Argus title : Horror of TB must be tackled
The 24th March is World TB Day.
I didn’t know this until a couple of days ago, when I was contacted by Alastair Burtt, Chief Executive of the Brighton-based UK charity “Target TB”. Alastair asked for help in raising awareness of this deadly, but curable respiratory disease which, acording to the World Health Organisation (WHO) kills more people worldwide than AIDS and Malaria combined.
As a child in South Africa I was always scared of tuberculosis. I couldn’t imagine what it would be like not to be able to breath, to choke to death or drown in your own blood.
I didn’t know of any Whites who had died of TB. Though I knew Whites could get it, it was mostly Black people who contracted TB – the dreaded isifo sofuba – and Black people who died of it.
When I was a child my mother’s parents had 2 servants, both Zulu men of the Msomi family. They were very kind to me and I was very fond of them. However, right through my childhood I was aware there’d been a third Msomi working for my grandparents, long before I was born. His benign shadow was always there – as a photograph in the family albums or a flickering image in 16mm cine films of family events. His name was Jim – and he had died of T.B..
Jim had helped my grandma through all the years of being wife to a prominent businessman. She used to say it didn’t matter if unexpectedly my grandpa brought people home for dinner. Jim could always rustle something up. He cooked, she said, far better than she did.
It scared me that Jim, who had cared for my mother and played such a important part in my family’s life, should simply have vanished. When he became ill, he asked for permission to return to his family’s ‘farm’. This was years before anti-biotic treatment was available. As a Black man, he would have had no access to rest and good food in a sanatorium as a White would have done. When he went back to the farm he went there to die.
Jim died quietly, out of sight if not out of mind, in the beautiful Natal countryside. He vomited no blood on my grandparents’ carpet, coughed no sputum onto their good food or starched sheets. To be honest, even if he had, they probably wouldn’t have got the disease. They were so well fed, comfortably housed and healthy that they would have been resistant to the bacillus.
That’s something I hadn’t realised about TB. At any one time around a third of people have the bacillus in their bodies, but most never develop the disease – usually because they have strong immune systems and can resist it. The people least likely to be resistant are the poor.
My nanny Cissie Buller was poor, born to a Coloured family, but classified White under the Apartheid laws. She was a lovely woman, one of the kindest and gentlest people I have ever known. She had looked after 2 generations of my family’s children, but when she retired she returned to live with her family, choosing to live in poor conditions in a ‘Coloured’ area. She died of TB, her immune system compromised by poverty and other untreated illness.
By my early teens she had already stopped working for us. However, I missed her and used to fantasise that when I was grown up I’d buy a house for her. I used to imagine the surprise she’d get when I gave it to her. But it was all just a dream. I was still at school when TB ravaged her lungs and threw her away like a tiny rag doll. I wasn’t allowed to go to her funeral.
TB was brought to South Africa – as it was to many other colonies – by European settlers. It thrived under British rule and became endemic under the Apartheid regime. The achievement of democracy should have brought an end to TB, but it did not. Ignorance, poverty and sexual inequality remained – and they are fertile breeding grounds for HIV/AIDS. And in Africa, over the past decade, HIV/AIDS has been the single most important factor determining the increased incidence of TB – for it feeds on depleted immune systems.
Worldwide one third of deaths of those who are HIV-positive are TB related , while people with HIV are 100 times more likely to develop TB than other members of the population.
The disease which now ravages Africa and South Asia, rampaged through British society in the 17th and 18th centuries, when, it is estimated, it caused 20% of deaths. In the 19th and early twentieth centuries it wiped out many of Europe’s most prominent musicians, writers and artists. While for the intelligentsia it acquired a certain gruesome glamour, it was always the poor who suffered most.
During the twentieth century in Europe there was a steady decline in the disease assisted by the development of penicillin and other antibiotics. It remained prevalent in the developing world, but most Europeans chose to forget this, considering TB to be a ‘cured’ disease.
However, since the advent of HIV/AIDS in the 1980s, TB has been increasing rapidly. Now even the richer nations are beginning to take notice. The inability of poorer nations to provide the treatment needed – coupled with the unwillingness of drug companies to reduce profits on retroviral drugs for AIDS – has delivered the poor into the clutches of disease.
According to the WHO, TB infection is currently spreading at the rate of one person per second. It kills more young people and adults than any other infectious disease and is the world’s biggest killer of women. In industrialised countries a quarter of all cases occur in those over 65. But in the developing countries of Africa and South America, TB is most common among young adults.
In 1993 the WHO declared TB “a global health emergency”. It predicts that by 2020 nearly one billion people will be newly infected with TB, of whom 70m will die. The worst affected areas are Eastern Europe with 250,000 cases a year, South East Asia with three million cases a year and sub-Saharan Africa with two million cases a year.
TB is almost 100% curable if antibiotics are taken over a 6 to 8 month period. Failure to complete the prescribed treatment can result in multi-drug resistant TB (MDR) which is extremely difficult and expensive to treat. It usually kills.
MDR TB is on the increase, especially in developing countries where patients frequently cannot afford or are unable to complete treatment.
The WHO’s strategy for dealing with this is a health management regime called DOTS (Directly Observed Treatment Short-course). This is designed to support patients to complete their course of treatment and avoid spread of the disease. It involves the appointment of TB managers, the training of specialist health workers and the increased use of monitoring.
In the UK the disease is beginning to stage a resurgence. Widespread travel abroad, flow of people across borders from poor countries with inadequate health systems, exploitation of workers employed in bad conditions and on low wages, sex trafficking, increased alcohol and drug use and the simmering problem of HIV infection, all make an increase in TB almost inevitable in this country.
It is vitally important that charities working with TB patients get the funding they need to carry on their work. Of recent years it has been AIDS charities which have received the funding. Though their work is vitally important it has drained TB charities of the funds they require to deal with AIDS related deaths from TB.
Alastair Burtt of “Target TB” is appealing for funds. He said: “Urgent donations are needed to recruit, train and enable community volunteers to care for 1000s of TB patients in Africa and South Asia, using the DOTS system. The simplest things like bicycles, gumboots, disposable surgical gloves and motorbikes will enable volunteers to carry out the work that we have trained them for. If even 1 patient is cured it stops 15 others from catching TB. Without immediate action there is a danger that TB will continue to spread and threaten people in all parts of the world.”
If you can help, in any way at all, please contact Alastair Burtt on 01273 821056. Or donate on-line at www.TargetTB.org.uk.