World TB Day 2010 highlights innovations in the global fight against tuberculosis. The 2010–2011 World TB Day campaign, “On the Move Against Tuberculosis: Innovate to Accelerate Action”, is launched today. World TB Day is held each year on March 24.
Tuberculosis claims the lives of 4,500 people every day, despite massive efforts across the world to control it.
We have to find new and innovative ways to stop TB, including stepping up research to find new drugs, diagnostic techniques and a new vaccine, and new approaches to helping people access effective TB treatment, says Dr. Mario Raviglione, director of the World Health Organization’s Stop TB Department.
One of the serious setbacks of the TB program is the problem of multiple-drug resistance (MDR) as exhibited by the tubercle bacilli and public fear of the scourge.
A patient has MDR TB (multi-drug-resistant TB) if sputum exams show the tuberculosis bacilli are resistant to at least isoniazid and rifampicin. These drugs are the most powerful anti-TB drugs currently available, and thus resistance to these drugs results in a very poor prognosis for the patient. Chances for a complete cure are a mere 50 percent.
MDR TB usually is the result of previous treatment failures. Treatment failure is not the fault of a patient, but more often the result of poor treatment. And poor treatment is usually the result of poor health service.
Poor treatment is mainly the responsibility of the doctor in charge or medical provider. They are the ones who know too well that if services are inadequate, the tubercle bacilli may become multi-drug-resistant.
The doctor should always see to it that the patient takes 100 percent of the prescribed drugs regularly (or at least 90 percent) during the full period of treatment.
All doctors know that taking drugs over long periods goes against human nature, especially if the patient no longer exhibits the symptoms of disease. To prevent a patient from defaulting, a treatment observer must make sure every single dose is properly taken by the patient.
This important task is usually entrusted to the nearest kin of the patient (spouse, parent or grown-up offspring). Without such an observer, the medical treatment should be postponed lest the patient abscond early from the treatment.
If phone service is not available, a diligent home visitor should within 48 hours meet the patient at their home and persuade them to immediately see a doctor for consultation and/or counseling.
The most important cause of multi-drug-resistant TB is incomplete or irregular treatment. Other causes include prescribing inadequate doses and control of drug content by the government or other health authorities.
The art of successful treatment is to effectively counsel the patient as necessary, especially as most patients tend to default.
It is the doctors (and not the patient) who know too well the disastrous effects of treatment failure and subsequent devastated lungs. In our TB program there is a saying that “regular treatment cures for sure and obviates relapses”.
There is a trend in technically advanced countries to keep TB patients in hospital for whatever reason. But facts prove that patients do not require hospitalization for their cure.
Hospital treatment is in no way better than ambulatory treatment, and hospitalization for long periods may even adversely affect the patient’s family at home. Patients in ambulatory treatment are no more contagious than hospitalized patients.
The art of successful treatment is to effectively counsel the patient as necessary, especially as most patients tend to default.
The writer is founder of TB program, St. Carolus Health Services, Jakarta
