Taiz anti-TB center: Citizens must pay for treatment [Archives:2006/960/Health]

July 3 2006

Yemen Times Staff
Taiz bureau

The current prevalence of tuberculosis (TB) in Yemen is 1.5 cases per 1,000 people. Medical reports estimate that between 2,000 and 2,500 Yemenis die from TB every year, making it the fourth cause of death in Yemen. This estimation seems in sync with several hospital statistics. In reality, most deaths in Yemen occur outside of hospitals, especially in rural areas where the majority of the population lives.

Therefore, in cooperation with international organizations, the Yemeni government is conducting a National Tuberculosis Program aimed at eliminating TB in Yemen. Anti-TB centers have been established in many governorates to receive patients and examine, treat and provide them drugs.

Additionally, the centers are responsible for preparing medical files including dates of patients' cases as well as determining methods to help patients become involved in the treatment program by providing them with free medical services. Such measures are supposed to remove obstacles for mostly poor patients.

However, many Taiz governorate patients claim that such measures aren't applied at the Taiz anti-TB center, as patients must pay for everything and in every section of the center, beginning from diagnosis and ending with the cost of medication.

The national anti-TB program manager addressed an April 10 memorandum numbered 111 to the Ministry of Health, wherein he highlighted the situation at the Taiz center. According to the memo, the center has established a lab to increase its income by conducting routine medical tests like blood tests, typhoid, rheumatism, pregnancy tests and liver and kidney function tests.

Additionally, the center opened a pharmacy selling medication at costs similar to those in the private market. According to the memo, such additions are against the program's policy and its main aim, which is building and equipping a Taiz governorate center specialized in treating TB patients freely, like centers in Sana'a and Aden.

The Taiz center manager couldn't be interviewed because he suffered a stroke due to an attack by unidentified individuals who struck him on the head. The deputy manager said he couldn't do an interview, saying he was very busy, particularly with the manager's absence.

Dr. Ameen Al-Swidi, head of the center's lab section, said the center receives very few TB samples. “The national anti-TB program has opened anti-TB units in many Taiz governorate directorates to reduce difficulties patients face in traveling to the center. We also trained technical personnel in these units to test, diagnose and distribute medications,” he said.

“The few samples that reach the center are for microscopy examinations. Such samples are sent to the center if routine tests fail to diagnose the infection,” he added.

Samples reach the center in closed, sterilized plastic containers prepared for that purpose. “The containers are used only once. Used containers are burned directly after we finish the tests to insure that they won't be the cause of infection,” he explained.

Al-Swidi confirmed that the Taiz anti-TB center is ready to diagnose TB infection by direct testing or microscopy examinations, adding that the center is discovering 600 to 800 TB cases annually.

“If there are any defects or trouble, we contact the national institute in Sana'a, which provides us with everything we need, whether equipment or solutions,” he noted.

However, Al-Swidi confessed that the Taiz center still lacks some equipment. “We have asked for a computer for many years. A computer is important to our work because we can prepare and save reports and databases of our patients, our center and other sectors and units,” he explained.

Regarding the safety of the center's staff, Al-Swidi said medical staff are exposed to infection, particularly those working in the lab because they deal directly with TB-infected patients or samples that are considered very dangerous.

“There's a lack of knowledge in this regard. That is, many patients don't know that sneezing, coughing or spitting are sources of contagion. So protective materials employees use in the lab aren't enough because they're exposed to infection in the corridor or anyplace where patients have spit or coughed, especially given that sanitation inside the center isn't good enough,” he said.

Dr. Abdulwarth Al-Sulwi, also from the Taiz center, discussed the disease and its treatment, explaining that TB is a chronic and acute bacterial infection caused by a rod-shaped bacterium called Mycobacterium tuberculosis. It primarily attacks the lungs, but also may affect the brain, kidneys, bones and lymph nodes.

TB symptoms include coughing, chest pain, shortness of breath, loss of appetite, weight loss, fever, chills and fatigue. Children and those with weakened immune systems are the most susceptible to TB and half of all untreated TB cases are fatal.

“Every year, eight million people contract this disease and tuberculosis causes two million deaths a year,” Al-Sulwi stated, “WHO predicts that between 2000 and 2020, nearly one billion will become infected with the TB bacteria and 35 million will die from the disease. Ninety-five percent of these patients are found in developing countries.”

According to Al-Sulwi, the reason for the disease's prevalence in such countries is their low treatment rates because patients don't complete the full six to nine months of antibiotic therapy required to cure TB. Many stop taking antibiotics when they begin feeling healthier, but successful TB treatment requires therapy beyond the period of obvious symptoms.

When patients fail to follow the prescribed treatment, they may become actively infectious, spreading the disease to others. An infected individual may infect as many as 10 to 15 others in a single year.

Failure to complete the full round of treatment also can cause the emergence of TB bacterial strains with acquired drug resistance, further complicating treatment by increasing the length and cost of therapy. The emergence of multiple drug therapy-resistant bacteria strains is a serious problem, particularly because no ready drug treatment is available to combat newly emerging strains.

TB is transmitted from person to person usually by inhaling bacteria-carrying air particles. When a TB patient coughs, sneezes or speaks, small particles carrying two to three bacteria surrounded by a layer of moisture are released into the air. When another individual inhales these particles, the bacteria may lodge in that person's lungs and multiply.

Al-Sulwi pointed to many general preventive measures that can be taken to reduce TB's spread in public places, including:

– Those infected with TB should cover their mouth with a handkerchief or tissue when sneezing or coughing.

– Those infected with TB shouldn't spit on the floor inside homes but rather in a tissue that must be burned afterward.

– Children must be vaccinated against TB immediately after birth and until they reach age 4.

– Avoid smoking tobacco or water pipe with others.

– Good and balanced nutrition.

– Early diagnosis and early treatment.

– Allow light, heat and air to enter the house by opening windows because fresh air with light and heat kills TB-causing bacteria.

While Al-Sulwi confirmed that TB isn't a hereditary disease, it is chronic. However, it's considered preventable, even in those who have been exposed to an infected individual. Fatality occurs only when the patient is late in diagnosis and treatment.

Diagnosing TB requires two separate methods. Tuberculin skin testing is a method of screening for exposure to TB infection. An individual infected with TB will have developed a hypersensitivity to the TB bacteria, even if he or she didn't develop the disease.

A purified protein derived from the bacteria is injected into the skin and the area is inspected for a bump 48 to 72 hours later. A positive test implies that TB infection has occurred. Skin tests aren't 100 percent accurate and they don't always indicate the presence of active disease.

TB diagnosis also is done by identifying bacteria in sputum (matter coughed up from the lungs) or other bodily fluids and tissues in conjunction with an abnormal chest X-ray and the presence of TB symptoms. Once TB has been diagnosed, further testing is required to determine the most appropriate drugs to treat the particular strain of TB bacteria.