Day after day, Asta Djouma’s world consists of a small hospital room in Northern Cameroon. She spends her time on a hard wooden bench or the equally hard concrete floor, gazing out from the doorway at a sliver of the world beyond.
Since October, Ms. Djouma, 32, has been confined here. She was diagnosed with a form of tuberculosis that resists common medications, known as multi-drug-resistant TB. Alongside a handful of other patients with the same condition, she’s required by the government to remain in isolation until she tests negative for the potentially fatal disease, a separation that has kept her from her three children, ages 9, 10, and 11, since her admission.
This method of TB treatment—long-term isolation in a sanitarium—was deemed obsolete in the United States and other affluent nations over six decades ago. While it persisted in Eastern Europe until about 15 years ago, it remains a common practice in certain low-income countries in Africa and Asia. These regions’ health systems simply lack the necessary funds to update policies, retrain staff, or deploy community health workers for at-home patient support.
For the past 15 years, the World Health Organization (WHO) has explicitly stated that TB patients should not be isolated or confined, or even hospitalized, unless they are severely ill. Extensive research indicates that at-home treatment leads to better outcomes, improving patients’ mental well-being and reducing their exposure to other infections.
The stark reality of infection risk is that most patients, by the time they are diagnosed, have already exposed their close contacts. Crucially, after just a few days of appropriate treatment, their bacterial load significantly decreases, minimizing the risk to family members at home.
However, the global adoption of these updated guidelines has been severely hampered by disruptions and a significant reduction in international funding for tuberculosis care.
Consequently, isolation remains standard policy in Cameroon, even in its capital, Yaoundé, which has a dedicated isolation ward in a major hospital. In the country’s far north, all patients battling drug-resistant TB are sent to a single church-run hospital in Maroua, the regional capital. Here, they endure cement rooms furnished only with a bed and a few plastic dishes for a minimum of three months, or longer, until they achieve at least two negative TB tests.
A spokesperson for Cameroon’s Ministry of Health stated that the country is gradually transitioning to the WHO standard. Clavère Nken, the spokesman, explained via email that the obstacle isn’t a lack of resources, but rather the need for a careful, phased approach to guarantee high-quality patient care during the shift to new treatment protocols, requiring enhanced team support and close monitoring of initial patient groups.
For the patients, the isolation and relentless boredom are agonizing.
“We’re just here,” Ms. Djouma recounted in a December interview. “We talk a bit. But we’re just here.” From her vantage point, a gap in the compound walls offered glimpses of the bustling main hospital area. Inside the isolation ward, however, only the sounds of coughing broke the silence.
Most patients in the isolation center, like Ms. Djouma, are in their thirties. They are parents and primary providers whose sudden absence inflicts immense hardship on their families. Sitting meters apart on wooden benches, they represent the profound neglect of tuberculosis treatment globally. TB remains the world’s leading infectious disease killer, claiming 1.2 million lives in 2024, the latest year for which comprehensive global data is available.
Yet, because TB disproportionately affects the poorest individuals in the most impoverished regions, the diagnostic and care systems remain tragically outdated. Most cases in Cameroon are still diagnosed using a century-old method: examining lung mucus smears under a microscope. The challenging and prolonged drug regimen, barely altered since the 1960s, also highlights this stagnation.
Frédéric Lingom, the nurse managing the Maroua treatment center, tells patients that isolation is necessary for him to closely monitor their demanding four-drug regimen, which often causes severe side effects, and to prevent them from infecting their families.
Over the past year, providing care for TB patients in rural Cameroon has grown even more difficult. Essential supplies dwindled following substantial cuts to global health funding by the Trump administration, as the United States had been the largest global donor to TB programs.
The WHO recommends immediate testing and preventive therapy (a six-week drug course) for close contacts of newly diagnosed TB patients. However, hospital staff reported that due to reduced resources and staff, tracing and testing contacts sometimes took months in 2025. By then, some contacts had already fallen ill.
Many community health workers responsible for contact tracing, funded by the U.S., lost their jobs. U.S. funding also supported molecular diagnostic tests, which by late last year had become scarce. Lab technicians found themselves rationing these critical tests, using them only for patients most likely to have drug-resistant TB, instead of testing every suspected case as the WHO advises.
Cameroon’s health ministry spokesman, Mr. Nken, assured that supply shortages were swiftly resolved through supply chain adjustments, and that close contacts are now being diagnosed and treated within days.
Earlier in 2025, when Ms. Djouma first developed a persistent fever, she was mistakenly diagnosed with malaria. Eventually, a local clinic identified tuberculosis and initiated treatment. However, without molecular diagnosis—the WHO-recommended method—they failed to detect her drug-resistant infection. She continued taking the prescribed drugs at home twice daily for five months, but her condition only worsened.
Finally, she sought care at the city’s main hospital, where a molecular test confirmed she had the drug-resistant strain. This diagnosis meant she would require more difficult-to-obtain and harsher medications. The hospital then referred her to Mr. Lingom, who had the challenging task of informing her that she wouldn’t be returning home anytime soon.
“People don’t love the idea of staying here for three or four months,” Mr. Lingom remarked, with a touch of understatement. “Imagine if you came to the hospital for something and they say you have to stay for four months — not four days, four weeks. Four months. They’re not thrilled.”
In 2024, approximately 40,000 people in Cameroon contracted TB, with 7,000 fatalities. Among them, 620 individuals were diagnosed with the drug-resistant form of the disease.
Even as Mr. Lingom manages this small, modern-day sanitarium in Maroua, he can’t help but worry about the psychological impact of isolation. “People are cut off from their family — they are all alone with their thoughts, and they get depressed,” he shared.
He attempts to uplift patients by reassuring them they are protecting their families from risk. Furthermore, at the hospital, he can guarantee them regular meals. For tuberculosis medications to be effective, they must be taken with food, a luxury many patients cannot afford daily when at home.
Momini Daibou, 32, arrived at the hospital in late October, after enduring months of relentless coughing, fever, and significant weight loss. “I felt I had no more blood in my body,” he explained. He shared a two-room home with his brother, wife, parents, and two toddlers, supporting them all by selling soap, brooms, and other household items as an itinerant vendor. “I am here and not working so it’s very hard, especially the question of food,” he lamented. “They are struggling.”
Mr. Daibou’s family underwent TB testing four weeks after his hospital admission, and he experienced profound relief when all their results came back negative.
During his first month, they managed to gather enough money for just one visit from his home village.
Twice a day, a brief flurry of activity animates the TB courtyard as Mr. Lingom distributes each patient’s boxes of drugs in recycled cardboard cartons. Another small stir occurs when the call to prayer echoes from a nearby mosque, prompting patients to unfurl their prayer mats outside their rooms.
However, for the most part, Mr. Daibou admitted, “we do nothing.”
He does find some company, as his two sisters chose to stay in a small row of guest rooms across the courtyard from the TB patients. It’s not unusual for family members to reside nearby voluntarily, cooking, shopping for their ill loved ones, and offering companionship from a safe distance.
Ms. Djouma, though thin and still battling a persistent cough, claims to feel stronger. She eagerly anticipates the day she can return home to her children. Despite the hardship, she accepts the mandatory isolation, understanding the severity of her illness. Her parents, an aunt, and an uncle all succumbed to tuberculosis. “Your health is the most important thing,” she stated, emphasizing her resolve.