PHILIPPINES: Tuberculosis remains a major killer


Photo: Leah Mae Damazo/IRIN

At a Queson Institute ward in the Philippines, patients with drug resistant tuberculosis receive treatment for free but must pay for costly additional antibiotics and vitamins

MANILA, 4 June 2008 (IRIN) – Each of the dozen or so beds in an airy ward in Quezon Institute, in Metro Manila, a private hospital dedicated to fighting tuberculosis, has a story to tell.
Rosalinda Dunton, 71, wonders when she can go back home to Capiz Province. She has been confined for three weeks now, suffering from a complicated form of TB. Her granddaughter stayed with her throughout, but with school opening next week, nobody will be by her bedside daily.
Next door is 60-year-old Juanita Gello-Agan, who was rushed to hospital a few days before because her diabetes had been complicated by tuberculosis. A nurse has just handed George, her son, a new list of medicines. George told IRIN the combined effect of his unpaid leave to care for his mother and the cost of medicines was taking its toll on his family. "The impact on our finances is really big," he said.
A financial burden
The Quezon Institute is free, as are the TB medicines. But patients must pay for the other antibiotics and vitamins prescribed, and in each of the beds, the stories are similar – finances drained because of the costly drugs and lives temporarily put on hold because of the ravaging disease that still ranks number six among the leading causes of morbidity and mortality in the Philippines.
According to the World Health Organization (WHO), the country has the ninth highest number of tuberculosis cases in the world and the highest in southeast Asia. Globally, there were more than nine million new cases and about 1.7 million deaths from the disease in 2006; the WHO estimates there are more than 14 million people living with TB, which kills 75 Filipinos each day, according to the Department of Health.


Photo: Leah Mae Damazo/IRIN

Rosalinda Dunton, 71, with her granddaughter. Dunton, who has been in hospital for three weeks, suffers from a complicated form of tuberculosis

But over the years, the government, with the private sector and humanitarian community, has steadily made gains against tuberculosis. The DOTS (Directly Observed Treatment Short-course) programme, recommended in the mid-1990s by the WHO, played an important role in this success. DOTS required patients to take their medicine in front of a health worker to ensure proper compliance with the entire treatment programme.
Before its implementation, patients often sold their free medication to other people once they started to feel better, Arnold Ortiz of the Philippine Tuberculosis Society, which runs Quezon, told IRIN. "Because of this poor compliance, patients develop multi-drug resistant tuberculosis," he said.
Early detection and surveillance
DOTS consists of improved case detection through strengthened laboratory testing and drug resistance surveillance, which, according to Maria Lorela Averilla, monitoring and evaluation officer of the government’s National Tuberculosis Program, is key to fighting the disease. On infected person can infect many more if left untreated.
Because of the success of DOTS, Averilla told IRIN, the Philippines is one of the first four among the 22 "high burden" countries to have met the WHO’s targets of a 70 percent detection rate and an 85 percent cure rate. The country’s detection rate is 77 percent and its cure rate 89 percent. In 1990, there were 819 cases out of every 100,000 Filipinos; in 2006, this dropped to 432. Mortality rates fell too, from 80 per 100,000 in 1990 to 45 per 100,000 in 2006.


Photo: Leah Mae Damazo/IRIN

Juanita Gello-Agan, 60, has diabetes complicated by tuberculosis. Her son took leave from his work to care for his mother. The effect of his unpaid leave and the cost of medicine has taken a heavy financial toll on his family

These gains, however, are mostly against regular pulmonary tuberculosis. Most challenging for health officials are new forms of multi-drug resistant tuberculosis and complicated cases in which the patient has other conditions, including diabetes and HIV/AIDS.
In fact, Ortiz said that because the government became aggressive in fighting tuberculosis, admission rates at the Quezon Institute for regular pulmonary tuberculosis dropped. The hospital trimmed bed capacity four years ago and focused on treating complicated tuberculosis cases.
Late diagnosis
"Most of the patients we lose are those who come in for treatment too late, who live in far-flung areas and don’t have easy access to medical facilities and who do not comply with the treatment programmes given to them," Ortiz told IRIN. "These are the ones who develop complicated or multi-drug resistant tuberculosis," he said. "Despite all the efforts at raising awareness, ignorance about tuberculosis remains high and the stigma still associated with it keeps people from seeking treatment."
Averilla said that while multi-drug resistant tuberculosis used to be treated only at private hospitals, it is now being addressed in public health centres.
Policies have also been set in place to address TB acquired because of other diseases. But she adds that, first and foremost, people have to have health-seeking behaviour. "We have enough resources in public health centres to treat tuberculosis," she says. "People just have to come and avail themselves of them."