It is true that tuberculosis or TB is the most common single infectious disease causing ill health and death in Myanmar. But heart and blood vessel diseases are number one. Put the word Myanmar into the controls on the left on this webpage to see. https://vizhub.healthdata.org/gbd-compare/
Most people are infected when they are young. Not in a bus or a tea shop when they are older.
Jamie
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Public health enemy number one
Htike Nandar Win
Myanmar Times
Friday, 20 January 2017
In a hospital ward in Insein township, skinny, gaunt bodies sit motionless on beds, their eyes dark and sunken, their mouths covered with blue masks. Among them is Ko Paing Soe, his thin, fragile body disappearing beneath his blue gown.
Ko Paing Soe is being treated at the Aung San Tuberculosis Hospital, the main hospital providing treatment to Tuberculosis (TB) patients in lower Myanmar.
He recounted his shock upon finding out that the cough he had was a symptom of TB.
“I was surprised when I discovered I had TB, as I have never even been near a TB patient. The doctors told me it can be contracted via air. I travel by bus and used to sit in tea shops, so I might have contracted it at those places,” said Ko Paing Soe, who has multidrug-resistant TB.
Ko Paing Soe says things have been difficult in the four months since his diagnosis. It has caused problems at home, he says, as he has to sleep and even eat separately from his wife and son. Even the water he drinks is separate. Once the breadwinner of his family, Ko Paing Soe has not been able to provide financial support to his family since contracting the disease, leaving them to scrape by financially.
Myanmar is one of 30 countries in the world with the highest rates of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB), according to the World Health Organization. Now, the country’s high rate of tuberculosis infections has spurred the government to introduce a national campaign to fight the disease.
The Ministry of Health and Sports intends to implement a National Strategic Plan for Tuberculosis Control, including programs to speed up diagnosis and treatment of the disease as well as to prevent its outbreak and spread.
As part of the anti-TB campaign, a survey to gauge the prevalence of the disease will be conducted in October this year. The head of the National Anti-Tuberculosis Program, Dr Si Thu Aung, stresses that all Myanmar citizens should participate in the campaign as anybody can be infected with TB, which is spread by airborne transmission.
Of particular concern to the government is the high incidence of MDR-TB and XDR-TB patients.
Most of Ko Paing Soe’s fellow patients at the Aung San Tuberculosis Hospital are MDR-TB patients. The total number of patients undergoing treatment is between 120 and 130 at any given time.
Like Ko Paing Soe, the other patients on the ward are thin and gaunt with a slow gait. Many of them require the aid of breathing apparatus.
MDR-TB is a form of TB which is resistant to two most powerful drugs used in first-line anti-TB treatment, and requires treatment for almost two years, according to specialist doctors.
Anyone can contract TB, anywhere
As tuberculosis is spread by airborne transmission, anyone can contract it regardless of age and economic status. Even health workers and doctors aren’t immune.
Dr Ko Oo (not his real name), a physician who contracted TB five years ago and has only just recovered, told The Myanmar Times of his shock and shame when he found out he was infected with TB.
“I don’t know from whom I caught it. I wasn’t a doctor who was in close contact with TB patients. I never thought I could be infected with a disease so easily. I have a thorough knowledge of medicine and prevention and I am supposed to be the one giving treatment to those who are infected. I felt ashamed that people would know I was infected myself,” he said.
Ko Khin Maung Than, a bus conductor, found out that he had contracted MDR-TB only when he fell ill with a cough for three months and was tested.
“I am always in close contact with people. At first, I had to warn them as they didn’t know I was infected with TB. I have decided not to go back to that job even after I am cured,” he said.
The head of the Aung San TB Hospital, Dr Thandar Mhun, said it is important for people to realise one can be infected with TB anywhere, even in normal living conditions.
“People think that TB can only be contracted if you work in a TB hospital, but a person can catch the disease anywhere. You can get it at work. You can get it from other general hospitals. Prevention is important,” Dr Thandar Mhun said.
Is TB easily spread?
Tuberculosis is an infectious disease which can be spread via the air. When an infected person coughs, sneezes, sings loudly or laughs, droplets of saliva with TB bacteria are spread through the air. If a person inhales those droplets, they enter into the lungs via the respiratory tract and they can be infected. TB is neither genetic nor hereditary, and it can be cured completely with proper treatment.
Experts point to the importance of treatment in curbing the spread of TB. If a person with TB does not seek treatment, he can spread the disease and infect up to 10 to 15 other people within a year, according to TB specialists.
There are some 140,700 TB patients in Myanmar, according to a report released at the TB Conference held on November 19 last year. The rate of new TB occurrences in the country is 365 persons in 100,000 and 49 persons per every 100,000 die from the disease.
TB treatment and side effects
The dispensing of drugs and necessary aids to control TB in Myanmar is conducted under the National Tuberculosis Program. A specialist from the Aung San TB Hospital, Dr Khin Aye Myint, said there were about 5000 to 6000 MDR-TB patients undergoing treatment in the Yangon Region.
“As they are discharged from hospital only when they are completely clear of bacteria, they can no longer infect others. They do not have TB bacteria but still receive treatment while staying outside the hospital.”
TB not only has physical effects, such as hearing loss, for patients, it also affects their families in terms of their health, social and economic situations. When the patient is the breadwinner, the family often suffers financially.
Another negative impact of TB is that, as it is an infectious disease, the patient may be shunned or abandoned by his or her family. Some patients are cared for by their families but some are abandoned out of fear that the other family members could become infected.
Ko Khin Maung Than, who was abandoned by his family when he was diagnosed with MDR-TB, said, “Both my parents are dead. My relatives no longer take care of me because they are worried about contracting TB. Even though I am now cured, there is nowhere for me to go to.”
Family support is important, said Dr Khin Aye Myint, especially as a MDR-TB patient suffers the effects of drugs more than a TB patient and it takes a long time to treat the disease.
“People are more afraid of MDR-TB than TB. Once resistant to drugs, the treatment will take longer. Drugs used are not the same. Drugs for MDR-TB are stronger. The patients suffer more and it makes them more tired,” he said.
A financial burden
The government allocated K3,394,342 in the 2015-2016 budget for the National Tuberculosis Program, and TB drugs are supplied free of charge through the state budget with assistance from the UN Global Fund.
However, a National Catastrophic Cost Survey conducted in March 2016 found that 65 percent of families of TB-patients spent 20 percent of their annual income on TB treatment, and TB can still be a financial burden for the families of TB sufferers, said Dr Khin Aye Myint.
“It costs about K270 lakhs to treat a MDR-TB patient. Drugs are expensive. If the family has to pay for all the drugs, it will be a huge burden for them. Just the drugs alone cost a lot. We get assistance from NGOs and international organisations, but for a person to bear the entire cost of treatment is difficult,” she said.
Can tuberculosis be eradicated by 2030?
Tuberculosis is one of the world top 10 most deadly diseases, with a mortality rate that is even higher than HIV, according to the WHO.
As TB is an infectious disease, it poses a danger for not only the doctors but also for healthcare workers, said Dr Than Win, Deputy Director General of Disease Control Unit of Public Health Department.
“That is why infection control is being conducted as a priority in hospitals and clinics. It is also being conducted for healthcare workers in collaboration with medical treatment departments. Healthcare workers will inevitably be in contact with the patients. There are some cases of doctors and nurses contracting TB, but they are rare,” said Dr Than Win.
In addition, the challenges posed by drug resistant TB strains compound the situation, stressed Dr Win Naing, professor and head of the respiratory medicine department at the Institute of Medicine.
“The WHO assumes that there may still be drugs for TB treatment. But I don›t think so. We are finding it difficult to cure XDR-TB now. There are no drugs,” he said. “It is like we are approaching a pre-antibiotic era where there are no antibiotics for the treatment of an infection. No drugs for treatment. The situation will become like that. People still can›t still accept it.”
Translation by Zaw Nyunt
http://www.mmtimes.com/index.php/lifestyle/24624-public-health-enemy-number-one.html
