A modern plague . . .

tb-alertJust a couple of weeks ago I watched a 90 minute documentary on BBC4 that left me depressed yet at the same time somewhat optimistic. I haven’t watched a program like that for a long time that had such an emotional impact on me.

TB: Return of the Plague documented the rise and impact of multi-drug resistant tuberculosis (MDR-TB) in Swaziland. Although it wasn’t explicitly mentioned, as far as I can recall, the increase in TB seems to be linked with the the spread of HIV/AIDS as patients immune systems are compromised by the virus. The deadly evolution of MDR-TB has occurred because TB patients have failed to complete the course of treatment against this disease. And even now the disease has evolved into EDR-TD, or extreme drug resistant forms.

Doctors – and patients – face a difficult dilemma. It may take six months to two years or more to ‘cure’ someone with MDR-TB, or at least show that they are no longer infectious, and the ‘cure’ seems almost worse than the disease. The ever stronger cocktail of drugs (ever more powerful antibiotics) have terrible side effects – injections and pills – have terrible side-effects: continual vomiting and loss of hearing among the nastiest. And so many patients despair of ever getting better and simply stop taking the drugs. When patients are too weak to continue taking the drugs because of the side effects, doctors are reluctant to stop treatment because of the risks that the pathogen will mutate once again There have been no new drugs for decades to combat TB.

This was the situation of Bheki, once a healthy and hard-working man in his 30s, whose passion was football. TB has robbed him of the energy to play any longer – all he can do is watch from the touch-line and encourage those who can play. It was heart-wrenching to listen to his despair; he just couldn’t take the pain any longer. And what was worse, his sister Zandile died of TB – she wasted away because she no longer had the strength to withstand the ravages of the drugs on her emaciated body.

Listen to the despair of this young woman robbed of her youth and opportunities in life because of MDR-TB. Not long after this was filmed sadly she died.

There is hope
Yet the program was also full of hope. Take the case of 13 year old Nokubheka who had lost her mother to TB. Supported by her 17 year old brother, she became an in-patient at a TB hospital far from home, and had to remain there for more than six months, taking her drug cocktail daily, until she was no longer infectious. She was lonely (all the other patients were adults) and many died. She was separated from her brother, who she missed. But, at the end of the day, Nokubheka recovered, was fostered with a well-to-do family (who had a daughter just a little younger than herself), she returned to school and was once again developing an optimistic outlook on life. Her ambition was to study, go to university and then work for the future of her country. I was left with the encouraging image of a little girl with a broad smile. Now that’s optimism for you.

We can eradicate disease
Recently there have been reports of the resurgence of other diseases. Only today on the lunchtime news there was a report of a new outbreak of the Ebola virus in West Africa. And while smallpox has been eradicated some years ago, polio stubbornly hangs on in Pakistan, Afghanistan, and northern Nigeria – yet the prevention of this terrible childhood disease is so straightforward if only the doctors and nurses could reach all children in those areas where the disease is still a problem. And there has been a resurgence of polio in war-torn Syria, where it had been eradicated. Nevertheless, the outlook for the total eradication of polio is encouraging. In the UK and in the USA, measles has made a comeback – because parents failed to have their children vaccinated, a consequence of the scaremongering some years ago over the MMR vaccine.

Let us hope that the latest developments of medical science, involving molecular biology and genetics, can lead to more effective and cheaper drugs to combat diseases that we thought we once had under control. And in the case of TB that’s important for us all. TB is highly contagious, and there are now reports of the disease making a comeback here in the UK, even MDR-TB. And of course there always the opportunity (through air travel)  for drug resistant strains of any disease to spread quickly. All schoolchildren in the UK are – or should be – checked to see if they need the TB vaccination. When I was at high school in the mid-60s one of our teachers was diagnosed with TB. Everyone had to be tested, even if they had been vaccinated before. I had the Mantoux skin test twice, and both times had a violent reaction, my arm swelled up, and I was in bed for at least a fortnight on both occasions. It seems I have a very high immunity to TB. But would that protect me against MDR-TB? Just a couple of days ago there were reports of TB in domestic cats and the threats of this passing into the human population. Prevention is certainly better than cure.

 

11-11-11

10:58 am. On the outskirts of Mons in Belgium. A rifle shot rings out. It must be a sniper, defending the retreating German troops as they moved eastwards away from the Western Front. A British soldier – one of the countless Tommies who perished during the Great War – falls dead in his comrade’s arms.

Two minutes later and it will 11 o’clock on the eleventh day of the eleventh month. 1918, and the Armistice that the Germans had sued for over the previous weeks comes into effect (although some exchanges of fire would continue for a couple more hours along the Western Front). All became silent, but two minutes too late for this British soldier. One more tragedy after more than four years of the tragedy of conflict, during which the combatants tried to slug each other to defeat without success – until now.

I had always wondered how Great Britain became embroiled in a European war that was started four years earlier in August 1914 following the assassination of Archduke Franz Ferdinand in Saravejo at the end of June. Just a month later Europe was consumed in a conflagration that came to be known as World War One or the Great War. How did an event hundreds of miles away in Bosnia drag Great Britain into war? Well, a couple of months I did write about the start of the Great War after reading Sean McMeekin’s excellent July 1914: Countdown to War published in 2013. In the first few months of the war, the respective front lines of the Entente Powers – France, Great Britain and her Dominions (Canada and Australia) and colonies, and eventually the Americans after 1917 and the Central Powers – Germany and her allies – were already established and didn’t move much over the next four years. Stalemate had been achieved.

So what changed in 1918? How did the war come to an end. I have just finished reading an excellent review of the last months of the conflict, A Hundred Days – The end of the Great War* by Nick Lloyd, Senior Lecturer in Defence Studies at King’s College London (based at the Joint Services Command and Staff College in Wiltshire).

The Germans had launched a Spring offensive in April and May 1918, and although they came within a whisker of a victory over the Allies, they were not able to achieve their objectives. The Allies withstood this major assault, but the Germans were irretrievably weakened. Then from mid-August the Allies went on the offensive and, using tanks, superior (overwhelming in fact) air power, and improved battlefield tactics, began to make the sort of breakthrough that had eluded both sides in the conflict through four years of stalemate. Soon, the Germans were out-gunned, out-witted, demoralized and apparently disproportionately affected by a flu epidemic; they began retreating north and eastwards.

The end of the Great War was approaching, and Wilhelm II – ‘Kaiser Bill’ – was forced to abdicate just before the Armistice was signed, bringing to an end centuries of rule by the Hohenzollern dynasty, and going into exile in the Netherlands. He never did accept that Germany had been defeated.

The debate over the end of the war, whether the Allies should have pushed for outright victory, continues, as does that over who was to blame for starting the conflict in the first place. Having entered the war in August 1914 Great Britain was there for the duration – only defeat of Germany was the acceptable outcome. And to a large extent that was what was achieved. It was Germany that sued for peace – she could no longer sustain the conflict. Political reality set in, the threat of revolution in Germany hovered over the country, and the German military had nothing more to give.

Were the terms of the peace treaty signed at Versailles in June 1919 too harsh? There are those who argue that they were, and historians like Niall Ferguson argue that Great Britain should never have become involved in the first place. Germany was a ‘broken’ country. Since the Allies never invaded Germany (apart from occupying the Ruhr) there were always those who denied that she had ever been defeated. Certainly there was an upsurge of nationalism after the war leading ultimately to the coming to power of the Nazis in the 1930s – and all the consequences that arose therefrom. Had we learned nothing from the First World War. It took another world war to defeat German militarism once and for all. Today Europe is a much more stable continent although the Balkans have seen their fair share of conflict in recent decades. The ongoing crisis in the Ukraine and the flexing of Russian muscles is all too redolent of the mistakes that led to conflict in 1914. We can only hope that in today’s geopolitical environment there are fewer chances of mistakes happening because opposing sides in a potential conflict are unaware of what each other is doing, unlike in the days leading to the outbreak of the Great War.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

* London: Viking. ISBN: 0670920061, 067092007X, 9780670920068, 9780670920075

These two books about the war are also worth considering:
Max Hastings, 2013. Catastrophe: Europe goes to war 1914. London: William Collins. ISBN: 0007398573, 9780007398577 

Ian F.W. Beckett and Steven J. Corvi (eds.), 2006. Haig’s Generals. Barnsley: Pen & Sword Military. ISBN: 1844151697, 9781844151691.