Transcript
ANN CLARKE: Our rates are up in the top 20 percent in the world, for drug susceptible tuberculosis, drug resistant tuberculosis and TB/HIV co-infection. So, we have a very real problem here in Papua New Guinea. And the causes or reasons for that are very, very complex. Here in Port Moresby which is one of the focal points of the TB problem, we have very high rates of population growth, we have a rapidly rising urbanisation problem. So, we have over-crowding and we haven't have a fantastic economy in the last few years. So, wherever you have a lot of people not eating well, not earning a living wage and not being able to live as we do in Australia or New Zealand, the potential for exposure is very high. And because tuberculosis is an infectious disease which is airborne, where you have over-crowded living space you have very much more opportunity for transmission within large families, who may not be eating well and may be sharing bed rooms and living facilities.
DON WISEMAN: Drug resistant TB - why are there so many people who take the drugs and the drugs don't work for them?
AC: TB resistance happens over time, it doesn't happen immediately. And drug resistance in TB is not peculiar to TB, the entire world is facing an anti-microbial resistance problem. So wherever you have people who have not completed their treatment in the past, who may have gone back to the village and enjoyed lots of fresh air, sunshine and fresh food, whose wellbeing and lifestyle improve, they actually learn to fight the bacteria better, but then five or ten years later they come back to the city and get sick again. The bugs come back better. So, drug resistance is largely as a consequence of poor case management over a long period of time. So, there are many things that contribute that, because taking TB drugs is really very difficult. A normal course of six months course of treatment, and without support and without good understanding of the disease processes and good facilities to ensure that all treatment and all comply, over time we run into problems. And one case of active TB disease can in fact infect up to 15 people in a year. So, we don't have to have the number of people change very much before very many more people can become exposed and become sick.
DW: And if you are drug resistant, your chances of dying from TB are very high.
AC: Yes, they are. The regimes for drug resistant TB is even longer than six months. So, if we focus on drug susceptible TB for just one moment, we have got a fixed dose combination of drugs for six months. For drug resistant TB, once we figure out just what drugs you are resistant to that course of treatment might be 18 months long and involve six months of daily injectable medicine as well as following up with tablets and if we know what the resistant type is we have got a much higher chance of success. But it is not just drug resistance TB, it is multi drug resistance, so there are levels of resistance as well. So, the cases can be very complex. Some people can't tolerate the medication for that long and out here it has become very much more difficult, and if they are also HIV positive and they are struggling with other chronic diseases or illnesses you can imagine that that's a very hard thing to endure.
DW: Now during International Women's Day last week you went out of your way to make the point that TB is something that affects - well it highlights the drastic inequalities. Can you just elaborate on that?
AC: We know that here in the Pacific and here in Papua New Guinea a very large percentage of the health workforce are women. So, at the coalface of TB here in PNG are very many women, and health workers are most at risk of [catching] TB. Every week we come across women who are taking an incredible lead and role in the national effort. Not just medical doctors doing an incredible job, but they may be people we have trained from within their workplaces who are now going out and doing active case finding. And those women are taking their roles very, very seriously, and they will be at the forefront for the response to all diseases in the next 20 years.
DW: Next week I think is World TB Day. Your organisation wants to highlight this. You are going to stage something of a festival in Port Moresby. What's going to be the focus of the festival?
AC: The focus is, as it is for our entire organisation, is not to whine about a problem but find a strategy for fixing it. So, it might seem a bit odd to have a TB festival but we've done is we have engaged many of our partners in many of the businesses who have come and done training in early active workplace case finding. And they will be hosting a little activity that's designed to engage the public as they wander around and down to the bus stops and things to downtown Port Moresby in learning something about TB. That is factual, that is real and that helps to make sure that anybody who's concerned about TB knows exactly what to do, how to help somebody and gets the problem fixed, and doesn't rely on myths and blame it witchcraft or any of the other terrible situations that prevent people from seeking treatment very quickly.
