Blowing out candles – World TB Day 2007

Recent headline in Swazi daily paper.

Days that are named after diseases come and go, usually unnoticed.

No department store sales. No gifts or candy. No bunny, elf, or fairy comes to visit.

No songs. No feast. No costumes. No egg nog.

No cake. No candles.

Yesterday was World TB day: TB’s closest thing to a birthday party.

Don’t know how old the mycobacterium is, but it’s very old.

Swaziland, where I live, leads the world in TB prevalence.

TB is second leading cause of death from infectious diseases worldwide, second only to HIV/AIDS.

Compared to TB, HIV is a baby. (Ambitious, yes, but young.)

Swaziland leads the world in HIV prevalence.

According to the World Health Organization, TB kills nearly 2 million people worldwide every year.

2 plus six zeros.

2,000,000

The number looks bigger if written like this: $2,000,000

A big number.

New TB infections occur at a rate of approximately one per second.

That equals thirty to forty new TB cases since you read the title above.

Numbers such as these are humiliating, apathy-generating.

Numbers with so many zeroes tempt well-meaning individuals to say,

“Too [darn] big.”
“To [heck] with it.”
“Not my [ ] problem.”

(The brackets often contain a spectrum of colorful vocabulary that I try to avoid on this website.)

Humiliation and rhetoric aside, TB is indeed our problem.

Alas.

Alongside HIV, it is very much my problem. 78% of TB patients here have HIV. Many of my patients have both.

Like HIV, TB is smart.

Like HIV, it is capitalizing on weak treatment programs worldwide and learning how to outwit our inconsistent medicines.

Unlike HIV, it knows how to fly.

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The Swazi Minister of Health, WHO Country Representative, and National TB Program Coordinator recently met and reviewed some of Swaziland’s tuberculosis numbers:

· TB accounts for approximately 25% of admissions in Swaziland hospitals
· 20% of institutional deaths in Swaziland are due to TB
· TB has increased 600% in the past 15 years in Swaziland

Only an estimated half of Swaziland’s TB cases are being treated successfully.

Fifty percent is nothing to be proud of, for TB can be treated with a simple and inexpensive treatment program.

Themba Dlamini, the ministry’s TB Programmes Manager, summed this up in a recent interview.

“TB is curable,” he said.

When TB treatment programs are sloppy, however, the bug becomes resistant to these simple and inexpensive cures.

This is all very old news, but, as you can see in the illustration above, every so often it still makes the front page of the Swazi Observer.

Dr. Paul Farmer, the co-founder of Partners In Health , has dedicated much of his career trying to get this old news out, to renew our sense of urgency.

His [paraphrased] mantra if this: “MDR and XDR-TB highlight a global failure to prevent and treat basic TB.”

Until we stop failing, this old, airborne germ is not going anywhere, except of course to one new vulnerable person per second, one new victim in one of the world’s poor places.