Multidrug-resistant TB on the rise in northern Mindanao

CAGAYAN DE ORO CITY, Philippines – Cases of multiple drug resistant tuberculosis (MDR-TB) in Region 10 are on the rise.

The Department of Health (DOH) said that even as the cure rate of the common pulmonary tuberculosis (PTB) has risen to 88% to 90% – higher than the government target of 70% – the cure rate ratio for MDR-TB has dropped to 20%. (READ: Drug-resistant TB in PH, 7 other countries)

Dr Evelyn Magsayo, National Tuberculosis Program Coordinator,  said the health department is now striving to raise the cure rate for MDR-TB which is more dangerous than PTB.

Magsayo said the DOH is doing contact tracing – a method that involves tracing those who made contact with people afflicted with MDR-TB to prevent the spread of the bacteria.

In 2008, the health department issued Administrative Order 2008-0018 acknowledging that the “MDR-TB has become a significant health problem,” not only the in the country but across the world.

Speaking at the International TB day forum in Cagayan de Oro in March last year, Dr Rosalind Vianzon, National TB program Manager, said that the number of TB cases in Region 10  is reflective of the number of cases around the country.

In 2011, there were at least 200,000 cases of TB across the country with Region 10 accounting for 8,800 cases – a thousand more compared to 2010. In December 2012, there were 10,000 cases. Region 10 consists of 5 provinces with a total population of 4,297,323.

Magsayo said that they are working hard to trace people with MDR-TB since if left untreated, they may infect others. (READ: Tuberculosis killed 1.3 million last year: WHO)

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Emiliano Galban Jr, DOH Region 10 spokesperson, said that the rise in the number of MDR-TB cases in the region is also due to increasing population and human congestion in small places.

He said that in Region 10, the health department has worked with the Committee of the German Doctors based at the Jose Rizal Hospital in Xavier University and the Iligan Society of Internists to help eradicate MDR-TB. 

Galban said two groups have put up a “halfway house” to treat persons with MDR-TB. In Cagayan de Oro, the German doctors housed at least 70 patients in a dorm where they are to stay for 18 to 24 months or until they are cured of the disease.

Magsayo said that unlike PTB patients, those with MDR-TB need to stay inside the regional halfway houses to make sure that they can be cured and be kept from self-medicating.

The 2^nd National TB prevalence Survey revealed that 1.4% of those newly infected with MDR-TB and 14.5% of those previously treated, self-medicate.

Magsayo stressed the danger of self-medication. “Some are doing self-medication for 5 years, which resulted in the development of MDR-TB.”

Social stigma poses problem

John Ronald Gilbolingo, MDR-TB coordinator for Philippine Business for Social Progress-Global Fund, said that while PTB and MDR-TB is curable, the social stigma of a TB patient is one of the root causes why patients self-medicate or worse, do not seek medical attention at all.

“There is nothing to be ashamed of if you are affected with the TB bacteria. TB can be cured; you just have to submit yourself to be examined and given medical treatment,” Gilbolingo said.

Galban shared that due to the social stigma, the poor and underprivileged tend to self medicate, which he said should not be the case since the government gives free medicine to treat the disease. He said TB is a bacterial infection and that the body has no natural immunity against it.

Magsayo said getting infected with TB is not a “choice” as “nobody wants to be infected with TB.” 

“It is not our choice to be infected, that’s why we call those who are infected with TB as ‘victims,’” Magsayo reiterated.

A social worker of the German Doctors’ Hospital’s Programmatic Management of Drug Resistant TB, believed that the stigma suffered by TB victims in the 19^th century, when curing the disease was a challenge, persists today.

“Before, TB victims were isolated for fear of transmitting the disease by coughing could affect others,” social worker Jun Langajed said in an interview. He said in the 1800s, TB victims were required to sunbathe as the warmth of the sun was known to kill the TB bacteria. 

“That is the root of the stigma suffered by the victims which is carried over these modern times when we have more advanced drugs that can kill even the multiple drug resistant TB,” Langajed said.

Modern medicine against an old scourge 

The DOH, which works with other organizations including the Global Fund, UsAid, and KOICA to address the TB scourge, acknowledges that government cannot fight TB alone.

Magsayo said the DOH has hired more nurses and TB experts and sent them to geographically-isolated and depressed areas. “Deep into the mountains where patients have no access to medications,” she said.

In Region 10, new equipment had been installed to help eradicate TB, including a device called “GenXpert-RIF” at the German Doctors Hospital. It is also equipped with Sputum Microscopy, Sputum Culture, Drug Sensitivity test to better serve those with TB.

The GeneXpert MTB/RIF assay is a novel integrated diagnostic device to diagnose tuberculosis and rapid detection of rifampin (RIF) resistance in clinical specimens. 

Magsayo said that with the GeneXpert-RIF, results from a specimen collected from a suspected TB-infected patient can now be obtained in just two hours, compared to the normal two-day waiting time.

Quick results mean more infections can be detected and processed, and the TB-infected person can start medication immediately.

Langajed said that scientific advances have developed anti-TB medicine that would keep the patient from passing on the disease to others two weeks after treatment. But the total elimination of the TB bacteria would take at least 18 months of continuous intake of the medicine.

The partnership between the hospital and DOH is under its Private-Public Management of Directly Observed Treatment System (DOTS).

DOH has allotted almost  P1 billion to its anti-TB campaign. The government is spending an estimated P200,000 per patient with MD-RTB.

The eradication of TB is one of the United Nations Millennium Development Goals (MDG) which the world hopes to reach by 2015. But it looks like it might take much longer for the Philippines. – Rappler.com