The WHO (the UN’s World Health Organization) has now declared a health emergency for Africa because of the increase in Drug resistant TBPartly due to HIV and increased urban development, cases of TB has quadrupled in Africa since 1990. Half a million people in Africa, and two million people in the world die of TB each year. And eight of the nine countries with the highest number of cases announce they are short of funding for treating tuberculosis.

Drug resistant TB is especially a problem, since common medicines don’t work, and the older medicines have more side effects. The only way to keep such cases from spreading might be to mandate isolation from the community, bringing up civil rights issues.

However, for ordinary TB, the way to eliminate or lower case rates requires a combination of several things.

One, improve nutrition. Most cases are in malnourished people.

Two: fight HIV. HIV patients cannot eliminate TB bacteria, even when treated, and this may contribute to both the spread of TB and the increase in drug resistance

Three: BCG vaccine. This grants partial immunity, by allowing the person to have their white cells sensitive to TB…so if they are exposed to TB, they do not develop the highly fatal “miliary” version of TB, and are less likely to develop full blown TB

Four: Restart screening immigrants for TB. My sons and my husband needed normal chest X rays to enter the USA…and I was required to have a normal Chest X ray to get permanent residency in the Philippines. Another priority should be to go back to yearly screening of all health care workers/daycare workers/teachers and require those working in restaurants and other food handlers. This last group includes many undocumented aliens, who have a higher risk for TB.

Five: increase funding, in a combination with HIV treatment. The bad news is that corruption is rampant, but funding churches and other NGO’s to run public health are where you should send your money.

Six: the best way to eliminate TB is to treat all TB skin test positive people, and/or screen them with yearly chest X rays. Alas, in countries where 90 percent of people are TB skin test positive, this is impossible.

Western countries need to be aware of the problem. You see, if you aren’t a doctor/healthcare provide/EMT/policeman, you don’t inject drugs, you are faithful to your partner, your chances of catching HIV are small.

But a single case of TB can spread it to hundreds, and all you need is to catch it is to have your chef or patient or the guy sitting next to you on the subway to cough to give you the disease.

Nancy Reyes is a retired physician who lives in the rural Philippines. Her webpage is Finest Kind Clinic and Fishmarket and she posts longer medical essays to Tioedong’s Xanga site

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