Los­ingL the fight against TB?

The Star Malaysia - Star2 - - MOVIES -

Pris­ons with high rates of TB in­fec­tions? Who cares, they’re just con­victs, right? Well, TB doesn’t stop at the prison gates. PRIS­ONS are of­ten ter­ri­fy­ing plac“The chance of fur­ther trans­mises, rife with abuse and bru­tal­ity. sion is high,” says Prof Dr Adeeba There is an­other hid­den threat to Ka­marulza­man, dean of Univer­siti life there that of­ten goes un­seen Malaya’s Fac­ulty of Medicine, who and un­con­trolled: tu­ber­cu­lo­sis, or is one of the lead­ers of the study. TB. Go­ing to prison is bad enough;

The level of TB in pris­ons has be­ing con­demned to a pos­si­bly been re­ported to be up to 100 fa­tal dis­ease is un­jus­ti­fied. times higher than that of the genIf you’re in­clined to say so what, eral pop­u­la­tion, the World Health these are pris­on­ers – think again. Or­gan­i­sa­tion ( WHO) says. In parts TB doesn’t stop at the prison gates. of East­ern Europe, pris­ons are hotIt’s an in­fec­tious, air­borne dis­ease. beds for TB epi­demics. Some­one cough­ing on an air­plane

Pro­longed con­fine­ment in can spread TB to nearby passe­nen­closed, crowded, poorly- ventigers. TB re­mains a top killer in lated cells – to­gether with poor Malaysia, killing far more peo­ple nu­tri­tion and lack of med­i­cal care than, say, dengue. – pro­vide the per­fect storm for TB, Last Thurs­day was World TB which is spread through aerosol Day. World­wide, al­most 10 mil­lion droplets from cough­ing, sneez­ing peo­ple fell ill with TB in 2014, of or speak­ing. which one in 10 were chil­dren;

That “storm” is rag­ing lo­cally. A and de­spite the avail­abil­ity of a 2014 study in Ka­jang prison, cure, some 1.5 mil­lion died, WHO Se­lan­gor, the na­tion’s largest pris­re­ports. on, and Pengkalan Chepa prison The bat­tle against TB is get­ting in Ke­lan­tan, found grim re­sults: harder. Multi- drug re­sis­tant TB, or 89% of pris­on­ers in Ka­jang and MDR- TB, is tougher, costlier and 88% in Pengkalan Chepa tested takes longer to treat. A course of pos­i­tive to tu­ber­culin skin tests, stan­dard TB drugs costs roughly which checks ex­po­sure to TB. The US$ 20 ( RM80) over six months, rate among prison of­fi­cers in but treat­ing MDR- TB can cost up Ka­jang was also high, at 81%. to US$ 5,000 ( RM20,000) and take

Such ex­traor­di­nar­ily high figtwo years, WHO says. ures in­di­cate that be­hind bars, the MDR- TB now plagues most TB epi­demic here is thriv­ing. coun­tries.

Worse, there is “ex­ten­sively drug- re­sis­tant” TB, which has turned up in Malaysia; and in In­dia, there is even “to­tally drug- re­sis­tant TB”.

Now this is scary. Un­treat­able TB? That sends us back to the past, when we were help­less against the much­feared “great white plague”, which in­ci­den­tally killed off some of the great­est artists, such as Ge­orge Or­well, Chopin and the Brontë sis­ters.

This un­der­scores why ev­ery­one with TB should be treated, and treated prop­erly, to pre­vent drug- re­sis­tant TB. Bil­lions of dol­lars of in­ter­na­tional fund­ing are given to­wards free TB treat­ment ev­ery year. Free treat­ment is crit­i­cal, be­cause TB of­ten af­fects the poor, and those at the bot­tom of so­ci­ety, such as im­mi­grants and pris­on­ers.

In the prison study, half the par­tic­i­pants were in­ject­ing drug users, who have a high risk of in­fec­tion of both TB ( for var­i­ous rea­sons) and HIV, which in turn raises the risk of TB de­vel­op­ing. Also, many pris­on­ers in the study had been pre­vi­ously im­pris­oned, some a few times, in­ten­si­fy­ing the like­li­hood of TB in­fec­tion.

De­spite all this, 92% of par­tic­i­pants in the study had never been tested be­fore for TB. That is as­ton­ish­ing. Ser­vices to test, pre­vent and treat TB in pris­ons must be im­proved.

Dr Adeeba – who con­ducted the study with vis­it­ing re­search fel­low Dr Haider Al- Dar­raji, and in col­lab­o­ra­tion with Prof Fred­er­ick Altice from Yale Univer­sity in the United States – says all pris­on­ers should be tested for TB upon ar­rival in prison and treated promptly for the dis­ease. In­fec­tion con­trol mea­sures, in­clud­ing bet­ter ven­ti­la­tion, are also needed.

Dr Adeeba adds that pris­on­ers sick with “ac­tive” TB were of­ten di­ag­nosed late. This leaves more time for TB to spread.

Ul­ti­mately, there is a “need to con­sider al­ter­na­tive ap­proaches” to im­pris­on­ment, she says. Most of the pris­on­ers in Ka­jang are there be­cause they took drugs. Is it worth send­ing them to prison to “re­form” when we know they won’t? With­out ad­dress­ing ad­dic­tion, we can only ex­pect a cy­cle in and out of prison, and even­tual in­fec­tion with TB, HIV and hep­ati­tis.

An al­ter­na­tive would be lo­cal “cure and care” clin­ics, which of­fer proper treat­ment for ad­dic­tion, such as methadone ther­apy and coun­selling. These clin­ics have shown en­cour­ag­ing re­sults.

The price of in­ac­tion is high. Rus­sia, which once had TB un­der con­trol, failed to deal ad­e­quately with TB in pris­ons af­ter the col­lapse of the for­mer Soviet Union. Today, Rus­sia has one of the largest TB epi­demics and some of the world’s highest rates of MDR- TB.

Let’s hope we don’t go down that route.

Man­gai Balasegaram writes mostly on health, but also delves into any­thing on be­ing hu­man. She has worked with in­terna tional pub­lic health bod­ies and has a Masters in pub­lic health.

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