Johannesburg’s Sizwe Hospital is surrounded by razor wire and sealed behind a barricaded gate. Armed guards patrol the grounds. Sizwe, like a few other South African hospitals, is dedicated solely to treating patients with highly contagious, drug-resistant strains of tuberculosis: MDR-TB and XDR-TB.

South African law states that anyone diagnosed with MDR or XDR must be hospitalized for at least six months, or until they’re deemed noninfectious. But hospitalization means patients are completely isolated from their families, their jobs, and their communities. A few patients have been in Sizwe for years, and many never respond to treatment; their only chance of leaving is in a coffin.

“Almost every time I go there, there’s a riot,” says UNC epidemiologist Annelies Van Rie. “Or there was a riot the week before, or there will be a riot the week after. The patients are very, very unhappy there.”

The staff are unhappy, too: about 20 percent of the nursing posts remain vacant. “Hardly anybody wants to work there,” Van Rie says. “And everybody’s scared of XDR, so the doctors kind of zoom in and out. Many patients complain that they’re hospitalized but only see a doctor once a week. It’s a very difficult situation.” Desperation sometimes drives patients to attack staff members or even take them hostage.

Many patients don’t even understand why they’re being detained, Van Rie says. “They just know they’re being held in a place with a lot of sick people and others who wear masks and give them a wide berth.”

Most escapes happen during the holidays. The police don infection-control gear, hunt down the escapees, and drag them back. They usually find the patients in their own homes, begging to stay with their families.

Right now TB test results take at least two months to produce, and patients must have two negative tests before they’re deemed noninfectious. Van Rie is working with colleagues to find a way to shorten patients’ time at Sizwe. “But we need data for that,” she says. “I think if we can develop very rapid methods to diagnose when somebody’s no longer highly infectious, then patients will understand when you say, ‘You’re ill, you might get sick from those drugs and we’re going to monitor that, we’re going to help you learn to swallow all these pills, tell you what the side effects are…’ I think that’s much better than what they say now, which is, ‘Six months at a minimum and it might be two years.’ I mean, how would you feel?”

Annelies Van Rie collaborates with South African doctors Ian Sanne, Martin Grobush, and Liesl Page-Shipp at Sizwe Hospital.