Tracking a Killer

he decayed boardwalk between the small stilted wooden shacks is just wide enough for a motorcycle. The nurse, however, maneuvers the little Honda with great skill to its destiny, a house on the end of the way, home to one of his tuberculosis patients.

He went this way every day during the last six weeks to bring medicine and advice to his client.

The nurse is working for Directly Observed Tuberculosis Short Course Treatment, a program that started in January 1997 to treat local TB patients more effectively. Tuberculosis is a major threat to the Cambodian population.

“There is hardly a country with a higher risk of acquiring tuberculosis than Cam­bodia,” says Nathalie Senecal, a French doctor working for Medicins Sans Frontieres in Cambodia and assisting with the short course program.

Every year, about 2.5 percent of the population acquires pneumonia tuberculosis, the infectious form of the disease. And an estimated 1.5 percent to 2.5 percent catch other forms of TB.

For Phnom Penh, with more than 800,000 residents, that means 2,000 to 4,000 new cases every year. If not treated, TB kills about 50 percent of the sick between 6 months and 5 years after infection.

What’s more, TB infections are likely to increase with the spread of HIV, the virus that causes AIDS. HIV infected persons have a very high risk of acquiring TB.

Because of this high rate of TB, the World Health Organization and the Cambodian Ministry of Health set up a program in 1994 to fight tuberculosis and declared the battle against TB a high priority. The aim was to detect at least 70 percent of all tuberculosis cases and to heal at least 85 percent of these.

It was planned that all TB patients be hospitalized to en­sure the success of the treatment. How­ever, this original intention failed. Tre­a­ting TB re­quires 8 months, split into an “attack” phase of 2 to 3 months and an additional 5 to 6 months of follow-up to ensure the patient regains health.

But a month-long stay in the hospital is just not viable for many patients. Children have to be taken care of, and even sick patients must continue to contribute to the family income. There also are not en­ough hospital beds to hospitalize all TB patients.

The short-course treatment grew out of these problems. The intention is to guide the patients safely through the TB treatment but to treat them at their homes. The nurses instruct the patients about the absolute necessity of taking the medication and supervise them taking up to 15 medications a day through the first two months.

If side effects become too strong or patients become more sick, they are taken to a hospital.

Additionally, family members and neighbors are observed for TB symptoms—a crucial task in a country where a majority of the families live in one room and hygienic conditions are often poor. Both factors facilitate the spread of TB.

Since the program started early last year, 321 patients have been treated. Only one patient could not be healed.

Dr Kong Kim San, the leader of the short-course program from Senat hospital in Phnom Penh, says the program, still in its pilot phase, most likely will continue permanently because it has been so successful.

Suburban districts of Phnom Penh soon will be included in the short course.                                     The program also is a step to prevention and awareness: As the information on the disease given by the nurses spreads in the neighborhoods, the shame that is connected to TB in the minds of many Cambodian people slowly disappears.

According to health-care officials working with the program, this makes it easier for people with symptoms of TB to consult a hospital for a proper check-up.

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