Lonely war against TB being fought in Philippines hinterland

WHEN the world celebrates International Tuberculosis Day on March 23, it will pass unrecognised in the tropical rainforest of Marag here.

This area once was a battleground between government army troopers and communist guerrillas 10 years ago. The dead and the dying back then were combatants.

Today, they are tribesmen from the vanishing Agta tribe — victims of the fast-spreading tuberculosis (TB).

About 2,000km away on the island of Mindoro, the scenario is no different. Dying tribes of people from the indigenous Mangyans are becoming a common sight. They add to the long list of Filipinos dying daily due to tuberculosis.

Dr Roger Sinda of the NGO Medical Ambassadors for Christ (MAC) says it is not only in Apayao where tuberculosis has fast-reared its ugly head. "Tuberculosis has spread at an alarming rate in at least nine provinces in Luzon in just two years," he said.

Even as the Philippine government has accelerated its efforts to get rid of the disease, it appears it has not been contained. Dawn Holbrook, a Seventh Day Adventist missionary treating tuberculosis-stricken tribes with her husband-physician Tim in Mindoro, said indigenous people have become highly susceptible to tuberculosis because of inadequate diet and that many families live in single extended huts and tents. The Agtas and Mangyans are two closely-knit indigenous tribes.

"About 68 people die of tuberculosis in the Philippines daily," she said, an assessment which perhaps validates a statement from the Tuberculosis Strategy and Operation of the World Health Organisation (TSO-WHO), which claimed that the country had the highest incidence of TB in Asia and the third-highest incidence in the world.

According to the Council for Health and Development (CHD), a national organisation of non-government, community-based health programs (CBHPs), institutions and individuals serving the poor and marginalised segments of society in the Philippines, TB is now the fastest re-emerging public health problem in the country, meaning the situation is deteriorating. An average of 30,000 Filipinos have died from the disease since 1994, it said.

Nationwide, 22 million Filipinos are infected with TB; almost one in every three. Every year, 270,000 Filipinos are contracting it; about 740 a day. Every day, 68 Filipinos die of TB and the average Filipino has a one in 40 chance of contracting it each year, CHD added.

The seriousness of TB in the country is noted by the fact that the Department of Health identified it as the fifth cause of morbidity and mortality nationwide, a condition which was not possible 10 years ago.

TB's re-emergence in the country, as well as in India, Bangladesh, Nigeria and Pakistan, has prompted TSO-WHO to warn that if the disease is not eradicated, 30 million people could die from TB in the next 10 years worldwide.

Already, it is the leading infectious killer of youth and adults, having infected a third of the world's population. The stark reality, TSO-WHO says is that someone is infected with tuberculosis every second.

Compounding the threat of TB is that it is likely the cause of more orphans than any other infectious diseases, at the same time, the leading infectious killer of people living with HIV/AIDS, TSO said.

This year's WHO battlecry of "DOTS-TB Cure for All" appears miniscule against the odds stacked against the handful of Philippine health workers in the country's hinterlands. DOTS (Directly Observed Treatment, Short-course) calls for controlling the TB epidemic through existing primary health care network, which is sadly wanting in the countryside.

Dawn and Tim as well as Dr Sinda and a few more volunteer NGO health personnel, especially from the Philippine Tuberculosis Society (PTS), have taken some of the slack.

But they are not enough. They provide much-needed anti-biotics, provide counselling and primary health care services. They are confronting the re-emerging health problem but are haunted by the emergence of drug-resistance strains of tuberculosis.

TB patients, Dr Sinda says, undergo a long and difficult time to recover, if they recover at all. If funds are available, a patient is subjected to a six-month regimen of the standard TB treatment costing close to US$225. This is hardly affordable for anyone in the country's rural areas.

CHD says that the widespread poverty and ineffective health services delivery system are the main causes of TB's re-emergence. "The health facilities and services nationwide is deplorable. There are frequent lapses in the supply of TB drugs that are often traced as redirected to the black market."

Also, under the present medical set-up of the health services network, some personnel are not adequately trained and are too busy with other patients, and that guidelines for TB treatment and diagnosis are not followed, CHD alleged.

The Philippines, while identified worldwide as a potential source of TB carriers, is itself plagued by the problem of contracting TB from outsiders. The John Hopkins University says that emigrants from the developing world are likely contributory to the fast spread of the disease among developing nations and to developed countries.

The immigrant population is "the future pool of the disease," said Dr Kenneth Castro, director of tuberculosis elimination at the Centres for Disease Control and Prevention in Atlanta, USA.

Statistics identify emigrants from Mexico, India, Pakistan, Vietnam and the Philippines as the leading carriers of foreign-born tuberculosis locally and nationally. US-born residents also would be at risk after extended stays in those nations.

But to the indigenous Philippine people, TB was brought in by the mainstream population. A cruel legacy left after exploiting the people and the natural resources. And even as the government trumpets it's waging a war against the disease, the number of people dying in the countryside continues to grow.

The Brunei Times