By Paula Akugizibwe, ARASA (Published in Business Day, 1 July 2008)
IN OUR deranged global system of relative rights, where one's money determines the value of one's life, it is not terribly surprising that very little research has been done on improving the management of tuberculosis (TB) — a leading cause of mortality in many poor countries — in the past 50 years. Equally unacceptable, but more surprising, is that even as global research machinery finally begins plodding towards serious action on this public health disaster, many national TB programmes continue to underperform without being held accountable.
Don't be fooled by the rhetoric — in recent years, every health authority with a voice has declared TB an "emergency", a "crisis", a "threat", a "catastrophe". There is talk of urgent action, of bold action, of immediate interventions. There is a constant and justified buzz of urgency in TB rhetoric, deflected by a constant and unjustifiable drone of lethargy in TB action. When an "emergency" becomes the status quo, it indicates a state of chronic failure.
How does a preventable, curable disease become the leading cause of all natural deaths in SA, and the leading cause of all AIDS-related mortalities on our continent?
Well, first we take drug-sensitive TB, a perfectly curable form of tuberculosis, and mismanage it for decades in health structures with poor infection control, weak diagnostic capacity, insufficient education on TB, inadequate resources and minimal political commitment.
We observe substandard cure rates and increasing mortality figures. Over time, our poorly functioning TB programmes are manufacturing drug-resistant TB strains — the result of inadequate or incomplete TB treatment — but we don't worry about this too much until multidrug-resistant (MDR) TB explodes in our faces.
Unfortunately, the programmes that are now forced to deal with this new demon are still plagued by the lack of education and capacity that manufactured MDR TB in the first place. Inadequate diagnostic capacity, for example, ensures that many cases go undetected and that, even in the cases where detection does happen, it takes place after a lengthy waiting period during which infection is spread further. Appropriate treatment is not always available. Support that is available for strengthening drug-resistant TB management is ignored by the countries that need it the most.
So, more people die. Many deaths go unrecorded. It becomes kind of chronic tragedy — one that features in millions of death certificates but few headlines.
Until, suddenly, TB is back in the spotlight — a more powerful and lethal strain is on the scene. The same failures in the TB programs that manufactured MDR TB have now produced its progeny: extensively drug-resistant (XDR) TB, which responds to very few TB drugs and kills with alarming efficiency. We're not quite sure how to lock down this killer, so we lock up the patients that have fallen prey to it, trap them in the system that generated XDR TB to begin with. We invest our energies in confining the victim to the scene of the crime, while the instigators of the crime continue to run rife. The great outrage is that these are the very same instigators that we have faced from the start, against which we have not made any significant progress, despite many promises of "urgent" action. As the global TB crisis grows worse, the chronic failure of TB programs to respond to this crisis becomes more and more obscene. Diagnostic systems are a disaster. Infection control is a disaster. Resource allocation is a disaster. Management of drug-resistant TB is a disaster.
That is how a curable, preventable disease becomes a leading cause of death — because our chronically failing systems give it licence to kill, because we cannot seem to summon enough momentum to shake the underperformance that got us to this point. The disaster that is TB today was not by any means inevitable — it has been systematically generated for decades. And it continues to be generated and aggravated as the sluggishness that characterised the global response to TB in the past persists, most markedly at country level, where the same old mistakes are perpetuated with the same stupefying apathy.
When will we learn from these mistakes, and correct them? When will the emergency be over? Where is the bold and urgent action? Where are the resources? How much longer will our leaders drag their feet on delivering on the lofty commitments that they have been making for years?
These are the tough questions that we need to ask every government in the region, starting at the South African National TB Conference in Durban this week. This is not about pointing fingers; it is about accepting responsibility and effecting leadership. It is about honest evaluation of the response to TB and honest commitments to improving it. Nobody needs to die of a preventable, curable disease. And yet they die in increasing numbers. So we have failed, and failed dismally. It is time to put out the dirty laundry, wash it and move forward.
Comments
Tuberculosis is a contagious
Tuberculosis is a contagious disease that most commonly affects the lungs and respiratory tract. This is the reason it is usually referred to as a fatal lung or respiratory disease. Some survey results about this really shocks me. It is always important to diagnose, treat, and cure people at the earliest. claim back ppi
Antibiotics to treat TB have
Antibiotics to treat TB have been available since the 1950s, and when used correctly they can cure TB in people with HIV.
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Preventing, Diagnosing and Treating TB: A human rights approach
HIV is the main challange in this decade. We see a significant incremant of affected people from this virus, Hope some one will find a working treat to solve it.
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The risk of death in the
The risk of death in the first five years following seroconversion was similar to that of the general population, with the excess probability of death becoming apparent only later in the course of the infection. Regards, cheap web hosting
Tuberculosis, or TB, is an
Tuberculosis, or TB, is an infectious bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs. It is transmitted from person to person via droplets from the throat and lungs of people with the active respiratory disease.
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Tuberculosis is a common and
Tuberculosis is a common and often deadly infectious disease caused by mycobacteria, in humans. Thanks for the superb preventive and diagnosing steps provided in this article. Will definitely share this blog with lot of my associates. Cannabis outdoor seeds
Tuberculosis (TB) is a
Tuberculosis (TB) is a contagious disease. Like the common cold, it spreads through the air. Only people who are sick with TB in their lungs are infectious. When infectious people cough, sneeze, talk or spit, they propel TB germs, known as bacilli, into the air. A person needs only to inhale a small number of these to be infected.
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a tool for analysis which focuses attention on the underlying inequalities and discrimination faced by people living in poverty and social isolation, which impede their development and deny them the opportunity to raise themselves out of poverty
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International football icon
International football icon and Stop TB Ambassador Luis Figo is the main character of an educational comic book that provides key information on tuberculosis (TB). Luis Figo and the World Tuberculosis Cup was produced by the Stop TB Partnership, an international health partnership whose secretariat is housed by the World Health Organization (WHO) in Geneva, with support from UNAIDS.
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In the UK and many other
In the UK and many other European countries, schoolchildren aged 12-14 were given a BCG vaccination against TB. However, this vaccination does not offer complete protection against TB, and there have been many cases of people who received the BCG jab as a child developing TB.
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Its not antivaccine?
Its not antivaccine, is pro SAFE VACCINATION, because what they are doing now is going to kill us all?
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TB is classic one
Well, TB is a old and classic one as other said, I got a good introduction about it.
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Is TB really a catastrophe?
Is TB really a catastrophe? I had no idea about this before reading this article. Essay Help
Bold Action
Bold action is indeed what we require, but I dont see where it's coming from
I fear if it does come, it will come too late.
T.B is one of the oldest and
T.B is one of the oldest and most dreadful disease , though now a days many medication are available but still they have adverse reactions as well . replica handbag
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I think that our whole World
I think that our whole World should unite and treat TBC globally. Mike from singorama review guide.
Good work! Your post/article
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True Statement
"where one's money determines the value of one's life" This is a very true statement.
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Well, i can say that
Well, i can say that Diagnostic systems are a disaster. Infection control is a disaster. Resource allocation is a disaster. Management of drug-resistant TB is a disaster.....That is how a curable, preventable disease becomes a leading cause of deat.This can be protected using Auto Glass so that germs cannot pass through our mouth.
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RE:
Unfortunately, the programmes that are now forced to deal with this new demon are still plagued by the lack of education and capacity that manufactured MDR TB in the first place. (printing design) Inadequate diagnostic capacity, for example, ensures that many cases go undetected and that, even in the cases where detection does happen, it takes place after a lengthy waiting period during which infection is spread further. (corporate logo) | (business logo)
TB in London
When I moved to London I was shocked to learn that rates of TB are actually very high in parts of London - and growing.
TB is no longer a developing world problem but increasingly affecting everyone.
Is having a strategy and a conference enough when drug resistant strains can strike anyone down?
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Good work! Your post/article is an excellent example of why I keep comming back to read your excellent quality content that is forever updated. Thank you!
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When will we learn from
When will we learn from these mistakes, and correct them? When will the emergency be over? Where is the bold and urgent action? Where are the resources? How much longer will our leaders drag their feet on delivering on the lofty commitments that they have been making for years? I dont know man, but I hope it will be soon. cheap pit bike and upvc window guide.
How sad but true
Its all to common that the powers that be look the other way from life threatning problems for the bottom line dollar. Its always the financial choice over the human right to survive. I hope the future brings about a more sympathetic aproach to life.
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Thank you for this
Thank you for this informative read, I really appreciate sharing this great post. Keep up your work.
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