Step up fight against Tuberculosis

Hara Mihalea CHE, MPH

PATH, Thailand

Let me share a real story I experienced in the field last year. During a monitoring visit for one of our programmes, I came across a referral slip made by a pharmacy staff referring a 36-year-old woman to the Directly Observed Therapy Short Course (DOTS) health center.

Looking at the symptoms circled on the slip, one could tell that this was certainly a pulmonary TB case; weight loss, fatigue, chest pain, fever, and cough with blood.

We traced the referral to one of the district health centres where we found out that the woman had indeed gone for further evaluation, she was checked, diagnosed, given medication and sent home.

We were told by the health centre staff that since the first visit, she had returned twice, each time sicker than before, and would be sent home again, no TB.

We decided to visit her at home where she lived with her husband, her in-laws, two small children and one baby. We asked the district TB officer to join us so he could be able to follow-up later on.

When we arrived in her small house we were taken up in her room, she was sitting on a straw mat on the floor, baby on the breast, glassy eyes, face flushed with fever. She repeated the same story that the health staff told us. She told us how disappointed, sad, and scared she felt, she said she was getting worse by the minute and no one could help her.

She said she wanted to go back to the health centre but they didn't have any more money and no transportation. Each time she coughed, she hit on her chest to show us where it hurts. I will never forget the pain on her face, the sound of the shortness of her breath when she tried to tell us her story.

I will never forget the fear I felt for the baby on her breast and her other two children and thinking that this woman unless treated immediately will soon die and leave these children orphans. The end of the story is that the woman did have pulmonary TB and the last we heard was that the district officer was trying to get the children tested.

So what went wrong? Why did this woman seek care three times and still was sent home with a bag of antibiotics and vitamins? This is a very common story and it is happening every day, many times a day around the world, especially in high TB burden developing countries.

I shared this story because I truly believe we might not be able to reach our goal to Zero the numbers of children dying of TB in our lifetime, let alone by the year 2015, if we don't take some drastic steps to address the real problems that are preventing us from doing a good job. We can have the guidelines and country operational plans for TB in children; we can have the treatment algorithms. However, I strongly feel these will not help much, especially in limited resource setting where stories such as this are real unless we start by:

(1) Holding the governments accountable for the health and wellbeing of their populations. Health is a right not a luxury. Advocate for the increase of the salaries of the health staff to motivate them to perform appropriately. Health staff in developing countries often do not get their salary for 3-6 months.

(2) Strengthening the DOTS programme. If we had a quality DOTS programme, the health staff would have been able to accurately diagnose and successfully treat the mom in the story. They would have being able to prevent TB and the needless suffering in her children.

(3) Integrating TB into primary health care and sensitising all health care providers on TB. Once sensitised, health staff can be able to screen children and moms during immunisation sessions, postnatal visits, reproductive health (RH) visits or other consultations.

(4) Recognising the symptoms of TB in children, creating linkages and partnerships between communities, private providers and TB services

(5) Intensifying case finding and contact tracing when TB is suspected to all family members, most importantly to children. The majority of the children get TB from a family member.

(6) TB is a poverty disease, half of the children in the developing countries go without meals and they are malnourished which makes them more vulnerable to TB. Addressing the nutrition needs of children is of out-most importance.

(7) TB in a child that is already living with HIV is a double heartbreak and so much more difficult to diagnose and treat.

Unless we can diagnose and successfully treat the mom or the infected caregiver, we will fail to diagnose and treat the child. The majority of the children get TB disease from a parent or a close relative. The longer the child is exposed to an infected caregiver the greater the risk of transition.

TB is very political and things are moving very slowly; we cannot afford to move slowly anymore, we should not allow it. We need to step up very fast.

What we should all see at the end of 2015 is not just the numbers, the statistics showing fewer deaths from TB among children, we should see children, happy and smiley faces, children free of TB. Where there is a will there is a way and I hope that collective voices will find the way.