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| Tuberculosis [TB] kills more people than any other infectious disease in the world. In fact, according to the World Health Organization, more people die each year of TB than die of AIDS and malaria combined. Yet it is rare to read articles about the scourge of TB in the popular press. TB has not been highly politicized in the developed world as AIDS has, and it has also somehow avoided the "exotic" personality people often associate with malaria. Despite being a widespread problem, in the developed world many people are under the misconception that TB is a thing of the past--just a quaint disease once called "consumption" that is found only in Russian novels and that must surely have been eradicated long ago. The truth is, though doctors now have the antibiotic tools to attack the problem head-on, more people are dying each day of TB than ever before. TB, much like the common cold, is an airborne infectious disease spread by close contact with an infected person who is coughing, sneezing, or even just talking. Persons who have been exposed to the disease may unknowingly be carriers but are not infectious unless they develop the full-blown infection, which usually only happens when their immune system is already weak. This may happen because of another illness, or simply because basic nutrition and hygiene has not been properly taken care of.
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An average of 68 people die of tuberculosis every day in the Philippines. Dawn Holbrook, a Seventh-Day Adventist missionary, working with the remote tribes of the Mangyan people on a remote part of the Philippine island of Mindoro, examines a woman for tuberculosis. The woman, who is believed to be around seventy years old, is called Kapera. Though members of this tribe don't traditionally have names, the Missionaries have encouraged the people to take names. The Mangyan are highly susceptible to TB because of inadequate diet and because many families often live communally in a single "long-house", an extended single-room hut.
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The Philippine government's TB eradication programs have had mixed success. NGOs and individuals, like missionaries Tim and Dawn Holbrook, have attempted to take up some of the slack. The Holbrooks note that sometimes the necessary antibiotics are unavailable in their area from government supported clinics because the medicines have been diverted to the black market. "So far we haven't turned anyone away who wanted to be treated for TB for lack of funds," says Tim Holbrook. Tim uses a satellite phone to connect to the world beyond the Mangyan village to coordinate with NGOs and to keep in touch with donors. "Without the technology we probably couldn't do three-quarters of what we do," he says. Before the satellite phone, "a letter could take two to three months getting there and back. There's no way we could do this much work and coordination with NGOs without digital communications."
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Cambodia has had greater success in combatting TB, but that success has been recently been put at risk by political developments in the country. In coordination with the many foreign NGOs that operate in Cambodia, the Cambodian Red Cross provides free treatment to any willing TB patients. TB can usually be successfully cured over the course of six months of active antibiotic treatment. But if that treatment is interrupted or only sporadically followed, strains of TB can emerge that are resistant or even impervious to today's antibiotics. In the months following the July 1997 unrest in Cambodia, many foreign governments withdrew humanitarian aid to the Phnom Penh government, leaving aid workers worried that there might be an interruption in supplies of antibiotics to combat TB. A woman infected with an advanced case of TB recuperates at a Phnom Penh hospital. Beside her is her young son, who lives with her at the hospital. This is a scene that is duplicated at many provincial clinics around the country.
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Sam Pun, also infected with TB, covers her mouth to avoid transmitting TB to her visitors. In addition to antibiotic treatment, extensive education is necessary on the causes of the spread of the disease in order to limit the spread of TB.
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A Cambodian doctor examines a TB patient. Doctors in Cambodia are paid about $14 a month. Doctors who treat TB are given a special 100% allowance in addition to their regular salary in order to entice them to deal with TB patients, who in the past have been stigmatized.
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Tuberculosis is often overlooked by the world's press in favor or more exotic or politicized diseases such as malaria or AIDS. In March 1997 I traveled to Laminosa, Sulu, a remote island in the southern Philippines, to investigate rumors of a Malaria epidemic that had reportedly killed over 150 people in a ten day period. It turned out that the reports had been wildly exaggerated--probably intentionally by some of the islanders in order to get the attention of the national government. Sure enough, the national government responded with Marines, food aid, and health workers, despite the fact that the mortality figures for Malaria were wildly overblown. That is not to say that there wasn't a health problem on the island--malaria--and especially TB--had claimed an unusual number of lives during that time because of insufficient medical care, poor hygiene, and inadequate diet, but it was only after the wheel squeaked about malaria that the Laminosa residents got some grease. A Muslim graveyard where some of the island's recent victims were buried.
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Since TB is an opportunistic disease, sanitation and diet are very important. Laminosa is a prime candidate for the disease and will continue to be because of the island's lack of potable water, poor sanitation, and crowded living conditions. In this picture a woman collects rainwater because the island has no other source of drinking water. |
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| All photographs on swallace.wirephoto.com are copyright
Stephen Wallace and may not be republished or redistributed in any form without
permission. |
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