Tag Archives: TB

Photo story: Finding TB cases in Cambodia’s Slums

The World Health Organisation estimates that of the nearly nine million people who become ill with tuberculosis every year, nearly one third are ‘missed’ by national health systems. This means that roughly one out of every three individuals with TB is never officially diagnosed or treated and continues to spread, suffer, and die from the disease.

In Steung Meanchey, Cambodia, a new programme, supported by TB REACH, has been introduced to help find people in slums who have symptoms of TB, but have never received a formal diagnosis. TB REACH is a an initiative of the Stop TB Partnership that seeks to use innovative and forward thinking techniques for finding and diagnosing cases of TB in hard to reach populations.

Steung Meanchey is a poor community on the outskirts on Phnom Penh that sits directly above a sewage lake and has high rates of TB due to overcrowded living conditions and poor nutrition. Many families in the community do not have access to health services or are unaware that symptoms such as a cough or weight loss could actually be the early stages of TB.  To address this problem, the programme sends health workers to visit families to see if any individuals have symptoms of TB. If they have symptoms, health workers collect a sputum sample from the individual, place it in a cool box and then transport it back to the lab for testing. If the person turns out to have TB, they are provided treatment free of charge, in their home, until they recover.

While the approach of actively finding people in Cambodia who have TB may not sound ground-breaking, it is this sort of alternative approach that has helped the country make inroads against one of the world’s most deadly infectious diseases. Bringing health services to those who might otherwise have difficulty accessing them is helping to ensure people are diagnosed sooner and put on treatment faster, thus stopping the disease from being spread further in the community.

A round up of ‘the best World TB Day ever’

Yesterday, March 24th, marked the 19th annual World TB Day and we saw an amazing day of advocacy, action, media, and high level announcements of new funding and policy from key organisations working on the global TB response.

IMG_2542RESULTS kicked off our day with a briefing in our offices with a group of advocates from around the UK. As people arrived at our office they were chatting about the article they had read in The Metro that morning about World TB Dayand the piece in the Independent Catholic News that our loyal campaigner Gillian Price had managed to get placed; the media was landing! Our Executive Director, Aaron Oxley, spoke about the theme of the day, ‘Reach the 3 million’. He described how each year an estimated three million people contract active, deadly TB but are ‘missed’ by health systems; meaning they either receiving no diagnosis, the wrong diagnosis, quack diagnosis, or are put on the wrong drugs, leading potentially to their TB becoming drug resistant. This year, World TB Day was aiming to re-focus international efforts on finding and treating the three million.

Our group of 20 then set off for Parliament for a meeting and briefing with key professionals working on the response to TB. The briefing was organised by the All Party Parliamentary Group for TB, TB Alert, and RESULTS. On the way we stopped to take a few snaps with our World TB Day boards:










We headed into Parliament for the kick off briefing which was addressed by three guest speakers. Mercy Annapoorni of Blossom Trust, India, who spoke about the work they are doing working on developing creative approaches to educating communities in Southern India about TB and how to detect and report Mercy and Anthony address the meetingit. We also heard from Anthony Chilembwe of the Sue Ryder Foundation in Malawi who spoke passionately and in detail about the work they are undertaking on developing innovative approaches they are deploying to getting TB diagnosis and treatment done in rural and remote areas of the country, including using cycle couriers to deliver sputum samples from villages to clinics for analysis.

Finally we heard from Dr Emily Wise, a UK infectious diseases registrar who had recently returned from a year’s sabbatical in Uzbekistan working with MSF on an MDR-TB project. She spoke passionately about the brutal reality of this killer disease, telling the audience about a young nurse who had died in her arms after succumbing to MDR-TB, reminding the audience of the crucial importance of finding and treating the many millions of people who contract TB each year.

Following the briefing, and feeling fired up, we headed out into Palace Yard in Westminster, where we were met by the Find & Treat mobile X-Ray clinic (used to find and treat vulnerable people with TB in London) along with staff and ‘peer

The Find & Treat staff and Peer Educators

The Find & Treat staff and Peer Educators

educators’ from the service and featured in an excellent supplement for World TB Day in the Financial Times. The Peer Educators work with Find & Treat to help locate and engage members of the vulnerable populations they work with. many of the Peer Educators are former users of the service, including Patrik, who contracted TB while living rough in London – after he was engaged by F&T he had to completely give up drinking in order to make his treatment work. He managed it, and now he volunteers with the service and is off the streets. Now he works with other homeless people telling them “get on the van!” – he doesn’t take no for an answer. The work that the team does is truly inspirational, dedicating their lives to find and help some of societies most vulnerable people; they really are helping ‘Find the missing 3 million’. The work of Find and Treat was also featured in an excellent supplment for World TB Day by the Financial Times that praised the work the team are doing to diagnose and treat vulnerable populations.

Thanks to the hard work of staff at RESULTS and Find & Treat, we saw a whole load of MPs and Peers drop by to hear more about the service, TB, and Finding the 3 million. Including:

Jane Ellison MP, Public Health Minister for the UK ; hearing all about Find & Treat from grassroots advocates

Jane Ellison MP, Public Health Minister for the UK ; hearing all about Find & Treat from grassroots advocates

Alan Duncan, Minister of State for International development

Alan Duncan, Minister of State for International development

Heather Wheeler MP

Heather Wheeler MP










Jim Dobbin MP

Jim Dobbin M

Simon Wright MP with Norwich group leader Mark Pointer

Simon Wright MP with Norwich group leader Mark Pointer

Virendra Sharma MP meets Dr Al Story, head of Find and Treat and matt Oliver of the APPG-TB

Virendra Sharma MP meets Dr Al Story, head of Find and Treat and Matt Oliver of the APPG-TB








Meanwhile in Johannesburg South Africa, ministers of state, the World Bank and the Global Fund to fight AIDS, TB and Malaria announced an exciting financial commitment to tackle TB in the gold mining industry of southern Africa. In this co-authored article from South African health minister Aaron Motsoaledi and Mark Dybul, head of the Global Fund, the pair called for a strong public-private partnership between mining companies and the state and announced that the World Bank and Global Fund are ready to commit $100 million each to tackle TB in the mines, providing mining companies come to the table. If created, this public-private partnership has the potential to save thousands of lives in the region and would help get the epidemic properly under control. The mining companies must now step up.

After a short trip to the LSHTM World TB Day symposium to hear a number of engaging talks about finding the missing 3 million cases of TB, we headed back to Parliament for the launch of a consultation on a National Strategy to tackle TB here in the UK. The event, hosted by the APPG on Global Tuberculosis and Public Health England, marks the beginning of a 3 month consultation period with key stakeholders before a final strategy is agreed upon. You can read more about the strategy in this press release from Public Health England.

Thanks to everyone who came down for an exciting and jam-packed day of campaigning and advocacy. We can safely say that this one of the best World TB Day’s ever!              

Photo story: Drug-resistant TB in Romania

The fifth and final blog in our World TB Day series comes from Tom Maguire in the form of a photo story from his recent trip to Romania.  During two weeks in December, Tom visited hospitals, sanatoriums and prisons to meet with drug-resistant TB patients and the doctors and nurses assisting them with their treatments. These photos of some of the people he met visualise both the severity of the treatment and the loneliness and isolation that many patients feel being away from their loved ones whilst completing treatment that can last up to 2 years.

Rosezenny Rivilla and her battle against MDR-TB. Part four in our World TB Day series

Today is our fourth and penultimate blog series on TB in the run up to World TB day on March 24th. Rosezenny is from the Phillipines, a country with a high burden of TB; demonstrating the truly global nature of this disease.

Rosezenny Revilla

When 41 year old Rosezenny Revilla of Casiguran, Aurora, Philippines was diagnosed with multi-drug resistant tuberculosis her whole world came crashing down. As a married mother of three children and a grade school teacher she faced the question “why me?”  Rosezenny’s diagnosis changed both her and her family’s lives. Rosezenny left her teaching job to move to Manila to seek treatment. At the beginning of her treatment Rosezenny faced shock and denial. Unlike cancer and other well-known and well understood sicknesses, TB is a lonely disease.  Rosezenny faces feelings of isolation and rejection from her peers and a lack of social support. Rosezenny’s resilient spirit is helping her through this debilitating disease. Rosezenny expresses gratitude towards the support provided by The Global Fund and is determined to conquer the disease.

While TB is most prominent among vulnerable populations, anyone is susceptible to it. Low levels of awareness of TB by the public and health care professionals results in a lack of social support for those suffering from TB.  To improve the long term impact of TB patient’s physiological and psychological well-being it is essential to continue TB research and to educate others on the disease. Spreading awareness and continuing TB research and funding is the only way to improve treatment prospects for the future.

Watch Rosezenny speak about her story here

Family; our most powerful ally in the fight against TB. The third in our World TB Day series

“If we fail to support the families that fight on the ground in this epidemic, we are neglecting our largest ally”.

The third post in our World TB day 2014 blog series comes from epidemiologist and campaigner on TB among gold miners, Jonathan Smith.

Blog Post Image Jonathan

He didn’t know what to say when I asked him. He was completely jarred by the question, a deer in headlights. With his eyebrows raised he shifted his eyes nervously between his sister and wife as they looked at him, as if he was watching a Ping-Pong match between the two. The room was silent as the two women waited in anticipation while the former South African miner – bedridden from the multi-drug resistant tuberculosis complicated by silicosis and HIV – mustered up the energy to respond. They both doubled as his caregivers, and his response would have significant impact on them far beyond the obvious. He composed himself, slowly took a sip of water from the glass resting on his bedside table, and delicately began to speak.

“I’d say they’re both pretty good cooks.”

The room exploded in laughter as a barrage of pillows flew his way. “That’s not an answer!” one woman shouted as she laughed. “Pretty good?” another lamented. He sheepishly cracked a smile, and then finally began to laugh. His laugh was deep, labored, and heavy; as if his emaciated body was doing all it could to get the chuckles out. Both women continued to proclaim that, indeed, they were the better cook.

That afternoon, the two women situated the miner in a chair before they carried his bed outside. With the southern African sun beating down, they placed it beneath the shade of a tree. “Outside is better, he likes it better out here,” his wife said as she made sure his head would be in the shade. “He hated indoors.” Once the bed was situated, the two women carried the former miner outside and laid him down, where we then ate lunch. Neither of the women were particularly good cooks.

It was rare for the two women to be together, as they typically had separate responsibilities. Each week, the wife would travel to the capital city, about a half-day’s travel away, to work as a cleaner at a bank. She also would secure the complex MDR-TB medication for her husband and bring it home each weekend. The sister, on the other hand, would travel from her home to the miner’s home in order to care for him on the weekdays, keep the children at bay, and get his HIV treatment from the local clinic.

This had been going on for two years, but now, without significant improvement, the women feared the worst. His body was becoming weaker, the drugs were becoming harsher, and his energy was depleting. He was dying. That evening, his wife pulled me aside.

“I’m not sure we will make it through the night. Is there anything you can do for us?” she asked.

Herein lies the confrontation that curiously only the wife of a miner can afford me.

Every expertise has its definition of success. In epidemiology, we often look at successes and failures of public health as a fluctuation in data – a regression line, an R0. This is a good thing. These analyses are critical in knowing how to overcome the world’s most pressing public health issues. In health policy, we look at successes and failures in public health as the influence of a policy on the health of a population – the uptake, the behavior change, etc. This is a good thing, and allows us to shape policy and rhetoric to be most efficient. In innovation research, we look at success and failures in public health as the ability to prove a vaccine, or a new way to deliver diagnostics. This is a good thing, and because of innovation, we have prevented countless deaths.

As an epidemiologist I could have told these women any number of things about overcoming TB in the mining sector – the changes that need to be made for silica dust reduction, the need for single dwelling and family style housing, continuation of care at home, and the list goes on and on. But even the most eloquent explanation would not have helped answer her question. In this moment, to these women, success was not defined by charts and graphs, or policies, but rather by one man making it through one night. It was that simple.

On the surface she was much better equipped to answer her own question. She knew his nutritional needs – where to find the vegetables, where to get fresh water. She knew how to navigate the public transportation to get his medications, and when to administer them. She knew to call her son over to lift his spirits; to remind him that his mother “would be so mad if you left us.” After all was said and done, these were the things that kept him alive. Hope. Grace. Love.

We overlook many of these things in our discussions of disease; they are looked at as soft, bleeding heart, or otherwise ancillary. Scientists get scared at things we can’t quantify. I don’t mention these things to draw an emotional response; these factors – factors that bind families and communities together – have a significant, tangible role in overcoming the epidemic. I can assure you that without the love of his wife, the hope of his recovery, and the grace of his family, this miner would have long since passed away. They are who got him his medication, fed him, bathed him, and all the while made sure he had a smile.

TB in the South African gold mining sector is the single worst public health issue in the world today. The mines have the highest incidence of TB ever recorded in the world, spanning any period in history, and the vast majority of the hundreds of thousands of men who work in the mines are oscillating migrants who travel back and forth between their rural homes and the urban mines. In addition to exposure to the TB bacilli, they are exposed to high levels of silica dust and HIV – two contributing factors to TB that, when combined, exhibit a multiplicative risk for development of the disease. Ultimately, this leads to a population that is incredibly large and highly mobile, and that is exquisitely susceptible to contracting and disseminating TB. Overcoming these issues will take a considerable amount of manpower, time, and ingenuity; and in many other writings my colleagues have provided data-driven papers to address them.

This is not one of those writings. The unattainable expertise of a family who suffers through TB is an area of the epidemic that is woefully under-represented. We speak of these things often – to put a “face to the epidemic,” the “people behind the data,” and so on – but we never consider how, and why this is important beyond the obvious.

If we fail to support the families that fight on the ground in this epidemic, we are neglecting our largest ally. If we fail to consider their lived expertise as equally important to our medical and epidemiological expertise, we are doing an injustice; not just to the individual, but to the entire global machinery that is TB control. To draw from the old adage – our data, policies, and recommendations can lead the horse to water, but the families make them drink.

But how do we provide this support? In the context of millions of cases of TB, how is this logical? The key is realizing that our version of the epidemic is not the same as those families fighting TB, though ours is equally as challenging. Our TB epidemic will never be characterized by cooking dinner for a man dying of TB, nor will we ever traverse the public transit system to locate the appropriate clinic. But that doesn’t mean there is nothing we can do. Our fight is to ensure that those fighting these battles have the tools they need to win; that the global TB funding for innovation and research is secured, that the new developments we need come to fruition, and that data-driven policies that support patient-centred care are rolled out. In continuing to fight our epidemic, we can ensure that future patients avoid illness and the devastation that accompanies TB.

Jonathan Smith is a lecturer in Global Health and Epidemiology of Microbial Diseases at Yale University and an affiliate of the Yale Global Health Leadership Institute, where he researches epidemiology of TB and HIV in the context of migrant populations. He is currently spearheading the Visual Epidemiology Project at Yale, an effort to combine data-driven academic dialogue with an individual, story-driven component. He also filmed, edited, and directed the film They Go to Die, a documentary film-in-progress investigating the life of four former migrant gold mineworkers in South Africa and Swaziland who have contracted drug-resistant tuberculosis and HIV while working at the gold mine.

This post first appeared on the blog of AERAS, a not-for-profit TB vaccine development organisation. http://www.aeras.org/blog/recipes-for-survival#.UymNHfl_uSo

Finding and Treating People with TB and HIV; part two of our WTBD series

This year, the theme of World TB Day on March 24th is “Reach the 3 million.” Advocates, researchers, experts, and communities around the world are rallying around a call to reach the 3 million people who have tuberculosis (TB), but do not receive the care they need.

In the second blog post of our week long series in the run up to World TB Day we look at the interaction between TB and HIV. TB is the leading killer of people living with HIV. To reach the 3 million, it is therefore essential to address this deadly co-epidemic. Our colleagues in the ACTION Partnership spoke to advocates and experts from Kenya, Malawi, South Africa, Tanzania, and Zambia on the challenges and opportunities surrounding efforts to find, treat, and cure everyone with TB and HIV.

TB and HIV Integration

Dr. Raymond Chimatira (@Selektarj) , Programme Manager, TB/HIV Care Association (South Africa)

TB is still the leading killer of people living with HIV, so we cannot divorce the two. There are a lot of documents with guidance on why and how TB and HIV planning and services must be integrated, but strangely, on the ground, these policies are not being implemented. Funding streams for these two diseases are often separated. At the national level, there are different TB and HIV departments that barely talk to each other, and that use different indicators and tools. If you go into communities, it’s the same – there are strictly TB screening programs and strictly HIV screening programs. In my lifetime, I need to see a stage where we don’t just talk about integration, where we just do it. This requires a mindset shift that starts with global organizations and trickles down to national programs.


Nathan Nhlane (@MNNhlane), National Coordinator of the Zambia National Anti­retroviral Support Programme 

The same levels of stigma that are there on HIV are there on TB. If a person has TB in a family, only the closest of relatives will know. The rest will be told it is pneumonia. That’s it. It’s because a simple message has gone out that TB is airborne, so even in households where the person with TB is being taken care of, you will see discrimination at its highest. If someone in that household who has TB uses a cup, others will try to find another cup, and let the first cup dry out. Stigma is there, and it’s high. We must make it more socially acceptable to seek treatment, and change the language of ‘confidentiality’ that surrounds TB and HIV.

Increased Domestic Funding

Maureen Milanga, Project Associate with the AIDS Law Project (Kenya)
People know about the Abuja Declaration from 2001, when African Union countries pledged to increase government funding for health to at least 15% of their overall budget. But 2001 was a long time ago, so now we must ask: How can countries in Africa get to 15%? And when you tell governments that you want 15% you have to tell them what it’s for. For instance, in Kenya, only about 300,000 people are on treatment for HIV. We also don’t have enough doctors.  So there’s more work for us as advocates to follow up on that pledge and make sure something actually happens.

Clara Banya (@ClaraBanya), Malawi Network of People Living with HIV/AIDS (MANET+)

As a person living with HIV, I’ve had the privilege of accessing treatment and having quality of life. I’ve been able to contribute to my family, but also to my country in a positive way. But I’ve seen a lot of women in my country, who are in the rural communities, who are facing many problems. Some, even until now, can’t access treatment. Increased domestic funding for TB and HIV is a part of solving this gap. Malawi has done a lot, that we have to appreciate, but as a country, I think there is more that we can do. Increased domestic funding for health will help to bridge gaps and also create a feeling of ownership. If we have that feeling of ownership, we can create sustainability. We will be able to ensure funds are being used in the right way, and we can monitor and evaluate efforts. People at all levels – from grassroots to implementers – would also feel that they are doing something for their country.

Community Involvement

Olive Mumba (@LivMumba), Programmes Manager, The Eastern Africa National Networks of AIDS Service Organizations (EANNASO)

There are national policies out there that impact treatment, care, and support, and affect how people in communities access services. My role at EANNASO is to make sure that when policies are being made, that they are community-friendly. Often, in decision making, the voice of national organizations represents communities. But why can’t people from the communities sit at the table? Communities should be part of decision making at national and regional levels, and the people living with these diseases should be the ones to voice their concerns. I have seen there is a big gap –people at the community level don’t know what is their right and responsibility. As part of their health budgets, governments should set aside a portion to support the capacity of communities to participate.

This post first appeared on ACTION.org here: http://www.action.org/blog/post/perspectives-finding-and-treating-people-with-tb-and-hiv

Amy’s story; the first in a new series leading up to World TB Day

“I want to see TB banished to the history books”

This year, the theme of World TB Day on March 24th is “Reach the 3 million”. Advocates, researchers, experts, and communities around the world are rallying around a call to reach the 3 million people who each year contract TB but do not receive the care and support they need. In the run up to World TB Day, we will be posting a different blog each day to profile the disease from a variety of perspectives. Today our post comes from Amy McConville; Amy is a TB  patient/advocate from the UK who works with the TB Action Group (TBAG). This is her TB story:


Over the course of several months my GP diagnosed me with a series of chest infections. The antibiotics made no difference. As my cough worsened my appetite faded away. After nearly nine months I got an appointment at the chest clinic and by that point, I only weighed five and a half stone.

The cough had developed into an awful pain in my left lung. I took to my bed and stayed there for weeks. The doctors couldn’t seem to diagnose me and I was scared that I might never recover.

It felt like my body was giving up on me, I was incredibly weak, I couldn’t eat, even my favourite food made me feel nauseous. TB is a wasting disease; it consumes you from the inside. I’d been ill for over nine months, I couldn’t remember the last time I’d had a proper meal.

Finally, the diagnosis arrived. I had active pulmonary TB.

TB drugs are daunting; I knew about the potential side-effects and they scared me, drugs are supposed to make you better, not make you ill. So I didn’t take them. A week passed then two, then three. I knew I should have taken them but I didn’t. Finally, I spoke to a TB nurse. She seemed to understand straight away, and said that she’d help me through any side-effects. So, a month after finally getting my diagnosis, I started taking the pills.

Although, at the time, that seemed like a huge first step, it was barely the start. By the time I swallowed the first set of pills my left lung had collapsed. I found out a couple of weeks later and was devastated. A vital part of me had literally died.

I was lucky that I didn’t experience the worst side-effects from the drugs, but that didn’t mean I got off lightly. I had searing joint pain. I used to wake up in the middle of the night with the feeling that my joints were on fire. My hair was falling out and I was put on pain medication and steroids. I couldn’t even guess how many pills I took during that first phase of treatment.

After battling on with the treatment, I was finally given the all clear at the end of that year. I was looking forward to putting the TB behind me and catching up on lost time at university.

But at the start of February the following year, just three months after getting the all clear, I relapsed. My Easter was spent in hospital, in my own room, alone. Everyone who entered had to wear a mask because the hospital was worried I might infect other people. TB is often a very lonely disease, and I have never felt so lonely as I did that Easter.

The first round of my TB treatment had not been successful at all. My collapsed lung had provided the perfect place for the bacteria to hide and when I’d stopped taking the drugs, it came back fast.

The doctors said that my left lung had become a “reservoir of infection” and was attracting other bugs that were making me ill. It was, according to the specialist, irreparably damaged and the only option was to remove it.

But before I could get to have the operation, there was another complication. I had a shadow on my right lung. I’d stopped treatment a couple of months before the operation, and the TB had bounced back again.

I can’t describe the shock. I was horrified. TB had already claimed one lung and was infecting the other. It was using my own body against me to make me ill. It was stealing away my quality of life.

The hospital didn’t have a plan for me. Nobody seemed sure what to do next. I was sick, my education was on hold and I didn’t know if I’d be able to finish my degree. As an intermittent student, I was ineligible for benefits but TB drugs hadn’t yet been made free for patients so I had to pay for them. I plunged into debt.

They added second line drugs into my treatment. May came around; the doctors decided it was the right time to have the operation.


Amy addressing a meeting of the All Party Parliamentary Group on TB

And all of a sudden, things got easier. I started putting on weight, I was getting fewer infections, I was still on treatment but I was finally getting better and my life was back on track. But it wasn’t quite that easy. Two years after completing the last round of TB treatment, I was diagnosed with depression and anxiety.

Academically I was struggling, I’d got support with my financial problems but it was still difficult. Although my health was under control, my life was not.

My GP said my depression was due to the “severity and prolonged nature of the illness”, but I think it was because I blamed myself for what happened. A doctor had once told a whole ward that it was my own fault that I was in hospital. It was a throw-away comment, but it stuck in my head and I felt so guilty.

Still, I managed to graduate, sorted out my finances and saw a counsellor. Now I do whatever I can to let people know about this disease and the effects it can have.

Nine years ago TB turned my life upside down and I’m still putting it back together. I’ll be carrying the consequences for the rest of my life and I’m one of the lucky ones; I survived. Whatever we can do to stop this disease, we have to do it. No one should have to go through what I went through.

The long delay that Amy experienced between the onset of symptoms and her eventual diagnosis are quite common. The median delay between patients experiencing symptoms and diagnosis with TB was 74 days in 2012, and 43% were diagnosed more than 90 days after the onset of symptoms. People who have active pulmonary TB and are left untreated remain infectious. Reducing the diagnostic delay is vital to reducing the number of cases of the disease.

Amy’s story also exemplifies the need for TB to be treated as seriously here in the UK as anywhere in the world. Improving doctors’ and nurses’ ability to find and treat TB at first glance is essential for ensuring that no one else has to go through a struggle like Amy.

TB in Cambodia: Seeking Sputum Samples in a Sea of Sewage

DSCN5514This is the third installant in our series looking back at RESULTS’ delegation to Cambodia a few weeks ago. The parliamentary delegation looked at how the country is improving the health and education of its population. Jess Kuehne, Health Advocacy Officer at RESULTS, describes Cambodia’s approach to finding and treating people with TB within some of the country’s poorest and most vulnerable communities: 

Some of you may remember the story in the news recently about London homes having to be evacuated due to a burst water main causing sewage to flood the streets.  Those affected described the flooding as “revolting”, “stinky” and “pungent”.

DSCN5518This experience was horrible and disgusting enough to make it newsworthy in the UK, something many would consider to qualify as intolerable living conditions. As unacceptable as the situation sounds, having your home surrounded a sea of raw sewage is the reality for some of the poorest communities in Cambodia: Steung Meanchey is a poor community on the outskirts on Phnom Penh. The village sits directly on top of a sewage lake – houses have been built on stilts and planks of wood create narrow walkways between peoples’ homes. Raw sewage flows beneath and round the village. The stench is overwhelming, yet children leap and run across rickety wooden boards that threaten to give way at any minute.

DSCN5503Unacceptable, you might ask? It is daily life for the 110 families that live in this community.

It is here that tuberculosis, the long-forgotten disease of the past, continues to flourish, thanks to risk factors like cramped and overcrowded living conditions and poor nutrition. Added to this is the lack of access to health services that stops individuals who are sick from seeking treatment.

Despite these deplorable conditions, a programme supported by an initiative called TB REACH is improving the health of the population that lives here. One of the aims of our trip was to examine how Cambodia is dealing with its extraordinarily high rate of TB. To put into perspective the sheer scale of the TB problem here – Cambodia successfully managed to halve its TB rate over the last decade, but it still has one of the highest rates of the disease in the world.

The World Health Organisation estimates that of the nearly 9 million people who become ill from TB every year, nearly one third are ‘missed’ by national health systems. This means that roughly one out of every three individuals with TB is never officially diagnosed or treated and continues to spread, suffer and die from the disease – Cambodia is no exception. This is where TB REACH comes in – it had funded over 100 projects in 44 countries aimed and supports new and innovative approaches to find and treat those who otherwise don’t have access in TB care.

DSCN5510In Steung Meanchey, rather than waiting for individuals to seek out health services, we saw health workers go door to door interviewing households to see if any individuals displayed symptoms of TB. If they had symptoms, the health worker would collect a sputum sample from the individual, place it in his or her cooler box, and transport it back to the lab for testing. If the person turns out to have TB, they are provided treatment free of charge in their home until they recover.

While the approach of actively finding people in Cambodia who have TB doesn’t sound ground-breaking, it is this sort of alternative approach that has helped Cambodia make inroads against what remains one of the world’s top infectious disease killers. Bringing health services to those who otherwise have difficulty accessing them means that people are diagnosed sooner and put on treatment faster, which improves their chances of recovery and stops them continuing to transmit the disease to others.

TB has long been the forgotten child in terms of the top poverty-related disease, as international attention is usually focused on the other top two killer infectious diseases – malaria and HIV/AIDS. The UK Government should continue the leadership it has demonstrated on malaria and HIV/AIDS and apply it to TB by supporting innovative programmes like TB REACH that are taking the initiative to drive out TB. Only then will we finally be able to consign this ancient disease to the pages of history.


Tuesday Night’s Conference Call, A Precursor to World TB Day

On the evening of Tuesday the 2nd of March, RESULTS held a conference call as a part of the World TB Day campaign.

TB is not only a global issue affecting some of the poorest countries in the world but also a local problem. There were nearly 9,000 reported cases of TB in the UK this year. This month’s action is about linking the local with the global. We invite you to join RESULTS on Monday the 24th of March for World TB Day.

During RESULTS Tuesday conference call Amy McConville, TB patient and advocate in the UK shared her personal experience with TB. Amy was diagnosed with pulmonary TB in 2005. Amy first had TB in her left, then right lung. It took 12 months from the point of experiencing symptoms for Amy to get diagnosed with TB. Because Amy’s diagnosis took so long, her TB was already at an advanced stage upon beginning treatment. Ultimately, Amy had to have surgery to remove her entire left lung. With delayed diagnosis come complications. In order to improve health outcomes of TB sufferers, TB must be diagnosed as soon as possible. The typical profile of a TB sufferer is someone with a compromised immune system that comes from an area with high rates of TB. It is important to recognize that while some groups of people are more vulnerable to TB, anyone can get TB. It is imperative that clinicians and the health community strengthen their awareness of TB and possible symptoms.

Amy describes TB as a lonely disease because of the low levels of awareness amongst the public and amongst healthcare professionals. When Amy was diagnosed with TB she experienced feelings of isolation due to the lack of support networks. She stresses that social support networks are essential to relieve the social hardships of the disease.

TB has a serious long term impact on both physical and psychological well-being. TB drugs have horrible side effects that may make the patient feel worse than the disease itself. Without social support, many TB suffers stop treatment and go on to develop a more serious, drug resistant form of TB. More effective interventions must be put in place. The voices of TB must be heard to improve treatment. TB is currently being treated in a clinical model of health but it needs to be recognized and treated as a social disease as well.

Amy’s campaigning work with the Tuberculosis Action Group (TBAG) has raised awareness of the disease and has united those impacted by TB. TBAG members have the patient perspective which is essential to improve the way in which TB is treated. TBAG has done work to raise TB awareness through media highlighting that the UK does not provide the services that TB patients need.

You can learn more about Amy’s story and the stories of other TB patients in the UK in RESULTS TB Voices Report.

You are invited to join RESULTS on Monday the 24th of March for World TB Day. 9:30am we will meet at the RESULTS office in Vauxhall for breakfast. At 11am RESULTS will head to parliament for a briefing with speakers from Malawi and India with first-hand experience with TB. The “Find and Treat” x-ray unit (a mobile x-ray that screens vulnerable populations for TB and gets them off to treatment) will be parked in parliamentary grounds. Many other World TB Day events will take place at parliament going on until the evening.

Tuesday the 25th of March marks the The Johannesburg meeting On March 25th, ministers of Health, Labour and Finance, along with CEOs from leading mining companies will meet in Johannesburg to continue negotiations on the next steps for the regional response to TB in Mining, including the Code of Conduct. TB in mining has been an issue for over 100 years and the Johannesburg meeting marks an opportunity for mining companies to take accountability for their worker’s health, even after they have returned to their villages.

RESULTS looks forward to you joining us this Saturday the 8th of March at 7pm. RESULTS advocates from around the world and our partner organisations will join together to hear from Alice Albright, CEO of the Global Partnership for Education, in advance of the Global Partnership’s June 2014 pledging conference.

Education and Tuberculosis in the News

The Guardian writes that the United Nations reports that one in four people in developing countries are unable to read. In addition, 250 million children do not have basic literacy skills even if they attended primary school for four years. Lack of education is a leading cause of extreme poverty. The Global Partnership for Education (GPE) has been providing aid and improving education in impoverished countries. Getting better teachers in schools and all children into primary school is a key component of reaching the education for all Millennium Development Goal. Education is not only a stepping stone to ending poverty, but will lead to increased child survival as well.

An investment in education, more specifically women’s education is an investment in the future. In 2012, research by UNICEF reported that investing in women’s education reduces poverty and increases social and economic development.  Making women’s education and health a priority will help reach the MDG targets. While these targets will not be reached on time, the realization and awareness that women’s health and education is a key component to many MDGs that will drive change. In the 23rd January UN conference, Secretary General Ban Ki-moon stressed that reaching development goals require ‘girl power’.  “The United Nations gives girls a ‘gold rating.’ When you invest in their future, you are guaranteed results that multiply across society – on health, education, peace and the welfare of future generations,”

Neglect in tuberculosis research and diagnosis is having damaging effects globally. There have been recent tuberculosis out breaks in a Colorado school in the US as well as more severe outbreaks in  Russia. A dangerous drug resistant tuberculosis strand has been discovered across Russia, Southeast Asia, South America and sub-Saharan Africa. The  World Health Organization reports that the management of TB drugs needs to be closely monitored for treatment to be successful. It has also been noted that additional research on TB and drug resistant TB is necessary.

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