Wrestling with hunger and tuberculosis

MANILA, Philippines – Her name is Quenie, almost like a queen. She is anticipating her 10^th birthday, alongside the end of her tuberculosis (TB) treatment.

The ‘e’ was intentionally dropped, “Para kakaibang reyna,” Quenie’s mother quipped. (So it sounds like a unique queen.)

Quenie is moderately malnourished; she is both too thin and too short. She often shocks people whenever they find out that the little queen is already in 5^th grade. She never seems to gain much weight, her mother observed.

She began her tuberculosis treatment last April; she has to take her medicines every day. Joining her in the 6-month treatment is her 8-year-old brother – the third in the family to have TB.

Months ago, the queen’s mother underwent the same treatment. “Siguro nga, sa akin sila nahawa,” the mother said. She also admitted to having water in her lungs in 2012, but she is now cured from all her illnesses.

The family was able to treat TB through the free services and antibiotics offered by the local health center, which is part of the country’s National Tuberculosis Control Program (NTP) headed by the Department of Health (DOH).

But TB is not the only disease shared by the family; most of Quenie’s siblings are also malnourished. (INFOGRAPHIC: What does malnutrition look like?)

The lack of adequate food has been haunting Quenie’s family for years, but the role of nutrition in their lives has never been more real now that her parents are witnessing how the lack of it is slowly corrupting their family’s youngest members.

TB, nutrition

“Nutrition is a big part in both prevention and treatment of tuberculosis,” said Jedy Molina, a registered nurse and the TB program facilitator of Children International (CI) Manila, a non-governmental organization (NGO) providing health and education assistance to the poor.

Molina explained how proper nutrition strengthens resistance to illnesses. “It also helps in faster recovery, especially if paired with proper hygiene,” she added. “Children should eat properly even after treatment; if they have TB the second time, the condition gets worse.”

The College of Home Economics of the University of the Philippines Diliman recommends the following diet for those with TB. They should be drinking lots of water and eating food rich in:

• Carbohydrates like rice, bread, root crops
• Protein like meat, tofu, milk, eggs
• Calcium like milk, small fish, and leafy vegetables
• Vitamin C like guava, mango, orange, pineapple

“If children are malnourished, they have weaker immune systems, hence they are more vulnerable not just to TB but other diseases too,” Kimbery Mandigma, CI Manila’s nutritionist-dietitian, stressed.

Aside from coughing, sweating, and high fever, other symptoms of TB include the loss of appetite and extreme weight loss.

To address the problem, CI Manila provides vitamins, family health and nutrition classes, and supplementary feeding programs for families across Quezon City, Caloocan, and Bulacan. Before the implementation of the NTP, it has also provided TB antibiotics. But since local health centers started providing such services, CI Manila now helps with the referral of patients.

Mandigma highlighted how important it is for parents to understand the nutritional needs of their children with TB. “Minsan hindi lang bata matigas ang ulo, pati magulang. Tama ba pinapakain nila sa bata?” (Sometimes it’s not just children who are stubborn, but also the parents. Are they feeding their kids the right food?)

She also clarified that TB is not inherited – although some households lacking access to health information still believe otherwise – but contracted when regularly exposed to an adult with active TB.

Poor households usually lack proper sanitation and live in small yet crowded spaces, hence making it easier for diseases to spread.

PH tuberculosis

The Philippines is the 7^th country in the world with the highest incidence of tuberculosis (TB) as of 2012, the latest report from the World Health Organization (WHO) revealed. Back in 1998, the Philippines also placed 7^th.

The WHO global tuberculosis report showed that the Philippines is just above Ethiopia and Congo. And among Southeast Asian countries, the Philippines ranked second to Indonesia.

In fact, tuberculosis is the country’s 6^th leading cause of mortality among adults, the DOH reported. And in 2010, it was reported that more than half of the country’s screened TB cases were children.

In the Philippines, DOH has been on top of controlling TB. Health facilities, NGOs, and local government units (LGU) follow guidelines set by the 2010-2015 Philippine Plan of Action to Control Tuberculosis. The end goal is for the Philippines, as part of achieving the the Millennium Development Goals, to reduce the incidence of major diseases like TB.

Health advocates laud the country’s TB program, particularly in detecting and monitoring cases. WHO also praised the government’s efforts in “making services accessible in difficult geographic and socioeconomic settings.” However, advocates observed that childhood TB still needs more attention.

“Among local health centers, sometimes there’s a lack of doctors specializing on pediatric TB,” Mandigma observed. Families like Quenie’s also asked LGUs to strengthen their information dissemination regarding TB among children, and to ensure that the supply of TB medication among health centers never runs low.

Bright future?

Meanwhile, Quenie is looking forward to school; this year, she will be competing in one of the country’s biggest math competitions.

“Inutang pa ng papa niya ang pang-review sa contest,” the proud mother said. (Her dad even borrowed money for her review in preparation for the contest.)

The little queen loves mathematics, and she is counting the days until she can be free of TB and can adequately prepare to be an accountant. – Rappler.com

To learn more about the projects of Children International Manila, you may reach them at 937-0161 or soa@mla.children.org.ph.

How can we help fight hunger? Report what your LGU is doing, recommend NGOs, or share creative solutions. Send your stories and ideas to move.ph@rappler.com. Be part of the #HungerProject.