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Tackling tuberculosis in the Asia Pacific

A woman sleeps on a hospital bed in the foreground, with an out of focus man sitting on a bed in the background.
A tuberculosis patient in Daru hospital, Papua New Guinea.

Supplied: Philippe Schneider / World Vision

Tuberculosis is the number one cause of death from infectious disease worldwide. While Australia has one of the lowest rates of tuberculosis globally, more than half of the world's multidrug-resistant cases are found throughout countries in our region. And Australians are playing a critical role in trying to end the global tuberculosis epidemic by 2030.

Lucy Dai lives on Daru Island, in Papua New Guinea's Western Province, and knows the toll tuberculosis can exact only too well.

It took a year and a half for her to be diagnosed with the disease known as TB.

"Before I was diagnosed I wasn't eating well, I was very weak and I was coughing a lot," she says. "My husband would carry me to the hospital on his back."

When the non-TB medication she was given didn't make her any better, she lost hope.

"My family gathered and told my husband that I needed to get checked with an x-ray. I was diagnosed in 2007."

But after a year of faithfully taking TB medication, Lucy's condition still hadn't improved, and she became fearful as she watched other TB patients die around her.

She was finally diagnosed with multidrug-resistant TB (MDR-TB) and started on the proper treatment.

"My treatment journey was very hard because I had to travel by boat to get to the clinic every month for the three years of my treatment."

Today she has come a long way since that first diagnosis.

A woman stands on stage holding a microphone.
Peer counsellor Lucy Dai speaking at a World TB Day event in Daru, PNG.

Supplied: Tess Keam

Now Lucy is working as a peer counsellor to support other people undergoing the long treatment journey for the disease. Her work is part of the Burnet Institute's RID-TB program, funded by Australian Aid.

"When I'm counselling, I always share my experience of what I went through and where I am now," says Lucy. "We all work together; us counsellors, treatment supporters and other staff to stop TB together."

She works with patients, as well as educating families and the broader community about TB and the importance of not discriminating against patients.

"That's the biggest thing I talk about, because if patients are discriminated against then it can disturb them from taking treatment."

"We've got a huge problem on our hands with TB," says Dr Suman Majumdar, a TB and health security expert at the Burnet Institute who has worked across the region. Every year 1.4 million people die from the disease.

A man and a woman in masks stand in a hospital corridor.
Dr Suman Majumdar (right) from the Burnet Institute.

Supplied

Dr Majumda says that in Asia, we are seeing huge TB burdens in India, China and Indonesia. There are also high rates of TB in certain parts of the Pacific, in particular PNG.

"What sets TB apart is it does affect, ultimately, the poorest and most vulnerable people in the communities.

"So it does cause a significant toll or cost to families and individuals, not just making them sick but also the economic burden of them having a disease that's chronic and long-standing."

The United Nations' Sustainable Development Goals (announced in 2015) aim to end the TB public health epidemic by 2030. That's an ambitious target, says Dr Majumdar.

There are multiple drivers for the epidemic in our region, he says. Social factors like overcrowding and poverty, diabetes and health systems that aren't working well in the first place all contribute.

"[If] people can't access basic services, they're not going to then get a test for TB."

Dr Majumdar argues that more needs to be done in both developing new tests and treatments for TB, and taking greater advantage of the tools we already have available.

Two women stand next to each other in rural Cambodia. A young girl watches them in the background.
Dr Kerri Viney with a TB patient during a visit to Kampong Speu Province, Cambodia.

Supplied: Sokhan Khann

Dr Kerri Viney from the Australian National University is an international TB and public health consultant and lived in the Pacific for five and a half years.

She says that while Australia doesn't have a large TB burden, the situation in the region affects us too.

"In excess of 80 per cent of our TB patients domestically are from other countries originally," Dr Viney says.

In her work as a TB advisor in the Pacific she encountered many challenges fighting the disease.

"I think some of the challenges relate to the fact that many patients do remain undiagnosed and accessing care can often be a challenge."

Dr Viney worked with the World Health Organisation to look at ways to better support countries when they had a case of MDR-TB.

"We can't have drugs for drug-resistant TB just sitting on the shelf in every Pacific Island country because they are expensive and they expire," she says.

They looked at three ways to tackle the issue. Firstly, giving laboratories in the Pacific access to another lab, usually in Australia, New Zealand or the US if they need advanced diagnostics.

Secondly, giving them quick access to drugs for MDR-TB shipped from the Philippines. And thirdly, giving them access to free clinical advice from an experienced TB doctor.

Despite the work ahead, both Dr Majumdar and Dr Viney are optimistic about our chances of eradicating TB.

"More than optimistic — it has to be done," says Dr Majumdar, "We have to at least tip it to a point where it's reducing and on the way down.

"If it can be done in resource-rich countries, there's no reason it can't be done overseas."

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