Tuberculosis Makes Filipinos Their Brothers' Keepers

By Kai T. Hill

Faced with an age-old health crisis that could be remedied with treatment and awareness, residents in the Maguindanao province of the Philippines have committed to fighting tuberculosis.

Controlling this disease has long been an uphill battle. Transportation is inadequate and many roads through Maguindanao's mountainous terrain and marshy lowlands are impassable. Residents in these subsistence farming communities can't afford transportation to distant clinics. This means delays in testing for tuberculosis, not to mention getting results. Besides, a good number of residents know little about the related symptoms to begin with.

As barriers to testing and treatment persist, so too does the disease.

Tuberculosis is a highly infectious disease that attacks the lungs and manifests itself in coughing, weight loss and night sweats. Unknown in much of the developed world, tuberculosis remains prevalent in 22 nations, including the Philippines, Indonesia and Cambodia. In 2007, The Philippines ranked ninth among the 22 high-prevalence countries, which collectively constitute 80 percent of global tuberculosis cases.

Catholic Relief Services continues to work alongside residents to help them get the treatment and support they need, even if it means knocking on doors to collect samples for testing or to make sure patients are taking their medicine.

"For tuberculosis, you need to be very supportive of the patient," says CRS' Elena McEwan, a health technical advisor. "We are willing to do whatever it takes to make sure more people are being diagnosed."

CRS and our local partners began the Maguindanao Tuberculosis Control project in 2005. Expected to reach over 475,000 residents by September 2009, the project partners with the Maguindanao province's Integrated Provincial Health Office to detect tuberculosis early and increase cure rates in 28 municipalities.

"When we start our work, we first determine how the community is structured," says McEwan, who is part of a team of health experts based in CRS' Baltimore headquarters. "We didn't want to establish a parallel structure just for tuberculosis. Instead we worked through and respected the natural structure."

A Contagious Enthusiasm

Seeing a need for functional health facilities, CRS, with funds from the U.S. Agency for International Development, upgraded the community's small medical outposts so that health workers could treat patients, store drugs and keep records more efficiently. Once these upgrades were made, McEwan says, there was a noticeable change in the work culture.

"The enthusiasm I saw was contagious. The nurses were very proud of being able to do their jobs more efficiently, and clients were happy with the treatment and attention they were receiving," she says. McEwan visited the Philippines in 2008 to assess the project and meet with patients.

So-called "Tuberculosis Clubs," where patients talk about their experiences, have helped develop a support system and much-needed dialogue within communities. Because of the stigma attached to many infectious diseases, tuberculosis patients are sometimes reluctant to disclose their status or seek treatment, but McEwan describes club participants as having a newfound boost of confidence.

"Clients were not shy. They exuded an attitude that said 'I am sick and I have the right to be treated'," she says, noting that residents who have overcome tuberculosis help lead the discussions.

Volunteers Drive Success

Tuberculosis treatment takes at least six months and requires a daily dose of antibiotics. One of the project's greatest successes is the use of local drivers, like Aladin Ali, to help deliver test samples to labs and, if needed, drive residents to testing and health care facilities. A "microscopy on wheels" worker, the 36-year-old Ali says that he is "truly happy" to be able to help people.

"That's something beautiful," McEwan says. "While existing health workers already have a mind-set of service, local everyday drivers are usually businesspeople with other interests. For them to be able to say 'I am going to help' is commendable because they saw a need and were open to helping."

The project has also trained volunteers to help test residents for tuberculosis. They visit homes and collect test samples. McEwan says volunteers are specially trained to handle in a way that ensures accuracy and prevents spread of the disease.

Additionally, the project designates community members to check in with their neighbors daily to make certain that they are taking their medications. "Overall, this project has been a great chain of collaboration," McEwan says.

Poor More Susceptible

Controlling tuberculosis in the developing world is no easy feat, given the number of setbacks that any one community may face. For local farmers, tuberculosis could mean weeks sidelined from work in the fields. The stigma attached to the disease causes some customers to buy their produce elsewhere.

McEwan stresses that the infection doesn't discriminate between the rich and poor. However, she adds, the lack of protective controls and awareness allows tuberculosis to proliferate more readily among the poor. Because people tend to be more malnourished in poorer countries, their bodies are more susceptible to contracting tuberculosis, McEwan explains. Also, the disease is easily spread in confined environments such as mines or in slums, where "each neighbor is living on top of the other."

Complicating Factors

CRS is working to eradicate tuberculosis in eight countries throughout Southeast Asia and Africa. When coupled with malnutrition, diabetes or HIV, tuberculosis poses a greater threat to the body. Because tuberculosis poses particular risks to HIV patients, CRS integrates tuberculosis testing and treatment into many of our HIV programs around the world.

"The main cause of death of HIV patients in Africa is tuberculosis, because people don't die of HIV but rather the opportunistic infections," says McEwan.

Since nutrition plays such an important role in fighting infectious diseases, some CRS programs provide food to tuberculosis patients to help strengthen their bodies' defenses.

"Even if you are providing food to very, very poor people, you are fighting tuberculosis," says McEwan. "These efforts are greater than providing drugs and treatment. It's more about everyone contributing to eradicate the disease."

Kai T. Hill is an associate web producer for CRS. She works at the Baltimore headquarters.