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.


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