Eradicating tuberculosis is one of the priorities of this administration according to the Department of Health. Photograph from ABS-CBN News
Culture Spotlight

Why TB remains a major issue in the Philippines — and how we can put an end to it

Even with advancements to its treatment, tuberculosis continues to claim the lives of so many Filipinos. But as one doctor points out, there are a lot of factors that need to be addressed beyond technological limitations: public and private dissonance, faulty medical practices, and widespread stigma.
Gideon Lasco, MD, PhD | May 01 2019

When Cely, a 52-year old laundry-washer, started coughing a lot, she thought it was just a passing sickness. Maybe it was caused by stress or the environment, she thought. It took months before she finally consulted a doctor, who prescribed her a week-long round of antibiotics. She felt some improvement and decided that she no longer needed any follow-ups.

Public stigma still prevail over TB in many parts of the country. Photograph from ABS-CBN News

More challenges in health and wellness:

 

But the cough persisted. Eventually, she went to another doctor, who ordered an X-ray. The doctor told her that she has weak lungs, and prescribed her with medications. But she only took them for only a few days because it made her urine turn red. It would take more months before she would see yet another doctor—and this time, it was in the emergency room. For the first time, she and her family were told that she has had tuberculosis, and bacterial pneumonia on top of it. With her lungs and immune system weakened, it was too late to control the infections; after six days in the hospital, she died of acute respiratory failure secondary to TB pneumonia.

As any doctor would tell you, Cely’s death was completely preventable. “Had she been diagnosed at the beginning, she could have received free treatment. And had she followed through with six months of medications, should would most likely be still alive,” as Dr. Terence Kua, a doctor to the barrio working in Misamis Oriental, tells me. He adds that he also encounters frustrating accounts of undiagnosed, untreated TB in his community.

While there are treatments currently available, accessibility still needs to be addressed. Photograph from ABS-CBN News

Indeed, the tragedy in our country is that there are countless stories like Cely’s. The DOH estimates that tuberculosis claims the lives of 60 to 70 Filipinos a day. This, despite the treatment for the disease being around for decades, and despite billions spent annually to control it. Clearly, the public health response has not been commensurate to the scale of this problem.

In what could be a glimmer of hope, the government itself has acknowledged that something’s amiss. According to Department of Health Secretary Francisco Duque, we cannot do business as usual. He said this at the United Nations General Assembly in New York last year, and he reaffirmed this commitment last month. Speaking at the 7th Union Asia Pacific Regional Conference last April, he says that finally putting an end to TB is a priority under the current administration.

Moreover, Sec. Duque reiterates the three-fold strategy he first articulated last year: “high-level commitment, massive screening, testing, and treatment, and mandatory notifications by the private sector.”

Perhaps the presence of President Duterte in the regional conference signals the “high-level commitment” that the secretary speaks of. But beyond rhetoric, we hope to see the government mobilizing its resources to scale-up TB control efforts. Apart from health programs, we need to address the social determinants of TB—including malnutrition, substandard housing, poor living conditions, and poverty itself. Accessibility will also be a factor; while there are health centers now, many simply can’t afford to go there.

 

Challenges abound

One problem is the lack of awareness. TB is a chronic disease with insidious manifestations—cough, slight fever, etc—and people don’t recognize it as a serious illness until it’s too late. Because of this, they are unwilling to allocate their resources accordingly. Also, stigma around TB persists in many parts of the country, and patients like Cely are not even told that they have it. Here, the support from the WHO, USAID, and other organizations is most welcome. The DOH and its partners will have to invest in more communications and education efforts in the coming years if TB is to be eradicated.

Another problem is drug resistance. Ideally, TB treatment ought to be free in health centers, and the intake of the medications should be directly observed and monitored by health staff. Unfortunately, some private MDs fail to recognize TB or refer them to the health centers. Instead, they themselves prescribe anti-TB medications, sometimes improperly. Because patients pay for the medications and are not oriented about the side effects (like Cely’s reddish urine), they often fail to continue beyond a week or two. This leads to relapses and drug resistance that is often devastating for both individuals and populations. Multi-drug resistant TB (MDR-TB) is much harder to treat, you see.

There are many factors that hinder us from ending TB in the Philippines, including undisciplined medical practices. Photograph from Arvin Chingcuangco on Unsplash

Of course, the public sector has had many shortcomings, too. As the dengue vaccine scandal and the measles outbreak show, a concerted, rapid mobilization of human and financial resources is possible when responding to public outcry. But in “boring emergencies” like TB, this kind of response is often missing. At the local level, the lack of human resources, facilities, and even medicines can also undermine control TB efforts.

These failures notwithstanding, we can still make meaningful progress. We need to identify and treat the estimated one million Filipinos with active TB, and prevent others from acquiring the disease. Now is the time to end tuberculosis. The Duterte administration needs to act on this priority they have identified. And we need to come together as a nation to deal with this largely-overlooked crisis that is leading to so much suffering and death to our people.