Tuberculosis remains global enemy
A DIAGNOSIS of tuberculosis is among the most dreaded statements that anyone wants to hear. Apart from the likely risk of losing a promising job, TB is among the diseases that carries stigma because it is potentially highly contagious. In Indonesia it is an old scourge; we have joined the G20, but it is deeply ironic that the nation ranks second in the world in contributing to the global burden of TB, and is a leading cause of death in the country.
Although the latest estimates show about 1 million TB cases in Indonesia, hundreds of thousands are grouped as missing cases, as patients have forgone the requirement of periodical treatment, while one carrier could spread the disease to up to 15 people through the air.
Eliminating TB is among the priorities of the 2015 to 2019 national devel- opment blueprint, part of the nation’s policies and action plans to reach its sustainable development goals target. Toward the goal of “Ensuring healthy lives and promoting well-being at all age”, Indonesia simultaneously focuses on improving vaccination coverage, which is struggling with resistance against immunisation; and also on reducing the prevalence of stunting.
Despite these seemingly insurmountable challenges, along with other nations we have a better chance of reducing TB, at least, with the first ever High Level Meeting on TB taking place on September 26 at the ongoing United Nations General Assembly in New York. Indonesia’s delegation, led by Vice-President Jusuf Kalla and Coordinating Human Development and Culture Minister Puan Maharani, is set to join a global pledge of nation- al leaders to end TB by 2030. This should boost commitments at all levels; including on educating families and communities on preventing TB and convincing people that it is curable with disciplined treatment.
Public education of TB is increasingly urgent because of the attached stigma leading to self-denial, or our tendency to ignore “bad coughs”. Public health experts fear many do not report related symptoms such as weight loss, shortness of breath, chills and other ailments. As a result, thousands of cases go unreported, and many more are categorised as multidrug resistant, while an effective vaccine for adults is yet to be developed.
Decision makers increasingly realise that all our public health problems are intertwined with other issues such as overcoming the challenges of poverty and the gap among provinces, including the gap regarding access to clean water and health services.
Poverty in the household means less priority on continuing treatment among TB carriers as the focus is on short-term earnings even when one may feel unwell; while prosperouslooking cities may blind us to the fact that TB can spread faster in dense, polluted areas.
One contributor of pollution is our infamously high rate of smoking. A few local leaders have indeed made progressive steps in addressing smoking-related diseases; such as enforcing no smoking areas. Our participation at the New York panel to end TB will need to be substantiated by consistency, including much more concerted policies in curbing tobacco consumption.