Confined to a hospital for 4 months because the treatment for her illness is outdated

All day Asta Djouma sits on a hard wooden bench or on a harder concrete floor and looks out the door of the small hospital room in northern Cameroon that is her universe.

She has been here since October, when she learned she had a form of tuberculosis that did not respond to the most commonly used medications. Ms. Djouma, 32, lives at the back of the hospital with half a dozen other patients who also have multidrug-resistant tuberculosis. Fearing they could infect others, the government requires them to remain there until they test negative for the potentially fatal disease. She had not seen her children, ages 9, 10 and 11, since she arrived.

The sanatorium model of tuberculosis treatment – isolating people for long periods of time – was declared obsolete in the United States and other high-income countries about 60 years ago. It existed in Eastern Europe until 15 years ago, but is still used in some low-income countries in Africa and Asia, where health systems lack the resources to update policies, retrain staff or deploy community health workers to help patients at home.

For 15 years, the World Health Organization has said that tuberculosis patients should not be isolated, confined or hospitalized at all unless they are acutely ill. Research shows that their tuberculosis treatment would be more successful if carried out at home as patients would have better mental health and be less exposed to other infections.

And the hard truth about the risk of infection is that by the time people are diagnosed, they have probably already exposed their families and colleagues. After just a few days of treatment, the number of bacteria drops, so that after diagnosis there is no longer any risk of them remaining in the family.

But efforts to enforce the updated guidelines everywhere have been hampered by disruptions and cuts in international funding for tuberculosis treatment.

Isolation remains the policy in Cameroon, even in the capital Yaoundé, where there is an isolation ward in a main hospital. In the far north of the country, all patients with drug-resistant tuberculosis are taken to a church hospital in Maroua, the regional capital. Here the patients live for at least three months, maybe longer, in cement rooms with just a bed and a few plastic trays – until they test negative for TB at least twice.

A spokesman for the Cameroon Ministry of Health said the country was gradually switching to the WHO standard. “The transition to a new treatment protocol requires increased support to teams and close clinical monitoring of patients in the first cohorts,” spokesman Clavère Nken said by email. He said the limitation was not due to resources, but simply the need to proceed diligently to ensure quality patient care.

The isolation and boredom are torturous for the patients.

“We’re just here,” Ms. Djouma said in an interview in December. “We talk a little. But we’re just here.” From her seat she could see the hustle and bustle of the main area of ​​the hospital through a gap in the walls of the compound. The isolation ward was silent except for coughing.

Most of the patients in the isolation center, like Ms. Djouma, are people in their 30s – parents and breadwinners whose sudden disappearance brings great hardship for their families. Sitting three feet apart on the wooden benches, they are the living embodiment of the profound neglect of tuberculosis treatment. Tuberculosis is the world’s leading infectious disease killer, killing 1.2 million people in 2024, the most recent year for which global data is available.

However, because tuberculosis is a disease of the poorest people in the poorest areas, systems for diagnosis and care remain outdated. Most cases in Cameroon are now diagnosed using the same method used a century ago: by looking at a smear of mucus from the lungs through a microscope. The drug therapy to cure the disease – long and difficult – has hardly changed since the 1960s.

Frédéric Lingom, the nurse who runs the Maroua treatment center, tells patients that it is best to isolate them, he said, so that he can monitor them on the four-drug regimen – which can come with dire side effects – and so that they do not infect their families.

Over the past year, caring for tuberculosis patients in rural Cameroon has become even more difficult as basic supplies became scarce following the Trump administration’s deep cuts to global health funding. The United States was the largest donor to tuberculosis programs in the world.

The WHO recommends that close contacts of a newly diagnosed tuberculosis patient be tested immediately and given preventative therapy – a six-week course of medication to ensure they do not become ill. However, hospital officials said it sometimes took months to trace and test contacts due to cuts in resources and staffing in 2025. At this point, some people were already sick.

Some of the community health workers conducting this contact tracing were paid with U.S. funds and lost their jobs. The United States also helped fund molecular diagnostic tests, but those ran out late last year. Lab technicians said they would ration them for use only on patients who appeared most likely to be infected with drug-resistant tuberculosis, rather than using them to test every suspected case of tuberculosis, as the WHO recommends.

Mr Nken, spokesman for Cameroon’s Ministry of Health, said supply shortages had been quickly resolved through changes in the supply chain and that close contacts were being diagnosed and treated within days.

When Ms. Djouma developed a persistent fever in early 2025, she was misdiagnosed with malaria. Eventually, a local clinic concluded she had tuberculosis and began treatment. But that clinic didn’t use molecular diagnosis – the method recommended by the WHO – and so missed the fact that her infection was drug-resistant. She took the medication twice a day at home for five months, but became progressively sicker.

She eventually went to the city’s main hospital, where a molecular test revealed she had the drug-resistant version of the disease. She would need medication that would be harder to obtain and harder to take. This hospital sent her to Mr. Lingom. It fell to him to break the news to her that she wouldn’t be going home any time soon.

“People don’t like the idea of ​​staying here for three or four months,” he said with subtle understatement. “Imagine coming into the hospital for some reason and being told you have to stay for four months – not four days, but four weeks. Four months. They’re not happy.”

In 2024, around 40,000 people in Cameroon contracted tuberculosis and 7,000 died; 620 people have been diagnosed with the drug-resistant strain of the disease.

Even though Mr Lingom runs the small modern sanatorium in Maroua, he worries about the impact of this isolation. “People are cut off from their families – they are all alone with their thoughts and become depressed,” he said.

He tries to encourage patients by telling them they won’t endanger their families. And he can guarantee them food in the hospital. To be effective, tuberculosis medications must be taken with food. At home, many patients cannot afford a solid meal every day.

Momini Daibou, 32, was hospitalized in late October after suffering from incessant coughing, fever and steady weight loss for months. “I felt like I had no blood left in my body,” he said. He shared a two-room house with his brother, his wife, his parents, and two young children, supporting them all with the earnings he earned as an itinerant salesman of soap, brooms, and other household items. “I am here and not working, so it is very difficult, especially the issue of food,” he said. “They’re fighting.”

Mr. Daibou’s family was not tested for tuberculosis until four weeks after his hospitalization. He was deeply relieved when everyone tested negative.

They were able to raise the money to come from his home village and visit him only once in his first month.

Twice a day there is a small burst of activity in the TB yard when Mr. Lingom carries out the recycled cardboard boxes that contain each patient’s medication boxes. And there is a bit of hustle and bustle when the call to prayer sounds from a nearby mosque and patients roll out prayer rugs in front of their rooms.

Most of the time, Mr. Daibou said, “we do nothing.”

He chats a little because his two sisters were staying at the hospital in a small row of guest rooms across the courtyard from the tuberculosis patients. It is not uncommon for family members to volunteer there to cook and shop for their sick loved ones and keep them company from a distance of three meters.

Ms. Djouma is thin and has a persistent cough, but says she feels stronger. She counts the days until she goes home to her children. But she accepts the forced isolation because she knows how sick she is. Her own parents and an aunt and uncle all died of tuberculosis. “Your health is the most important thing,” she said.