4 Months Trapped in a Hospital for an Obsolete Way of Treating Their Disease

Why It Matters

Prolonged isolation undermines patient recovery, strains already fragile health systems, and contradicts evidence‑based WHO recommendations, risking both public health and human rights. Accelerating home‑based TB care could reduce costs, improve cure rates, and align low‑income countries with global standards.

Key Takeaways

• Cameroon still uses obsolete TB isolation wards.
• MDR‑TB patients confined months, separated from families.
• WHO advises home treatment unless patient is acutely ill.
• Funding cuts stall policy updates and community health workers.
• Isolation worsens mental health and infection risk.

Pulse Analysis

The persistence of the sanitarium model in Cameroon reflects a broader challenge faced by many low‑income nations: translating global health guidelines into actionable, locally funded programs. While the World Health Organization has advocated for community‑based treatment of drug‑resistant tuberculosis for over a decade, implementation hinges on reliable financing, trained community health workers, and robust monitoring systems. In regions where health budgets are constrained and donor support fluctuates, hospitals become default containment sites, perpetuating outdated practices that were abandoned in high‑income countries decades ago.

Evidence increasingly shows that home‑based care for MDR‑TB not only accelerates bacterial clearance but also safeguards patients’ mental well‑being. Studies indicate that once patients begin effective therapy, infectiousness drops dramatically within days, making prolonged isolation unnecessary. Moreover, patients receiving support at home are more likely to adhere to lengthy drug regimens, reducing the risk of further resistance. The psychological toll of confinement—exemplified by Asta Djouma’s four‑month separation from her children—can exacerbate comorbidities and impede treatment success, underscoring the human cost of policy inertia.

Addressing this gap requires coordinated action: renewed international funding streams, capacity‑building for community health cadres, and policy reforms that prioritize patient‑centered care. Governments must streamline approval processes for home‑based treatment protocols and invest in mobile diagnostic tools to monitor patients remotely. By aligning resources with WHO recommendations, countries like Cameroon can improve cure rates, lower healthcare expenditures, and uphold the dignity of those battling one of the world’s deadliest infectious diseases.

4 Months Trapped in a Hospital for an Obsolete Way of Treating Their Disease

Health workers in developing countries know that isolating tuberculosis patients is an outdated and potentially harmful practice, but lack the resources to move away from it.

By Stephanie Nolen

Photographs by Arlette Bashizi

Stephanie Nolen and Arlette Bashizi reported this story from a tuberculosis isolation ward in northern Cameroon.

Feb. 12, 2026

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

She has been here since October, when she learned that she had a type of tuberculosis that does not respond to the most commonly used drugs. Ms. Djouma, 32, lives at the back of the hospital with a half‑dozen other patients who also have multi‑drug‑resistant tuberculosis. Fearing they could infect others, the government requires them to stay 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 sanitarium model of TB treatment — confining people in isolation for a lengthy period — was declared obsolete in the United States and other high‑income countries some 60 years ago. It lingered in Eastern Europe until 15 years ago, but it is still used in some low‑income countries in Africa and Asia, where health systems lack the resources to update policy, retrain staff or deploy community health workers to help patients at home.

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

And the hard truth about the risk of infection is that by the time people have been diagnosed, they have probably already exposed their families and co‑workers. After just a few days of treatment, their bacteria count will plunge, and so there is no further risk to having them stay among family after diagnosis.

But efforts to have the updated guidelines adopted everywhere have been hobbled by disruptions and declines in international funding for tuberculosis care.