Tuberculosis need not kill

22 WorldHeolth r 50thYeor, No. l, Jonuory-[ebruoryl997 Iuberculosis need not kill litendro luli "l wos told thot if I compleled my treotment under supervision, lwould be oble to return fo my fields in o few months. I did os I wos told, ond here I om, working from sunrise fo slnset." anwar, a young farmer, is back in his fields after a break of a few months. "This is where I belong, this is my life", he says, stacking up bundles of freshly harvested maize. A few months ago, however, Manwar could never have imagined that he would be able to put in the strenuous hours at work that farming demands. That was when he was stricken with tuberculosis. "I never thought I would survive. Thanks to the insis- tence of my wife and some others in my family who took me to the health centre, I am alive today and able to narrate what happened to me," he explains. As Manwar recalls, he developed a nagging cough just over a year ago. He consulted the vlllage vaid, or traditional healer, who gave him some herbs to boil in water and asked him to drink the water when cool, three times a day. The healer also gave him some pills. When this treatment did not work, Manwar consulted anangrezi, or allopath, who prescribed antibiotics. "These were very expensive, but after taking them for a few weeks I felt no better. In fact, worse," he says. The persis- tent cough became more severe and Manwar would go into spasms, particularly at night. After one such bout, his wife noticed specks of blood in his sputum. The next morn- ing she insisted on taking him to the A pot'tent receivtng hrs medtcine under direct observofion. Photo: WHO health centre, which was an hour's bus ride from their village. At the centre, Manwar had his sputum collected for examination. The technician on duty asked them to return in a few days for the report, when the doctor would also meet them. When Manwar returned, the doctor was waiting for him and told him that he had tuberculosis. "I was totally shattered by the news," re- veals Manwar. "I thought it was the end. What would my poor wife and young children do? Who would look after them? What would the villagers say? Would I be shunned by them?" He was also worried about the long duration of treatment - perhaps for years - and also whether he could afford to buy all the necessary drugs. The doctor was very understanding and explained that tuberculosis is an entirely cur- able disease. There is no reason for anyone to feel ashamed about it, nor is it a disease that should lead to any kind of isolation. Health workers in the area have been taught that tuber- culosis is curable, but only if the treatment is taken regularly, without breaks, to ensure a complete cure and avoid the danger of drug resis- tance. After a couple of weeks of treat- ment, patients feel so much better WorldHeolth r 50thYeor, No. 1, Jonuory-Februory)997 23 that they think it is no longer neces- sary to take the medicine. For this reason, health workers are trained to observe each patient directly, to ensure that they not only receive their medicine but actually swallow it, each and every time. In fact, Manwar was told that, in accordance with the revised strategy of Directly Observed Treatment, Short Course (DOTS) recommended by WHO, the treatment period had been reduced considerably. His fears about the cost of the drugs were allayed when the doctor informed him that all the necessary drugs would be given free of charge. "I was told that if I com- pleted my treatment under supervi- sion, I would be able to return to my fields in a few months. I did as I was told, and here I am, working fiom sunrise to sunset," he says with a broad smile. While at the health centre, Manwar was surprised to learn that more than three million people in the South-East Asia Region are infected with tuberculosis every year. This is nearly 40Vo of the world's total. He was even more surprised to learn that an estimated 1.2 million people in the region had died ofthe disease in 1995. The economic loss sufTered as a result of tuberculosis is estimated to be over 1000 crores ofrupees (US$ 300 million) every year for India. And yet tuberculosis is one of the diseases lor which treatment is the most cost-effective. Curing patients is the cheapest and most effective form of tuberculosis pre- vention. he was told. Manwar. of course, did not have to pay fbr his treatment as he could get the medi- cine he needed fiom the health centre. But he had been told that the cost ofthe drugs was very high. "I calculated the cost of the treatment and was shocked to know that it was as much money as I would earn in a year. But for the government facil- ity, I would never have been able to afford the treatment," he says. Having been cured, Manwar is now convinced that tuberculosis need not be f'eared. In fact he has become a welcome ally of the health centre. and has himself become a supervisor of DOTS treatment for a fellow villager. As he eagerly ex- plains to anybody willing to listen: "Tuberculosis need not kill. I am proof enough." And people believe him. I Mr litendro Tult wos formerly lnformolion Of{tcer ot WHO's Regronal Offtce for Sout'h Eost Asio, World Heolth House, New Delhi- / I a002. lndia. The doctor reossures fhe palienl thot fuberculosis is curoble: the heolth service will moke sure that he follows the treotment until he ts completely cured. Phofo: WHO/J Kumoreson. !nlectious diseoses in South-Eost Asio The WHO South-Eosi Asio Region is populous ond heterogeneous, with complex ond voried socioeconomic conditions. Most countries depend on ogricu lure but ore increosingly turning to industriolizotlon. Poverty ond illiterocy ore still widespreod ond noturol disosiers cloim on importont port of scorce resources. However, the Region hos ochieved noiiceoble success ogoinst o number of infectious diseoses. The Exponded Progromme on lmmunizolion conducted by most countries hos resulted in o remorkoble decline of poliomyelitis, neonotol tetonus ond olher childhood diseoses. Guineq-worm diseose is heoding towords erodicotion ond the incidence of visceroi leishmoniosis hos olso dec ined considerobly. The less optimistic side of lhe regionol heolth situotlon is coused by high incidence ond prevo ence of ocute respirotory infections, diorrhoeol diseoses, molnutrition ond nutritionol deficiency disorders, vecior'borne diseoses - especiolly molorio - ond tuberculosis. Chollenges for the fuiure ore the persistence of molorio ond tuberculosis; the resurgence of plogue; the emergence of chronic noncommunicoble diseoses such os cordiovoscuor diseoses, concer ond diobetes; ond the emergence of other infectious diseoses such os dengue hoemorrhogic fever, Joponese encepholitis ond cholero (El Tor). Though HIV/AIDS is becoming o serious problem, there hove been o few notoble successes in some countries due to the increosed use of condoms ond peer educotion progrommes which hove resu ted in o decline of sexuolly ironsmiited diseoses. Leprosy is on importont public heoith problem in South-Eost Asio, occountinglor 70% o[ oll coses regislered worldwide. The nine couniries where leprosy is endemic ore implementing notionol plons for the eliminoiion of the disdose by the yeor 2000 Forecosts for the next 5-10 yeors envisoge thot the moin couse of morbidity ond mortolity will still be infectious diseoses, with the beginning of o shift towords chronic noncommunicqble diseoses. However, the HIV/AIDS epidemic will be present lhroughout the region ond is expected to spreod ropidly in mosi countries. Summcttzed from the World Heolth Report 1996, p.100 (see p.3l for further rnformotion)