Not a thing of the past
by Laura Fumiko Keehn
Tuberculosis (TB) is very much a modern problem. Drug-resistant TB is a highly infectious disease requiring a difficult and prolonged treatment process, that is increasingly showing up in areas where incidents of “regular” TB infection are high.
The logistics are daunting. Treatment is a very slow process and there is no one-size-fits-all treatment. A series of time-consuming tests are required to detect exactly which drugs the TB is resistant to. A cocktail of expensive drugs are then put together for effective treatment. Trial and error and constant patient-doctor contact is necessary. Such labor-intensive treatment is difficult even under the most ideal conditions.
Needless to say, for many people infected with drug resistant TB, conditions are less than ideal. Infectious diseases thrive in close quarters, with jails and poor housing districts hit the hardest. Combined with the third-world association to the disease (it conjures up images of the deep dark past), it’s no surprise that there is a stigma attached to TB. Dr. Isabelle Le Gall of Medicins Sans Frontieres (MSF) came across this prejudice when setting up a treatment center in Armenia. “People feel as if they will be looked down on, so people hide the fact that they are infected,” explains Dr. Le Gall. And denial is not conducive to treatment.
A lot of MSF’s efforts in Armenia focused on education. The root of the problem, after all, is in the poor treatment of the relatively straightforward “regular” tuberculosis. “It is easy to detect, four commonly available antibiotics can be used to treat it, quarantine is only one or two months, and recovery rates are high after six months of correct treatment,” explains Dr. Le Gall. Problems arise when the patient does not finish his or her six-month treatment. “After two months, you feel better, so you stop your treatment,” says Dr. Le Gall, describing the common mistake that leads to drug resistant TB. By this time the disease has grown resistant to the commonly available antibiotics, and you’re in for the long haul.
At this stage many patients enter a cycle of disease and partial treatment that leaves many jaded, not to mention contagious. Dr. Le Gall has seen it many times. “Maybe they’ve had TB for years, and they don’t trust doctors anymore. They’ve maybe been in jail, perhaps they are addicted to drugs or alcohol and their endurance is down, etc.” Visions of moving mountains with teaspoons spring to mind. What would happen if efforts to steep the tide fail? “The alternative is that more and more people will get sicker and sicker, it will spread and people will die,” explains Dr. Le Gall matter-of-factly. I take this to mean that the alternative is not even worth considering.