Uloyiso Nentlekele
“Kwiminyaka engama-30 eyadlulayo isifo sephepha besinembali yoloyiso neyintlekele—uloyiso lwezazinzulu ezavelisa indlela yokulawula neyokude zitshayele esi sifo, nentlekele yokusilela okwandayo kokusetyenziswa kwemveliso yazo.”—J. R. Bignall, 1982.
KUDALA isifo sephepha siqengq’ ugodo. Sathwaxa ii-Incas zasePeru kude kudala ngaphambi kokuba abantu baseYurophu baye ngeenqanawa eMzantsi Merika. Sabhuqa amaYiputa ngexesha oofaro babesesemanqwanqweni. Iincwadi zakudala zibonisa ukuba isifo sephepha sasithwaxa izinhanha nezixhwitha-ntamo kwiBhabhiloni yamandulo, eGrisi naseTshayina.
Ukususela ngenkulungwane ye-18 ukuya kuthi xhaxhe ekuqaleni kwenkulungwane yama-20, isifo sephepha sasitshatshele ngokubulala kumazwe aseNtshona. Ekugqibeleni, ngowe-1882, ugqirha waseJamani uRobert Koch wavakalisa ngokusemthethweni ukuba ude wayifumana intsholongwane ebangela esi sifo. Kwiminyaka eli-13 kamva uWilhelm Röntgen wenza ii-X reyi, esenza kube lula ukuhlola enoba imiphunga yabantu abaphilayo ayinazimpawu zesifo sephepha kusini na. Kwandula ke, ngowe-1921, izazinzulu ezingamaFrentshi zenza isitofu sokulwa nesifo sephepha. Njengoko sithiywe ngezazinzulu ezasenzayo, isitofu iBCG (Bacillus Calmette-Guérin) sisatshila sodwa kumlo nxamnye nesi sifo. Sekunjalo, isifo sephepha siye sathi gqolo siqengq’ ugodo.
Unyango Ekugqibeleni!
Oogqirha bathumela abaguli abanesifo sephepha kwizibhedlele zokunyanga imilwelwe. Ezi zibhedlele zazisoloko zisakhiwa ezintabeni, apho abaguli banokuphumla baze basezele umoya omtsha khona. Kwaza ke, ngowe-1944, oogqirha baseUnited States benza istreptomycin, isibulali-zintsholongwane sokuqala ekwafunyaniswa ukuba siyakwazi ukulwa nesifo sephepha. Ngokukhawuleza emva koko kwenziwa amanye amayeza okuthintela isifo sephepha. Ekugqibeleni, abaguli abanesifo sephepha babenokunyangwa, kwanasemakhayeni abo.
Ikamva lalikhangeleka liqaqambile njengoko lalisihla inani labantu abanesi sifo. Ezi zibhedlele zokunyanga imilwelwe zavalwa, ibe kwayekwa nokuxhasa ngezimali uphando ngesifo sephepha. Iinkqubo zokukhusela esi sifo zaphoswa kwesinomhlwa, ibe izazinzulu noogqirha bakhangela izifo ezitsha ezilucelomngeni kwezonyango.
Nangona isifo sephepha sasisengudubul’ egeqa kumazwe asakhasayo, babesaqinisekile ukuba noko kwakuya kubakho umnyinyiva. Isifo sephepha sasiyinto yezolo. Abantu babecinga ngolo hlobo, kodwa babewuphosile umhlola.
Sibuya Sele Siqengq’ Ugodo
Kwiminyaka yee-1980, isifo sephepha sabuya kakubi yaye siqengq’ ugodo. Kwandula ke, ngoAprili we-1993, iWorld Health Organization (WHO) yathi isifo sephepha “yingxaki esehlabathini lonke,” isalek’ umsundulo ngelithi “esi sifo siya kubulala abantu abangaphezu kwama-30 ezigidi kwiminyaka elishumi ezayo ngaphandle kokuba kuthatyathwe inyathelo elikhawulezileyo ukuthintela ukunwenwa kwaso.” IWHO yayiqala ngqa ukukhupha isindululo esilolo hlobo kwimbali yayo.
Ukususela ngelo xesha, alikho “inyathelo elikhawulezileyo” eliye lathintela ukunwenwa kwesi sifo. Eneneni, imeko iye yamaxongo ngakumbi. Kutshanje, iWHO iye yanikela ingxelo yokuba abantu abaninzi baye babulawa sisifo sephepha ebudeni bowe-1995 kunawo nawuphi na omnye unyaka kwimbali. Kwakhona iWHO yalumkisa ngelithi abantu abazizigidi ezingama-500 basenokugula ngenxa yesifo sephepha ebudeni beminyaka engama-50 ezayo. Abantu abangakumbi baya kuba ngamaxhoba esifo sephepha esinganyangekiyo, nesikwaziyo ukumelana namayeza amaninzi.
Kutheni Sibuya Sele Siqengq’ Ugodo?
Esinye isizathu sikukuba ebudeni beminyaka engama-20 eyadlulayo, iinkqubo zokuthintela isifo sephepha ziye zayekwa okanye zaphela kwimimandla emininzi yehlabathi. Oku kuye kwaphumela ekubeni kuthabathe ixesha ukufumanisa nokunyanga abo banesi sifo. Loo nto iye yaphumela ekubeni liqham’ itshoba kwabaninzi size sinwenwe esi sifo.
Esinye isizathu sokubuya kwesifo sephepha kukwanda kwabantu abahlwempuzekileyo nabangondlekanga abahlala kwizixeko ezixineneyo, ngokukodwa kwizixeko ezikhulu zamazwe asakhasayo. Ngoxa isifo sephepha singaphelelanga kubantu abahlwempuzekileyo—nabani na enokwasulelwa sisifo sephepha—ukuphila phantsi kweemeko ezingentle ngokwezempilo nokuxinana kwenza ukuba abantu basulelane lula ngesi sifo. Kwakhona kwandisa amathuba okuba inkqubo yokuzikhusela yabantu ibe buthathaka gqitha ukuba ingamelana nezifo.
I-HIV Nesifo Sephepha—Ukhwembekhwembe Oluphindwe Kabini
Ingxaki enkulu yeyokuba isifo sephepha siye sakha ubuqabane nomnye umbulali, iHIV, eyintsholongwane kaGawulayo. Kubantu abasisigidi ekuqikelelwa ukuba babulawa zizizathu ezinxulumene noGawulayo ebudeni bowe-1995, mhlawumbi umntu omnye kwabathathu wabulawa sisifo sephepha. Oku kungenxa yokuba iHIV yenza buthathaka amandla omzimba okumelana nesifo sephepha.
Isifo sephepha aside sifikelele kwinqanaba lokubagulisa abantu abaninzi. Ngoba? Kungenxa yokuba iintsholongwane zesifo sephepha zivalelwa kwiiseli ezibizwa ngokuba zimacrophages. Apho, zitshixelwa yinkqubo yomntu yokuzikhusela, ngokukodwa ziiT lymphocytes, okanye iiT cells.
Iintsholongwane zesifo sephepha zifana namaphimpi avalelwe kwiminyazi eneziciko ezivalwe ngci. Le minyazi ziimacrophages ibe iziciko ziiT cells. Noko ke, xa intsholongwane kaGawulayo ifika apho, ikhaba iziciko zaloo minyazi. Xa oko kusenzeka, ezi ntsholongwane ziyaphuma zize zenze unothanda zisonakalisa naliphi na ilungu elisemzimbeni.
Ngoko ke, kunokwenzeka ngakumbi ukuba abaguli abanoGawulayo sibaqhenqethe ngamandla isifo sephepha kunabantu abanenkqubo yokuzikhusela esebenza kakuhle. Enye ingcali ngesifo sephepha yaseSkotlani yathi: “Abantu abaneHIV basengozini ngeyona ndlela. Abaguli ababini abaneHIV kwenye ikliniki yaseLondon bafumana esi sifo ngoxa babehleli epasejini ngethuba kugqitha umguli onesifo sephepha ekhwele kwibhedi enamavili.”
Ngaloo ndlela, uGawulayo uye wancedisa ekubaseleni ubhubhani wesifo sephepha. Ngokutsho kolunye uhlolisiso, ngonyaka wama-2000, ubhubhani onguGawulayo uya kubangela abantu abasisigidi esi-1,4 babe nesifo sephepha nto leyo ebisenokungenzeki. Inkalo ebalulekileyo ekusasazekeni kwesifo sephepha asikuba amaxhoba kaGawulayo asengozini ngeyona ndlela kwesi sifo kuphela kodwa nokuba asenokusidlulisela nakwabanye abantu isifo sephepha, kuquka nabo bangenaye uGawulayo.
Isifo Sephepha Esimelana Namayeza Amaninzi
Inkalo yokugqibela ebangela umlo nxamnye nesifo sephepha ube nzima ngakumbi kukuvela kwesifo sephepha esimelana namayeza. Olu hlobo lunamandla lusenokubangela esi sifo siphinde singanyangeki, njengokuba sasinjalo ngaphambi kokufika kwezibulali-zintsholongwane.
Okubangel’ umdla kukuba, ukungasetyenziswa ngendlela efanelekileyo kwamayeza okulwa nesifo sephepha kungunobangela oyintloko wesifo sephepha esikwaziyo ukumelana namayeza amaninzi. Unyango oluphumelelayo lwesifo sephepha luthabatha ubuncinane iinyanga ezintandathu ibe lufuna abaguli basebenzise amayeza amane ngokuthe rhoqo ngaphandle kokuphazanyiswa. Umguli kusenokufuneka atye isipha seepilisi ngosuku. Ukuba abaguli abazityi rhoqo iipilisi okanye abawagqibi amayeza abo, kuvela isifo sephepha ekunzima okanye ekungenakwenzeka ukuba siphele. Ezinye iindidi ziyakwazi ukuxhathisa de abe sixhenxe kumayeza esifo sephepha aqhelekileyo.
Ukunyanga abaguli abanesifo sephepha esimelana namayeza amaninzi akunzima nje kuphela, kodwa kukwabiza imali eninzi. Kunokubiza imali enokuphantse iyiphinde kangange-100 imali yokunyanga abanye abaguli abanesifo sephepha. Ngokomzekelo, eUnited States, iindleko zonyango zomntu omnye zisenokuthi kratya kwii-R1100 000!
IWHO iqikelela ukuba abantu abamalunga nezigidi ezili-100 ehlabathini lonke basenokwasulelwa sisifo sephepha esikwaziyo ukumelana namayeza, bambi babo abanakunyangwa lilo naliphi na iyeza lokulwa nesifo sephepha. Ezi ndidi zibulalayo zisulela kanye njengezo zixhaphake gqitha.
Ukusithintela Nokusinyanga
Yintoni eyenziweyo ukuhlangabezana nale ngxaki yehlabathi lonke? Eyona ndlela ifanelekileyo yokuthintela esi sifo kukukhangela kuze kunyangwe abantu abanesi sifo sasulelayo sisaqala. Oku akuncedi kuphela abo sele begula kodwa kukwathintela ukunwenwela kwesi sifo kwabanye abantu.
Xa isifo sephepha singanyangwa, sibulala ngaphezu kwesiqingatha samaxhoba aso. Noko ke, xa sinyangwa kakuhle, phantse kuzo zonke iimeko isifo sephepha siyanyangeka ukuba asibangelwa yintsholongwane emelana namayeza amaninzi awahlukeneyo.
Njengoko siye sabona, unyango olusebenzayo lufuna ukuba abaguli bawagqibe onke amayeza abo. Abasoloko besenza ngolo hlobo. Kutheni? Eneneni, ukukhohlela, umkhuhlane nezinye iimpawu ziyanyamalala kwiveki ezimbalwa emva kokuqalisa ukusebenzisa amayeza. Ngoko, abaguli abaninzi baye bacinge ukuba baphilile baze bayeke ukusebenzisa amayeza.
Ukuze ilwe nale ngxaki, iWHO iye yavelisa inkqubo ekuthiwa yiDOTS, emela “directly observed treatment, short-course [ukubekw’ esweni okwethutyana kwendlela asetyenziswa ngayo amayeza].” Njengoko eli gama libonisa, oonompilo baba liliso ukuze baqinisekise ukuba abaguli basela iyeza ngalinye abalinikwayo, ubuncinane kangangeenyanga ezimbini zokuqala. Sekunjalo, oku akusoloko kulula ukukwenza ngenxa yokuba abaninzi kwabo banesifo sephepha bakowona mgangatho uphantsi kwibutho labantu. Ekubeni besoloko bephila phakathi kwezaqunge neengxaki—abanye abanamakhaya—kunokuba lucelomngeni kubo ukuqiniseka ukuba bayawasebenzisa amayeza.
Ngoko ngaba akho nawaphi na amathemba okoyiswa ngokupheleleyo kwalo bhubhani uthwaxa uluntu?
[Ibhokisi ekwiphepha 5]
Iinkcukacha Ngesifo Sephepha
Inkcazelo: Ngokuqhelekileyo isifo sephepha sisifo esihlasela size sonakalise imiphunga, kodwa sinokunwenwela kwezinye iindawo emzimbeni, ingakumbi engqondweni, kwizintso, nasemathanjeni.
Iimpawu: Isifo sephepha semiphunga sinokubangela ukukhohlela, ukuhla komzimba nokungabi namdla ekutyeni, ukubila ngokugqithiseleyo ebusuku, ukuba buthathaka, ukukhefuzela kwaneentlungu esifubeni.
Indlela esifunyaniswa ngayo: Uvavanyo lolusu ekuthiwa yituberculin lunokubonisa enoba lo mntu ukhe wanale ntsholongwane. Ukuxilongwa kwesifuba ngeX reyi kunokubonisa umonakalo osemiphungeni, nto leyo enokubonisa ukuba wasulelwe sisifo sephepha. Ukuhlolisiswa kwesikhohlela elebhu kuyeyona ndlela iqinisekileyo yokufumana iintsholongwane zesifo sephepha.
Abo bafanele baxilongwe: Abo baneempawu zesifo sephepha okanye abo bakhe basondelelana izihlandlo eziliqela nomguli onesifo sephepha—ingakumbi kumagumbi angangeni moya kakuhle. Isitofu: Sinye kuphela isitofu—kuthiwa yiBCG. Sithintela isifo sephepha esize ngamandla ebantwaneni kodwa asifane sibancede abakwishumi elivisayo nabantu abakhulileyo. Ubukhulu becala esi sitofu sikhusela kangangeminyaka eli-15. I-BCG ikhusela kuphela abo bangenaso esi sifo; ayibancedi nganto abantu abasele benaso.
[Ibhokisi ekwiphepha 6]
Isifo Sephepha Nefashoni
Nangona kusenokuba ngumhlola, ebudeni benkulungwane ye-19, kwakuliqhayiya ukuba nesifo sephepha, ekubeni abantu babekholelwa kwelokuba iimpawu zesi sifo zazimenza umntu abe nobugcisa ngakumbi.
Umbhali wemidlalo yeqonga nokwangumbhali weenoveli ongumFrentshi uAlexandre Dumas wabhala wathi ngemeko eyayikho ebutsheni beminyaka yee-1820 kwincwadi yakhe eyiMémoires: “Kwakusefashonini ukuba neengxaki zesifuba; wonke umntu wayenesifo sephepha, ingakumbi iimbongi; kwakuyinto eyamkelekileyo ukufa ngaphambi kokufikelela iminyaka engamashumi amathathu ubudala.”
Ngokutsho kwengxelo imbongi eliNgesi uLord Byron wathi: “Ndingakuvuyela ukubulawa sisifo sephepha . . . kuba zonke iintokazi ziya kuthi, ‘Khawukhangele usizana olunguByron, akamhle ukuba makafe!’”
Umbhali waseMerika uHenry David Thoreau, ekubonakala ukuba wabulawa sisifo sephepha wabhala wathi: “Ukubola nesifo kusoloko kubukeka, kanye . . . njengobuhle obungapheliyo besifo sephepha.”
Ligqabaza ngoku kuthabatheka sisifo sephepha, inqaku leThe Journal of the American Medical Association lathi: “Oku kuthandwa kwesifo kudidayo kwangenelela ekuthandeni kwabantu ifashoni; amabhinqa ayefuna ukuba nenkangeleko eyahlukileyo abe nemizimba ecekecekana, ezibhukuza ngezithambiso eziwenza abe mhlophe ngakumbi, ibe ayethanda iilokhwe ezincinane neziyasuyasu—ekhangeleka kanye ngendlela abakhangeleka ngayo oonobuhle abanengxaki yokutya namhlanje.”
[Ibhokisi ekwiphepha 7]
Ngaba Kulula Ukwasulelwa Sisifo Sephepha?
UGqr. Arata Kochi, umalathisi weNkqubo YeWHO Yehlabathi Lonke Yesifo Sephepha ulumkisa ngelithi: “Akunakuze uyizimele intsholongwane yesifo sephepha. Nabani na unokwasulelwa sisifo sephepha ngokusezela intsholongwane yesifo sephepha ayifumene emoyeni ngokukhohlela okanye ngokuthimla. Ezi ntsholongwane zinokuthi saa emoyeni kangangeeyure eziliqela; kwaneminyaka eliqela. Sonke sisengozini.”
Noko ke, ngaphambi kokuba umntu athiwe nqo sisifo sephepha, kufanele kuqale kwenzeke izinto ezimbini. Okokuqala, umele asulelwe yintsholongwane yesifo sephepha. Okwesibini, le ntsholongwane imele ikhulele ekubeni sisifo.
Nangona usenokwasulela kukusondelelana okungephi nomntu ogula gqitha, kulula ngakumbi ukuba isifo sephepha sisasazeke kukusondelelana naye ngokuphindaphindiweyo, kanye njengamalungu entsapho ahlala kunye kwiindawo ezixineneyo.
Iintsholongwane ezisezelwa ngumntu owasulelweyo ziyaphindaphindeka esifubeni. Noko ke, kubantu abasi-9 kwabali-10 inkqubo yokuzikhusela iyakuthintela ukunwenwa kwesi sifo, ibe umntu owasulelweyo akaguli. Noko ke, maxa wambi iintsholongwane ezingasebenziyo zisenokuvuselelwa ukuba inkqubo yokuzikhusela yenziwa buthathaka ngokugqithiseleyo yiHIV, isifo seswekile, nonyango lomhlaza ekuthiwa yichemotherapy, okanye ezinye izinto.
[Inkcazelo Ngomfanekiso okwiphepha 4]
New Jersey Medical School—National Tuberculosis Center
[Umfanekiso okwiphepha 7]
Iintsholongwane zesifo sephepha ezikhutshwa yintsholongwane kaGawulayo zifana namaphimpi avulelwe emnyazini