Home Health End discrimination and stigma to end tuberculosis

End discrimination and stigma to end tuberculosis


By Henrylito D. Tacio

Tina, a mother of seven, was washing clothes under the heat of the sun. After doing so, she went to take a rest. It was already dark when she woke up. She had to prepare dinner for her family and so she stood up.

She was in the kitchen when she started vomiting blood. “I think I vomited about a cup of blood,” she recalled.

It was good that her eldest son and two daughters were there. Being young, the three didn’t know what to do. The eldest son went to the neighbor who came up to the house. When she saw Tina was lying with blood coming from her mouth, she was totally terrified.

Together, they helped Tina ride a pedicab and brought her to the nearest community hospital. The doctor examined her and after a test, she was diagnosed of having the dreaded tuberculosis (TB).

The doctor had given her some drugs as treatment. She was also advised to take the much-needed rest. She was brought back home, where she recuperated from the disease.

When her neighbors learned that she had TB, they started to avoid talking to her. Even her husband tried to segregate her from the rest of the family. Tina had her own spoons, plates, and cups.

Tina’s persistence with her treatment paid off. Six months after she religiously took the medicines the doctor had given her, she was finally cured. “I was totally happy when the doctor told me that I was finally free from taking those medicines,” Tina said. “But what stayed in my mind was how I was treated by my neighbors.”

Up until now, there are still so many misconceptions concerning TB. Most of these concerns are hearsays and not even true. And its high time to dispel these if we have to eliminate this disease from this part of the world.

This is what Evelyn Uy-Gelito, National TB Program and National Laboratory Professionals Council nurse coordinator of the Davao regional office of the Department of Health (DOH), was trying to emphasize during this year’s commemoration of World Tuberculosis Day last March 24.

“There are still a lot of people who don’t know what TB is all about,” Gelito was quoted as saying by Edge Davao’s roving reporter, Maya M. Padillo during Kapehan sa Dabaw at SM City Davao. “There are still a lot of misconceptions about TB and this is the time that we will correct these misconceptions.”

Just like the dreaded coronavirus disease virus, the bacteria that caused TB is spread through the air from one person to another. ““When a person breathes in TB bacteria, the bacteria can settle in the lungs and begin to grow,” the US Centers of Disease Control and Prevention (CDC) explains. “From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain.”

The CDC says TB is not spread by shaking someone’s hand, sharing food or drink, touching bed linens or toilet seats, sharing toothbrushes, and kissing. “The disease is almost never transmitted through clothes, bedding, or other personal items,” assures the book, The Medical Advisor: The Complete Guide to Alternative and Conventional Treatments.

Despite being a preventable and curable disease, TB still kills 1.5 million people every year. This makes the disease “the world’s top infectious killer,” according to the Geneva-based World Health Organization (WHO).

Although TB is present all over the world, it is most common among those living in low- and middle-income countries. About half of all people with TB can be found in 8 countries, including the Philippines.

With 554 cases for every 100,000 Filipinos, the Philippines ranks fourth worldwide in TB incidence, the WHO tuberculosis report 2020 states. About one million people have active TB, and nearly 70 Filipinos die every day from it, the DOH reports.

“Most people who develop the disease are adults,” the WHO points out. In 2021, men accounted for 56.5% of the TB burden, adult women accounted for 32.5%, and children the remaining 11%.

“Tuberculosis is perhaps the greatest killer of all time,” said Dr. Frank Ryan, author of Tuberculosis: The Greatest Story Never Told. “A timeless epidemic, tuberculosis has seemingly always been there throughout history… a familiar evil, yet forever changing, formless, unknowable.”

The tenacious Mycobacterium tuberculosis has preyed on people since antiquity. TB-induced skeletal deformities point to the disease’s existence as early as 8000 BC. Unmistakable signs of tubercular bone decay were found in the skeletons of Egyptian mummies as long ago as 2400 BC.

“Year after year, century after century, it tightened its relentless grip, worsening with wars and famines that reduced people’s resistance, infecting virtually everyone but inexplicably sparing some while destroying others,” wrote Dr. Frank in his book.

TB is almost always associated with poverty. But rich people are not spared from the disease. Wuthering Heights author Emily Jane Bronte was stricken with the disease and was only 30 when she died of it. Hollywood actress Vivien Leigh and English actor Denholm Mitchell Elliott also succumbed to TB. Filipino actors Rene Requiestas and Narding Anzures also died of the disease. Even President Manuel L. Quezon was not spared.

“After subjecting me to a rigorous physical and fluoroscopic examination, the doctor diagnosed my case as tuberculosis of the lungs,” Quezon said in a speech delivered during the dedication ceremonies of the Quezon Institute, a sanatorium for TB. “I was then ignorant of this disease. I had always felt vigorous and healthy throughout my life and had never thought seriously of diseases.”

The TB bacteria is spread from person to person through microscopic droplets released into the air. “This can happen when someone with untreated, active tuberculosis coughs, speaks, sneezes, spits, laughs, or sings,” the Mayo Clinic says.

When the particles are inhaled, bacteria lodge in the lungs and multiply. “You can contract the disease only if you are exposed to an infected person for a long time,” The Medical Advisor says. “If you spend 8 hours a day for six months, or 24 hours a day for two months, with someone with an active case of TB, you have a 50 percent chance of acquiring the disease.”

Malnourished people or those who live in close quarters stand the greatest chance of contracting TB. Healthcare workers, long-term hospital patients, and prison workers or inmates also face a greater-than-normal risk of becoming infected with TB.

Another reason why TB is becoming hard to beat is because of the increasing number of Filipinos infected with human immunodeficiency virus (HIV). “Because HIV is a state of lowered immunity, many people living with HIV (PLHIV) are prone to TB infections,” wrote Dr. Mary Ann Evangelista and Dr. Gideon Lasco in an Inquirer commentary. “Although difficult to treat to begin with, TB is specially complicated on top of HIV, and it ranks as the leading cause of deaths among PLHIV.”

A less common route of transmission is through the skin. Pathologists and laboratory technicians who handle TB specimens may contract the disease through skin wounds. TB has also been reported in people who have received tattoos and people who have been circumcised. 

Not all who are infected with TB bacteria develop the disease. According to health experts, a person’s immune system may destroy the bacteria completely. In fact, only 5-10 percent of those infected with TB actually become sick. 

The four most familiar signs of TB are chronic cough, mild fever in the afternoon and sweating at night, chest and back pain, and progressive weight loss. In more serious or advanced cases, the symptoms are spitting blood, pale and waxy skin, and a hoarse voice.

In the past, being diagnosed with TB was considered a death sentence. In 1944, 21-year-old “Patricia” with progressive, far-advanced pulmonary TB received the first injection of streptomycin. She improved dramatically during the ensuing five months and was discharged in 1947. She was evaluated in 1954 and found to be healthy and the happy mother of three children.

Today, the most common medications used to treat TB are Rifapentine, Moxifloxacin, Isoniazid, Rifampin, and Myambutol (ethambutol). Those who are diagnosed with TB are advised to take their medicines exactly as prescribed for as long as it’s prescribed.

In the Philippines, the government is spending money to treat TB. TB treatment is free in public hospitals, clinics, and health centers. But studies showed about 60% of Filipinos with TB go to private doctors for comfort and anonymity. They spend for consultation, diagnostic tests, and medicines.

 “There is no reason that a person that has TB will not be treated,” said a health official.

“After taking antibiotics for two weeks, most people are no longer infectious and feel better,” the CDC says. “However, it’s important to continue taking your medicine exactly as prescribed and to complete the whole course of antibiotics. Taking medications for 6 months is the best way to ensure the TB bacteria are killed.”

But there are those who may forget to take the prescribed medications. For that reason, directly observed therapy (DOT) is used to make sure a person is taking their medicine. DOT means a trained healthcare worker provides each dose of medication, watches the patient swallow it, and documents that the medication has been taken.

The success of drug therapy and the declining rates of disease incidence in the middle part of the 19th century instilled a sense of confidence in public health officials that TB could be conquered in due time.

But like a phoenix that rises from ashes, TB has staged a comeback – in a deadlier and more complicated form. “Call it what you may – a time-bomb or a powder keg. Any way you look at it, this is a potentially explosive situation,” deplored Dr. Margaret Chan at the time she was the WHO Director-General. 

Dr. Chan was talking about multidrug-resistant TB (MDR-TB). It happens to those who don’t complete the whole course of the prescribed medications. Doing so may make the TB bacteria resistant to the drugs. This is potentially serious because, according to doctors, it can be difficult to treat and will require a longer course of treatment with different, and possibly more toxic, therapies.

“Drug-resistant TB has a very expensive treatment,” the DOH claims.

Although TB is curable, people still abhor those infected with TB. In fact, stigma and discrimination are among the most commonly identified barriers to fight the TB epidemic. The United Nations health agency says reducing stigma is important because it hampers care seeking, contact tracing, outbreak investigations, treatment initiation, adherence and quality of care.

“Let us end the stigma associated with the disease,” urged Dr. Francisco T. Duque III when he was still the health secretary. “TB is a treatable disease and we can prevent deaths and possible outbreaks if TB is detected and treated early. We call on people who are experiencing symptoms of TB or those diagnosed with TB to consult with your local health centers or TB clinics for free treatment.” 

Credits: Photo from WHO and graph from lalpathlabs.com

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