By Patricia B. Mirasol
ERADICATING TUBERCULOSIS (TB) entails being aware of how the social determinants of health — economic stability, equitable use of land, and adequate housing — cause the spread of the disease, according to Médecins Sans Frontières/Doctors Without Borders (MSF), one of the main non-governmental providers of TB care worldwide.
Cramped living quarters “is a reality that a majority of families in places like Tondo face,” said MSF’s Dr. Marve Duka-Fernandez, who is coordinating a project in the said Manila district.
“They are practically helpless in the spread of tuberculosis and other infectious diseases that spread through droplets or airborne transmission. There are no two ways about it: they need to live in better housing! People left to live in such conditions will always be at high risk for recurring infections,” Dr. Duka-Fernandez said in an e-mail to BusinessWorld.
In the meantime, she advised individuals to wear masks at home, use mechanical ventilation such as fans, and clean house surfaces.
In an Aug. 12 MSF webinar on TB, Dr. Duka-Fernandez noted that in Ukraine, where she was previously assigned, stigma prevents people from getting tested. “TB is associated with substance use disorder, poverty, and unemployment,” she said. “We’re just launching in Tondo, but I fear that stigma might also play a role here.”
Despite the challenges, Dr. Duka-Fernandez said these are exciting times for TB diagnostics, as next-generation technologies are in the pipeline for screening and early identification of the disease. These include computer-aided detection software that utilizes artificial intelligence and identifies lung abnormalities in x-ray images, and next-generation biomarker tests that do not require a sputum sample.
“Many with AIDS [acquired immunodeficiency syndrome], as well as children, are not able to produce enough sputum,” Dr. Duka-Fernandez told the Aug. 12 webinar audience. “These [developments] can fill the gap for TB screening and triage … and make chest x-rays more feasible, close to the point of care, and at a large scale.”
The Xpert MTB/XDR test, meanwhile, can profile drug-resistance TB in under 90 minutes. Rapid detection of the disease paves the way for an early treatment regimen and an increased chance for survival.
“Our goal in Tondo is to support the National TB Program,” Dr. Duka-Fernandez said, adding that MSF’s project approach is guided by patient-centered care, and will include psychological counseling, acknowledging financial concerns, and meeting patients in their homes.
“Patients are people with complex needs,” she said. “The fight against TB goes beyond the health center.”
TB is caused by a bacterium that usually attacks the lungs, but can also attack other parts of the body such as the kidney and spine. It is spread through the air when a person with active TB disease of the lungs or throat coughs, sneezes, speaks, laughs, or sings. Among the preventive measures for stopping the spread of TB are making a home well-ventilated and finishing the medications prescribed.
The Philippines is ranked fourth among the 30 high TB burden countries, according to the World Health Organization. Eradication of the disease calls for the re-educating health professionals on holistic care, ensuring patients are part of the decision-making process, and acquainting everyone on the social determinants of health.
“It’s not only about sharing information about the disease, but also listening to a person’s life experiences — especially the ones that brought him/her to be ill — and working together towards changing this,” said Dr. Duka-Fernandez.