By Diana J. Choyce
Nov 08 - 14, 1999
The World Health Organization reports that 22 countries together
account for 80 percent of TB
cases across the world. TB is the largest worldwide killer after cancer
and heart disease, even though under normal circumstances it is fully curable. However
many of these countries are developing as drug resistant "hot zones" including
the Dominican Republic, India, the former Soviet Union, and Argentina. If solid procedures
and help are not put into place soon, TB could make a devastating resurgence. As it stands
now up to 2 million people die each year and another 8 million are infected.
"TB resistance was noted right after the first use of streptomycin
in 1948. But other drugs became available in the 1950s and 1960s which made resistance to
streptomycin a non-issue. In the 1970s and 1980s, there was a very effective multidrug
regimen, so regulations relaxed. Then HIV came in. And these two factors combined to
create an explosive problem with tuberculosis. Now we see multi-drug resistant cases. If a
patient takes just one drug, or three or four but once in awhile, the resistant strains
are selected. The patient can transmit that resistant strain to others" says Dr.
Pablos-Mendez.
India has the highest TB rate at almost 2 million new cases per year
and kills nearly 500,000 people each year.
Apparently bureaucratic delays and insufficient priority by the Indian
government has made it virtually impossible to implement a plan devised by the World
Health Organization(WHO), called the Revised National TB Control program (RNTCP). The
World Bank released a loan to India in early 1997 for $142 million. According Dr Luelmo of
the WHO, "one year later we don't have drugs that should take three to five months to
purchase in the international market.'' The sad thing is that India does have the money
and health resources to battle TB effectively. But its neighboring countries do not and
they are the ones who stand to lose in the long run.
The main push of the WHO program is using health care workers and
volunteers who observe and log that patients are taking proper doses of anti-TB drugs and
noting when they are cured. In China the program has worked very well and covered over 50%
of the population. The full treatment costs only $2000US per patient over the six month
course. The most serious problem that has emerged is that patients do not complete a full
course of treatment. In this case the patient not only continues carrying the disease but
can develop a resistance which they pass on to others. Treatment of drug resistant cases
can cost as high as $250,000 per patient. If this continues, TB could well return to the
days when it was incurable.
Another "hot zone" of TB is in the Russian prison system.
There are about 100,000 cases of active TB and nearly 40% of those cases are drug
resistant. The danger in this is that 30,000 inmates with active TB are released each year
and 400 prison guards have been found to also have the disease. "These epidemics are
only briefly local," said Dr. Paul Farmer, a professor of social medicine at Harvard
and author of the report on Russia.
"They will not remain within prisons; they will not remain within
national borders."
Pakistan is counted among one of the 22 "hot zones" surveyed
by WHO. According to an article in the Dawn early this year, Punjab Governor Shahid Hamid
has said "the government is paying more attention on the preventive, curative and
rehabilitative services to ensure better healthcare facilities to the citizens".
Currently, we are spending 2.2 per cent of the GDP on education while only 0.8 per cent on
health. No nation in recent years has been able to make any substantial progress without
investing in human resources at levels far higher than the levels that we have in Pakistan
at present," he said. The federal government intends to expand the Social Action
Program Project (SAPP-I) while including nutrition, TB control and first referral level
care. An International Conference on Tuberculosis and Chest Diseases is expected to be
held from 5 Novenber - 7 November at the Pearl Continental Hotel in Lahore. It has been
organized by the Pakistan Chest Society, Institute of Chest Medicine and Mayo Hospital,
Lahore.
According to the Centers for Disease Control and Prevention,
Tuberculosis accounts for more than 25 percent of preventable adult deaths in Pakistan.
The international Inter Press Service reported earlier this year that TB kills more woman
in Pakistan than all other maternal mortality. Researchers are saying that the reasons
include lower detection rates, unreliable treatments, and higher illiteracy rates compared
to men. There is also a stigma attached to the disease that may keep woman from seeking
treatment.
However when all is said and done it is our children that will bear the
burden of this disease. Whether by losing their mothers or catching the disease
themselves. Children can be easily cured with proper attention and care. If they are
treated early and if they are not infected by the drug resistant strains. This can only be
achieved by providing the funds and the means needed for early detection, access to
medical care, and persistent follow up on every case. Unlike other infectious diseases TB
is both treatable and curable. Its up to us to make that happen.
