“If the misery of the poor be caused not by the laws of nature, but by our institutions, great is our sin.” – Charles Darwin
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Three years ago, Marianne received an e-mail from her mother. She was petitioned of going to the United States. The 32-year-old single teacher from Davao City was ecstatic to hear the news. After all, she had been dreaming of going to the land “where milk and honey flow.”
Unfortunately, it has been more than six months already but her visa application is still pending. She wondered why. It all started when, after having a medical check-up, she was found to have tuberculosis (TB).
Although TB cases in Davao City has gone down by 5% in the past five years, it is still way below the 50% reduction set under the Millennium Development Goal. According to Dr. Ashley Lopez, head of the city Chest Center, the decrease of TB cases was due to their “widespread campaign against the disease in every barangay and proper diagnostics.” In addition, TB medication was readily available in barangay health centers.
“People should be given correct information so they would understand the nature of the disease,” Dr. Lopez was quoted as saying.
TB is still common not only in Davao City but in almost parts of the country. “TB is the number six leading cause of death in the Philippines,” wrote Dr. Willie T. Ong in his column, “Mind Your Body.”
All over the world, the Philippines has the ninth-highest burden of TB. The Department of Health (DOH) says sixty percent of those who die of TB occur among the productive age group of 15-64 years old. Some P8 billion is lost annually from sickness and deaths due to TB.
The regional office of the World Health Organization (WHO) estimated some 260,000 incident cases in 2011 in the country, of which 28,000 died in a year. But what alarms Dr. Ong are those Filipinos who have active TB. “This is alarming since each person with active TB can spread the disease to 10 other Filipinos each year,” he deplores.
If you multiply the number of Filipinos with active TB by 10 and you get the idea why it is frightening. “Just imagine how much TB is being spread yearly,” Dr. Ong points out. “Hence, if someone in the household has been diagnosed with TB, all the other members of the household should get tested for TB, too.”
An estimated 80% of Filipinos have latent TB, according to Dr. Ong. “In this condition, we already have the TB infection in our bodies, but the TB is still in the inactive state,” he explains. “Hence, we feel no symptoms and we are not contagious to other people.”
In industrialized countries like the United States, they treat those with latent TB with medicines. “But we can’t help it because we are born in the Philippines,” Dr. Ong says. “We just need to observe a healthy lifestyle, or else the TB infection might get reactivated.”
Back with vengeance
Despite advance knowledge in science and recent discovery of sophisticated drug regimes, the disease has continued its deadly progression. “Tuberculosis is perhaps the greatest killer of all time,” wrote Dr. Frank Ryan, author of Tuberculosis: The Greatest Story Never Told. “Tuberculosis rose slowly, silently, seeping into the homes of millions, like an ageless miasma. Once arrived, TB stayed (and become) a stealthy predator.”
Although the “predator” has been tamed in some parts of the world, it continues to take its toll in most developing countries, including the Philippines. “The disease, preventable and treatable, has been grossly neglected, and no country is immune to it,” the WHO deplores.
With every tick of the clock, a person is being infected with TB somewhere. “One-third of the world’s entire population is now infected with the TB bacillus,” the United Nations health agency claims.
TB is a disease that is transmitted almost entirely by the aerial route. “When infected individual coughs, sneezes, or spits, infectious particles are released into the air,” writes Dr. Maya Santos in her column which appeared in Vital Signs. “Anyone who inhales these particles is at risk of contracting TB. Transmission is enhanced in overcrowded and poorly ventilated places.”
This is the reason why TB is more prevalent among those living in squatter communities and correctional institutions. Based on a recent study of seven detention facilities in the Philippines, the prevalence of this disease inside jails and prisons is up to five times higher than among the general population.
Two stages
The disease can occur in two stages: primary and secondary. “In primary TB,” explains Maria Luisa Padilla in Encarta Encyclopedia, “a person has become infected with the TB bacteria but often is not aware of it, since this stage of the disease does not produce noticeable symptoms. Macrophages, immune cells that detect and destroy foreign matter, ingest the TB bacteria and transport them to the lymph nodes where they may be destroyed or inhibited.”
TB is not contagious in the early stage. “About three weeks after initial infection,” Padilla continues, “bacteria may be inhibited, destroyed, or allowed to multiply. If the bacteria multiply, active primary TB will develop.” Symptoms of carriers include coughing, night sweats, weight loss, and fever. A chest X-ray may show shadows or fluid collection between the lung and its lining.
At the primary stage of TB, the disease does not progress, but bacterial may remain dormant in the body for many years. If the immune system becomes weakened, the tubercle opens, releasing the bacteria, and the infection may develop into active disease, known as secondary TB.
In the secondary TB, the formerly dormant bacteria multiply and destroy tissue in the lungs. They also may spread to the rest of the body via the bloodstream. Fluid or air may collect between the lungs and the lining of the lungs, while tubercles continue to develop in the lung, progressively destroying lung tissue. Coughing of blood or phlegm may occur. At this secondary stage, carriers of TB can infect others.
Mycobacterium tuberculosis ( MTB), the microorganism that causes TB, divides every 16 to 20 hours, an extremely slow rate compared with other bacteria, which usually divide in less than an hour.
Considered a “wily foe,” MTB can live only in human beings. “It cannot be carried by animals, insects, soil, or other non-living objects,” the Merck Manual of Medical Information states. “A person can be infected with TB only from another person who has active disease. Touching someone who has the disease does not spread it, because the bacteria are transmitted only through the air.”
The MTB usually attack the lungs, but it can also attack any part of the body such as the kidney, spine, and brain. The WHO says a person with TB may demonstrate some or all of the following: persistent cough for at least two weeks; significant weight loss, with or without loss of appetite; fever and night sweats (persistent low grade fever of more than a month); chest pains (breathlessness) or back pains; and, hemoptysis (blood-tinged sputum).
“Symptoms depend on the organ affected,” says Dr. Ong. “TB of the spine causes severe back pain, while TB of the kidneys can cause bloody urine. Hence, TB should be checked and treated as early as possible.” – (To be concluded)
