Via The New York Times, an alarming op-ed: Losing the Fight Against Tuberculosis. Excerpt:
On a recent morning at Persahabatan Hospital in East Jakarta, patients, some from remote villages accessible only by boat, gathered in a waiting room. Nearby, lab technicians used new diagnostic technology to test sputum samples for multidrug-resistant tuberculosis, in an effort to tackle a growing caseload of the deadly disease.
Indonesia’s recently sworn-in president, Joko Widodo, takes the reins of a rising economic power poised to play a larger role on the world stage. But he also confronts a set of entrenched public health problems fueled by the poverty in which millions of Indonesians still live. None is more urgent than the spread of drug-resistant tuberculosis across this sprawling archipelago.
Thanks to support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, the international financing mechanism established in 2002 to help poor countries address these diseases, Indonesia has been able to provide the costly drugs for drug-resistant tuberculosis to patients free of charge. It has also supplied laboratories like the one at Persahabatan with the Xpert MTB/RIF device, which allows health workers to diagnose suspected cases of drug-resistant disease in under two hours (conventional methods take as long as eight weeks).
These are encouraging steps, but as Indonesia is learning, the tools of clinical medicine can do only so much. “This is a social disease,” Dr. Erlina Burhan, the head of pulmonology medicine at Persahabatan, told me, referring to multidrug-resistant tuberculosis. “We have 7,000 new MDR cases a year, and many of those are defaulting on their treatment.”
It’s easy to understand why. For one thing, there’s the financial strain; the drugs may be free, but as a recent multinational study found, the cost to patients — for everything from transportation and hospital stays to months of missed work — can amount to a year’s earnings. And then there is the treatment itself: a grueling, two-year regimen of toxic drugs involving months of daily injections and possible severe side effects. And so stigmatized is tuberculosis in Indonesia that when volunteers go house to house looking for cases, families often try to hide sick relatives.
“Most of our patients don’t know how the disease is transmitted,” Dr. Burhan said, “so they return home and spread their drug-resistant strain to others.” The World Health Organization estimates that every untreated MDR patient will infect, on average, between 10 and 15 people per year — and some of those may be their children, in whom tuberculosis is more difficult to diagnose and treat.
In October, the W.H.O. reported that improved data collection had revealed an epidemic significantly larger than previously estimated: In 2013, nine million people developed active tuberculosis, and of those, nearly half a million were infected with multidrug-resistant strains. Indonesia, home to the world’s fifth-highest number of tuberculosis cases, is expected to publish its own prevalence survey soon; experts believe those figures will only add to the global burden.
It's all very romantic to be dying of TB in some 19th-century novel or opera; in the 21st century, not so much.