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Apparently, in some provinces of South Africa, people who suffer tuberculosis can be legally detained to prevent them posing a threat to public health.

Not all tuberculosis sufferers, of course: only those with the “extensively drug resistant” strain, or XDR-TB. This strain of tuberculosis is resistant to almost every drug available to treat it. Like every other strain of tuberculosis, it also spreads through the air, when people cough and sneeze. It’s highly contagious. It would be difficult to say you wanted sufferers loose in the community.

Everything about the crisis is horrible. The disease itself is horrible. It’s not like there’s anything you can do to prevent catching it — if you’re out and about, and someone on the street happens to have tuberculosis and happens to cough as you walk past, you might now have it too. You’re more likely to be infected if you’re immuno-compromised, but really, anyone who passes a sufferer on the street is at risk.

The solution, therefore, is to take sufferers off the street. At least, that’s the theory of these South African provincial governments. They don’t care about people with treatable strains, because they’re treatable, but they do not want people on the street who can create a public health crisis. That is, another one.

All of this means that, if you are infected with certain strains of tuberculosis in certain provinces of South Africa, you will be imprisoned. You’ll be imprisoned in a run-down understaffed hospital surrounded by barbed wire fences and armed guards, and you will stay there until you get better. Or die. These governments truly aren’t fussed.

I do not like the idea of being able to catch a dangerous, virtually untreatable illness while going about my daily business. At the same time, if that did happen, I would not be comforted by the thought of being imprisoned in a badly maintained hospital from which I’d be unlikely to ever be freed. People who contract illnesses have committed no crime, and it’s totally callous to treat them like they have.

I think there are other ways to deal with this crisis. I also think those possibilities should be exhausted; imprisoning innocent people should always be a last resort.

Most cases of XDR-TB result from people who’ve refused to complete a course of treatment. They’ve taken half of it, but stopped before the virus has been completely eradicated. What remained of the virus has built up tolerance to that treatment, thus mutating into drug-resistant tuberculosis. If this is the root cause of XDR-TB, the solution is simple — to force people to take their medication.

Barriers to treatment should be removed to the greatest extent possible. It should be paid for by the government, it should be readily accessible, and so on. You don’t want people going without treatment because they can’t afford it, or can’t access it. People should be informed of just how dangerous it would be if they stopped taking their medication. This way, they would be less likely to stop just because it’s “inconvenient”. And if, despite all of this, they continued to insist on endangering society and not taking their medication… well, okay, they could be locked up. I would have no real problems with that.

People who contract XDR-TB directly, rather than cultivating it through stupidity and laziness, should not be punished. I suppose it’s a fine line to toe: you don’t want members of the community to contract XDR-TB, but you also don’t want people imprisoned when they’ve done nothing wrong. And yes, I firmly believe that people who’ve done nothing wrong should never, ever be imprisoned.

But I suppose it’s a matter of the lengths sufferers are prepared to go to. I’m sure there are medications to suppress coughing and sneezing. Sufferers could also wear surgical masks, but that would make them easily identifiable as tuberculosis sufferers and could easily lead to ostracism. It would also seem difficult to protect them from infecting family, or housemates. How could that be done?

Still, for XDR-TB sufferers to preserve their freedom, they would have to make these kinds of concessions. To refuse to do so would be selfish, and dangerous, and ultimately something they couldn’t be allowed to do. Hard as that is to admit.

I suppose the bright side for me is that I don’t have to make these kinds of decisions. It’s not my responsibility to decide the fate of the sick in South Africa; I just sit here and comment on it. This is probably a good thing, because despite everything I’ve said above, I’m not sure what I’d really do.

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One Comment

  1. It is unbelievable that that kind of stuff happens. It’s really sad 😦

    Your last paragraph really caught my attention. That is often how I feel about issues that are far away from me but that really bother me. I can’t help but be angered at people for the injustices they commit against others but I can’t offer a solution anyway so I’m glad I don’t have the big responsibility of making decisions to change the status quo.


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