Going the distance

November 18, 2015 by Emily Shea

Tuberculosis (TB). To many students at the College, it is little more than the reason behind having to take an annoying purified protein derivative (PPD) test to work or volunteer in the health care field or go on a trip abroad. However, outside Williamstown and the United States, it can be a fact of life. What is even graver is that many cases of TB, new or recurring, are resistant to the most common treatments. These cases are known as multi-drug resistant TB (MDR-TB) and extremely-drug resistant TB (XDR-TB). The World Health Organization estimates that 480,000 people developed MDR-TB in the year 2013. Though treatments for this serious condition are available, there were still 210,000 deaths in 2013 due to MDR-TB. Some of the reasons for these deaths include people not receiving any treatment in the first place or their treatments being interrupted. However, in Carabayllo, Peru, a community health worker visits a woman with XDR-TB every day. Because of this, she is able to fight TB, and has survived and thrived for eight years with a disease thought to be imminently fatal. Nevertheless, some legislators, economists and more may argue that complex medical treatment, such as fighting drug-resistant TB, in resource-poor countries is unfeasible. However, the success of community-based treatment is a testament to the fact that this is untrue. Complex medical treatment is both possible and necessary in resource-poor countries.

There are multiple arguments for why medical treatments like those for drug-resistant TB are “impossible” in countries with less infrastructure and fewer resources than the United States and most of Europe. Treatment success is dependent on people continuing to take medications as instructed for the full course. However, due to issues of access (i.e. needing to travel a long way to a hospital, or needing to take expensive transportation), some people in countries like Peru either stop treatment before they complete it, or never get the chance to start. Alternatively, the drugs can cause serious side effects, leaving patients exhausted and, without proper education and encouragement, likely to drop out of treatment.

Though these issues are cited as reasons for the implausibility of treatment, community-based treatment is able to circumvent these problems. There are many aspects to this treatment model, but some of the most important include the nurses and community health workers that come to visit patients. Instead of requiring long travel, health care comes to the patient. Instead of feeling alone and depressed during treatment that comes with severe side effects, patients have someone to talk to. And even when patients start to feel better, community health workers ensure that treatment continues for the full course.

This treatment model is not just a myth or idea, but has seen success. Partners in Health (PIH) implemented this model to start using antiretroviral therapy to treat AIDS in Haiti in the late 1990s, when no one thought this would be possible. But, of the first 60 patients treated, 59 had a positive clinical response. By 2008, over 3500 patients in Haiti were on antiretroviral therapy provided by PIH, and the one-year survival rate for these patients with AIDS jumped to 94 percent. If this model can be successful in AIDS treatment, it can also succeed with TB treatment.

To be sure, these treatments are complicated and expensive regimes. In fact, due to the costs of these drugs, it has been suggested that the world should focus on prevention of new cases, rather than spend the money it takes to treat these patients. However, it is important to realize that treating people is an effective method of disease prevention. TB, even and especially those cases with drug-resistance, is passed in the air by coughs and sneezes. But once a patient starts treatment, his or her bacterial levels drop off so that he or she is no longer contagious. Therefore, to get this epidemic under control, already-infected patients cannot be ignored for other focuses. Their treatment is critical to the success of prevention.

In the purple bubble, it’s easy to ignore the problems of Haiti or Peru because these countries are so far away. It is also easy to feel helpless and believe that “nothing can be done” to help individuals with MDR-TB. I live in a wealthy country and community and am lucky to live here because I know I can get the medical treatments I may need. But it is clear that if we look to my country’s history, it shoulders some blame for the poverty in resource-poor countries. Thus, in addition to it being feasible to treat TB in Peru, it is also morally the right thing to do. By supporting global health work, we can all become more engaged citizens of the world and break out, ever so slightly, from the comfortable purple bubble in which we reside.

Emily Shea ’16 is a biology major from Nesconset, N.Y. She lives in Prospect.

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