was also given conflicting medical results for TB and medical personnel failed to appraise him on his condition regularly as is standard practice for people affected with TB which he says caused him stress and mental anguish.
In December of the same year, he was suspected to be having Multiple Drug resistant TB because he was not responding to first line medication for TB. As a result, he was given MDR -TB treatment at Princess Marina Hospital as a patient. He was then discharged from hospital on 9th January and put on home based care. In April 2008, he went for a review and the doctor discovered that he was not prescribed one of the required essential drugs “amikacin”. Later the same month, it was included to the regimen until 3rd June when he was placed on a home-based care treatment.
Health care workers were required to administer intravenous treatment on a daily basis and to make sure that he took his TB medication. Unfortunately, this was not done. Later that month, he was admitted back at Princess Marina coughing blood and very weak.
When discharged a few days later, he was given a short supply of Multi Drug Resistant TB medication and sent back to Mahalapye where the TB Coordinator told him that he could not prescribe the medication he had been using from Princess Marina Hospital.
Sibanda then decided to give up on treatment until his treatment plan was sorted out.
Then TB coordinator and some nurses came to interview him and warned him that TB policy states that, if one ceases to take treatment and is a citizen he is forcibly admitted at the hospital and given treatment and that for non citizens they are deported with immediate effect. Two weeks later, on the 9th of July 2008, the TB coordinator came with policemen to fetch him.
On arrival at Princess Marina Hospital he was taken to the isolation ward and was then given a letter from the Ministry of Health stating that he was harbouring an infectious disease. He was then kept at the hospital for 21 days without treatment and was told that the Ministry was preparing for his deportation. On the 31st of July he was given “Notice of Determination as a Prohibited Immigrant”.
He is, however, challenging his deportation order at the High Court in Lobatse.He has filed an urgent application before Justice Abednico Tafa challenging the Ministry of Health to show cause why he could not be released from the prison clinic to a medical facility preferably Princess Marina Hospital where he can be kept in isolation for the protection of himself and Batswana pending the out come of his appeal against the deportation order.
He also wants the Ministry to show cause why he can not be provided with the necessary Multi drug resistance Tuberculosis treatment pending the outcome of the appeal. Sibanda also challenges the Attorney General, Ministry of Health and the Department of Immigration to show cause why they should not be ordered to pay costs of the application on an attorney client scale and that the order being prayed for be issued urgently. He has, in the meanwhile, appealed against the Immigration department’s decision to deport him arguing that he was improperly declared a prohibited immigrant because he was diagnosed with tuberculosis.
The case highlights the hidden and often shocking world inhabited by destitute Zimbabwean immigrants and how failure to tackle the poor health service they endure could create a major public health hazard for Botswana. There aren’t any official figures on numbers of Zimbabwean migrants with TB, but health workers say cases are on the increase. Figures from the Ministry of Health show that TB infections in Botswana are on the rise especially on the back of the HIV\AIDS pandemic. Health officials say Sibanda’s case is far from unique. They explained that while Sibanda had residence papers most Zimbabwean immigrants are illegal and have sunk out of view of normal society. They stay in crowded squats where up to 15 people share one small room and they keep their TB status underground with them.
Health workers are concerned that the government is keen to restrict foreigners to emergency-only public health facilities use, which will simply push the TB problem further underground. “Closing down access to public health services is a worrying development, and, particularly in terms of TB, has serious public health implications.”