Untreatable TB poses huge threat

Editorial, Normal

The National, Monday 28th November 2011

THE World Health Organisation (WHO) is warning of the potential for an untreatable form of tuberculosis to develop on Australia’s doorstep.
It says infections of multi-drug resistant tuberculosis (MDR TB) in Papua New Guinea’s remote south-west have reached crisis levels.
Health Minister Jamie Maxtone-Graham says tuberculosis is now a greater health emergency than HIV/AIDS.
Dr Catharina Van Weezenbeek, from WHO, says it is now clear the problem is in a state of emergency.
“If you just look at the numbers of MDR TB cases, it is clear that we are dealing with a crisis,” she said.
“Children 14 years old are infected with MDR TB in a family where already five patients are dying.”
A research team from WHO found the rural health centres run down with very limited or no medical supplies.
There is no TB coordinator in the region so no one is monitoring patients to ensure they stick to the lengthy treatment of drugs required to beat the disease, meaning many do not.
WHO’s Dr Donald Enarson says that has led to the emergence of MDR TB.
“Multi-drug resistance has passed from being created from bad treatment to now being established in a community by itself and spreading among community members,” he said.
Local medical records show 94 people have contracted MDR TB in Western province since 2005.
But the records are incomplete and WHO suspects those cases are just the tip of an iceberg.
The organisation’s MDR TB expert, Dr Ernesto Jaramillo, says the situation has the potential to get worse.
“When treatment is delivered under the current conditions, which many patients are having, then, it is a matter of months or years before we have forms of TB that cannot be cured,” she said.
Half the identified cases of MDR TB were treated at tuberculosis clinics in the Torres Strait which is just a short boat ride across the maritime border with Australia.
Earlier this year, Queensland’s department of health said it would close the clinics because of a funding dispute with the federal health department.
Australian tuberculosis experts have criticised the move as irresponsible.
But Weezenbeek says despite the best of intentions, the treatment of PNG nationals across the border has contributed to the emergence of MDR TB.
“The cross border is, in fact, is complicating the situation. In fact most of those patients are being lost,” she said.
Maxtone-Graham responded to WHO’s report by saying TB is now a greater health risk than the country’s HIV/AIDS epidemic.
“It is very frightening,” he said. “HIV/AIDS is more confined to people who are active, sexually active. But multi-drug resistant TB, the whole home is all at risk.”
Australia’s aid agency AusAID has provided A$1 million to improve health facilities in Western before the Torres Strait clinics close.
The money is being used to train and recruit medical staff, to buy a boat for outreach programmes and to construct a TB ward at Daru General Hospital.
A gradual clinical handover of PNG patients being treated in the Torres Strait is underway but an AusAID spokesman says they will not be transferred if there is no treatment support in their area.
A decision on whether to keep the clinics open will be made in January.
Despite the dire warning of the potential for an untreatable form of tuberculosis to develop, Weezenbeek is confident MDR TB can be contained.
“We have the measure and momentum now,” she said.
“We have Australian aid assisting. We have technical assistance of all the partners. We have commitment of the PNG government. We have committed and competent people now in place.” – ABC