Tuberculosis Takes Deadly Toll on Cambodia

As they poked their heads inside the dead man’s room Tues­day, fellow patients at the tuberculosis ward of Preah Ketoh Mealia Military Hospital stared first at Prom Lorm’s body, then covered their mouths and noses. The half-dozen nearly naked children running down the filthy hallway had to be reminded to do the same as they passed the room.

“He’s only been here a month,” Prom Lorm’s relative, Sun Ry, 41, said, sitting in the room littered with mud-covered rice, old cigarette butts and a dead cockroach lying on its back, its gnarled legs curled under it.

For Prom Lorm, found dead around noon, rigor mortis had already set in. His left eye was cracked open, and his hands curled, fingers wide apart, under the red-checkered sash that served as his shroud. He was 27 years old.

This scene, health experts say, occurs almost 9,000 times a year in Cambodia: a person dead of tuberculosis.

About two hours before staff at the hospital found Prom Lorm dead, international and governmental health officials gathered on the other side of Phnom Penh —with golden scissors—to cut the ribbon of the newly built National Tuberculosis Center, which officials hope will enable authorities to gather information, treat patients, and train officials in combating one of Cam­bodia’s leading causes of death.

According to a government news release, $7.6 million from the Japanese government went into the new center. The ribbon-cutting comes four days before World Tuberculosis Day.

“Cambodia is still considered as having one of the poorest health services in the West Pacific Region,” Prime Minister Hun Sen said during his hour-long speech at the ceremony. “One of the major concerns that we have is controlling the spreading of the disease.”

TB is a bacterial infection that spreads through the air when an infected person coughs, spits or sneezes. It usually affects the lungs.

Although TB is curable, it can spread rapidly and disrupt not only the public health, but the economy and culture of a developing economy, experts say. Only 5 percent of those people carrying the TB bacteria will ever develop the disease, but experts say that the poor, and poor nations, bear the brunt of it.

Cambodia is not alone in its struggle against TB. According to the Web site of the US government’s Centers for Disease and Control, someone dies from tuberculosis every 10 seconds. Among infectious diseases, TB is the second leading cause of death worldwide. At least 2 billion people carry the bacteria that causes tuberculosis, the CDC’s Web site states.

One in three people carry it in Cambodia, said Dr Turo Mori, of the Japanese Research Institute for Tuberculosis. That is the highest infection rate in Asia, and the highest in the world, outside of sub-Saharan Africa.

Later Tuesday, sitting on a rusty bedspring in the dead man’s room, Leng Dyna, 41, said he had beaten the disease.

“I had lost both of my lungs. Before I came here, I couldn’t even walk, but now I’m getting better. I hope I will be all right in the next three months,” he said.

Although Cambodia cures 92 percent of its cases, about 27,000 new cases of TB arise here each year, the World Health Orga­nization’s Bill Pigott said.

And TB rates are one way to indicate the health of a country’s economy. Even “so-called developed nations” are seeing increases in their TB infections, Pigott said.

“There’s an association between poverty and tuberculosis. It‘s an indicator of the widening gap between rich and poor,” he said.

Leng Dyna is a good example. A former soldier, his medical care at Preah Ketoh Mealia Hospital is covered. His wife, Chin Luon, 35, and children are not covered.

“There’s tightness in my breath. I can’t eat and I feel dizzy. This is just like my husband’s condition five months ago. But I can‘t have a TB test,” Chin Luon said.

A chest X-ray to check for TB costs $8, which the family cannot afford, Leng Dyna said.

The wealth gap is evident globally as well, Pigott said. The poorest 20 percent of nations account for 45 percent of TB cases, while the richest 20 percent of countries account for only 3 percent of global TB cases, Pigott said.

And because tuberculosis af­fects adults of productive age, it can devastate the economy, Mori said.

“There is a definite cycle,” he said.

Many families at Preah Ketoh Mealia say they are caught in that cycle.

“Since I came here, I can’t do my job, and I’ve had TB for a year already,” said Chhun Mao, 33, a farmer from Kompong Thom prov­ince who moved into the hospital after her husband Chhim Oy, a 37-year-old soldier, developed the disease. “I need to spend 5,000 riel [about $1.25] to feed the family.”

The news seems to be getting worse for their family, Chhim Oy said.

“I think my son might have TB now, too,” he said.

And even those cured of the disease may not be able to recover economically from it.

“I don’t think I can get back to work. This disease I could never totally recover from,” Leng Dyna said, adding that his wife and 3-year-old son are starting to show signs of TB infection.

Nearly 70 percent of new TB cases in Cambodia affect adults of “economically active age groups,” the Stop TB Web site states.

TB treatment and prevention is therefore a sound investment, Pigott said. Every dollar a country spends on TB treatment will yield $50 within 20 years, he said.

“If you treat TB, you not only get people back to work, you reduce the number of people affecting one another,” Pigott said.

The high TB rate in Cambodia compounds, and is compounded by, another acute health-care problem, Pigott said: AIDS.

“When you’ve got AIDS, of course, you’ve got a very close relationship with TB,” he said.

HIV and AIDS complicate a country’s TB problem in two ways, Mori said. In the first place, HIV-positive people are much more susceptible to TB, because TB is what experts call an “opportunistic infection,” taking advantage of a weakened immune system.

Be­cause they are much more likely to develop TB, HIV and AIDS patients are more likely to spread TB as well. Of the 9,000 estimated Cambo­dians who die each year from TB, about 2,000 of those are HIV-related, the Stop TB Web site states. Cambo­dia is one of the 20 countries most affected by TB, the Web site states.

Im Vanheurn, 39, a military nurse from Kompong Chhang province, said she is one of the lucky ones. After eight months of pills and monitoring, she is almost ready to go home.

”I feel better,” she said, her toddler daughter clinging to her shirt. ”I think I can get back to work be­cause I was told that I could after I recover.”



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