Care for the forgotten is key to eradicating tuberculosis

Shin Young-soo says one-fifth of all TB cases in the region go undetected

PUBLISHED : Monday, 24 March, 2014, 3:33am
UPDATED : Monday, 24 March, 2014, 3:33am

Gloria lives in a makeshift hut in a squatter area of a large Asian city. She works long hours selling simple handicrafts on the street to provide food for her children. Their situation was precarious already, but then Gloria contracted tuberculosis, though she didn't know it.

It started with a cough, then she became weak, and then she felt feverish. Soon, she couldn't work at all. Gloria tried to get treatment from local healers and doctors who prescribed medicine she could hardly afford, but her health still did not improve.

After all her money was exhausted and her debts grew too high to borrow more, and after many hungry nights and days, she was finally taken to a health centre. Gloria was diagnosed with TB and received free treatment.

After several days, her health improved, and she went back to work. A catastrophe was averted, but recovering from the massive debt she incurred will take some time.

"Gloria" stands for hundreds of thousands of real people across Asia and the Pacific, and indeed millions all over the world, who experience immense suffering from what is a curable illness with free treatment provided by governments across the region.

TB has long been associated with poverty, unfairly preying on the most vulnerable among us.

While Gloria eventually found treatment, for many others the story doesn't turn out well. People with untreated TB slowly waste away to a painful death. And before dying, they expel millions of microbes through a deep persistent cough, often infecting loved ones and others with whom they come into close contact.

If these people don't receive adequate treatment, they might improve for a few weeks only to have the TB return with a vengeance - this time possibly resistant to the original drugs used. Treatment of multidrug-resistant TB costs up to 200 times more, takes up to two years, and involves daily medication and injections, often with dangerous side effects.

TB strains resistant to even more drugs are nearly incurable and leave little hope for survival.

For public health, we must prioritise TB interventions that will bring the most benefit to the most people. In 1994, the World Health Organisation recommended a package of interventions for use in resource-limited settings. Since then, we've made enormous progress combatting TB.

In the countries of the Western Pacific region, over 10 million patients were diagnosed and treated and an estimated 800,000 deaths have been averted in the past 10 years alone. For example, the estimated mortality rate for TB in China plummeted by over 80 per cent from 1990 to 2012.

Now is the time to take all we have learned to ensure no one is left behind.

We estimate that we are currently missing a fifth of all TB cases in the Western Pacific region, including the elderly and children whose TB can be more difficult to detect, as well as those in slums and squatter areas, in prisons, and in migrant and other marginalised populations.

With the very real threat of TB transmission, should we avoid these pockets of vulnerable and high-risk people? Absolutely not. Not only does this encourage the spread of TB, at the risk of losing the gains we have made, it also fosters the already strong stigma against TB patients - making their burden even heavier.

We must extend to everyone effective service delivery systems that include drugs and trained health staff. Otherwise, TB cannot be controlled.

To alleviate the burden TB places on far too many of our fellow human beings is to provide a safer world for our children, to increase social equity and to eliminate this disease once and for all.

Dr Shin Young-soo is regional director for the Western Pacific of the World Health Organisation. Today is World TB Day. For more information see: