Detour on road to TB eradication
IN conjunction with World Tuberculosis Day (March 24) and in response to Mangai Balasegaram’s article “Think we’re done with TB? Think again” (Star2, Sunday Star, March 26), it was interesting to note that there is a resurgence in the incidence of tuberculosis infection in this country.
Health Ministry figures show that in 1990, there were 10,000 cases. In 2014, the number rose to 24,000, a whopping increase of 41%.
In 2012, according to the ministry, there were more cases of TB than dengue fever in this country. What is behind this spike and how should it be tackled?
It is often said that TB is a poor man’s disease. It thrives well in slums and squatter settlements where sanitation is poor. It is also considered a Third World disease.
Is Malaysia a Third World country then? Are our towns, cities and villages crammed with squatter areas that have poor sanitation and ventilation? Definitely not, so something is not right here.
After independence, the government embarked on five-year plans, which included lifting the health standard of citizens through various programmes to be implemented by the Health Ministry. One such initiative was the National Tuberculosis Control Programme which employed the vertical process. A director was appointed to draw up a programme to be implemented nationwide with trained medical teams and sufficient funds from the federal authorities.
These medical teams set up their own clinics, known as chest clinics, throughout the country in general and district hospitals. In the health centres, which were basically in rural areas, nurses and medical assistants played a vital role in implementing the National TB Control Programme.
There was also a drastic change in the treatment of the disease. The earlier practice was to admit TB patients to sanatoriums for longterm treatment. One such sanatorium was located on Pulau Jerejak in Penang. This practice created stigma for TB patients who, once dis- charged from the sanatorium, were segregated in their homes and were at times shunned by society.
Change came when it was decided that admission to hospitals for TB treatment was not a must but only an option, depending on the circumstances. Majority of patients were treated as outpatients who could continue treatment at the health facility nearest to them, whether urban or rural. It emphasised supervised treatment where the patient took the medication under the supervision of a medical person. If there were defaulters, a special team called the home visiting team visited them to find out the reason for their absence and persuade them to continue medication. Those who came into contact with the TB patient were investigated to see if they had contracted this highly infectious disease.
Through these concerted efforts, TB, like malaria, was soon on the verge of eradication. According to the World Health Organisation, for a disease to be declared eradicated by any nation, there should not be any incidence of it for a period of 10 years.
This was not to be the case, however. The steady and progressive march of the National Tuberculosis Control Programme towards absolute success came to a screeching break when the vertical programme was abandoned and TB control was integrated as part of infectious disease control.
This integration was the beginning of the end of the march towards the eradication of TB in Malaysia.
Besides this wonderful programme, another factor that should be mentioned is the magnificent role played by the Malaysian Association for the Prevention of TB (MAPTB), a voluntary organisation that was set up to help needy patients financially and to provide the support service they needed in order to comply with their treatment.
The influx of illegal immigrants is also a contributing factor in the resurgence TB in Malaysia.
As these illegal immigrants do not go through any form of medi- cal examination, those who carry this disease are potential transmitters. When they exhibit symptoms of the disease, the employers would take them to the nearest health facility for treatment. Subsequently, two things would take place: The employer would terminate the worker’s services or the patient would default and move to another area for employment, and he would likely transmit the disease to people in the vicinity.
The drug menace has also compounded the problem of eradicating TB. Drug users who contract HIV become very susceptible to TB due to their weak immune system.
As such it is pertinent that the Health Ministry reconsiders its strategy in stopping the spread of TB. It has to go back to the drawing board as has been suggested by many chest physicians during conferences and symposiums. There needs to be an overhaul to prevent health workers from contracting this disease as well.