Efforts to fight widespread TB infection

Eleven-year-old Joaquina Francisco is a success story. Just a couple of months ago she was weak and wasted as tuberculosis wracked her body, making her young life a misery. She was one of the first patients at the "Camacupa" tuberculosis programme, set up last June by the international medical NGO, Medecins sans Frontieres (MSF). Joaquina was declared cured in February after six months of directly observed treatment (DOT), which saved her life. "I couldn't run at all, I'd run out of breath and get tired really easily," she said. "Now I can run and play, and do everything I used to do before I got sick. I help in the house, I carry water from the fountain and I wash the dishes - now I can help my mother," she told IRIN. The Camacupa project is an offshoot of the MSF programme that cares for 410 patients and has witnessed dramatic results in Kuito province. "In the year-and-a-half we have been working here, we have seen the cure rate double," said Mieke Steenssens, the MSF nurse responsible for TB projects. "In 2002 the cure rate was only 35 percent here, now we have a cure rate of 77 percent. This is really nice to see - it's working. We have a target cure rate of 85 percent, and we think we'll reach that this year," Steenssens commented. WIDESPREAD PROBLEM Elise van Belle, a doctor and field coordinator with the Camacupa project for MSF (Belgium), is worried that TB is much more widespread than had been thought - 40 percent of those tested in the central province of Bie are TB positive. However, mined roads are preventing medical personnel from reaching vast portions of the population. "It's impossible to say how many people have TB here, but it's endemic for sure," said van Belle. "As soon as we set up a project we have a lot of new cases." Pulmonary tuberculosis is an infection of the lungs that causes coughing and breathing difficulties. Extra-pulmonary TB triggers ganglions - unsightly lumps in the neck or abdomen - or attacks the vertebrae in the spine, causing occasional paralysis. Angola has substantial poverty, exacerbated by poor nutrition, overcrowding and the growing prevalence of HIV/AIDS - the conditions in which TB flourishes. The disease is contagious and spreads easily in the cramped huts where many of Angola's rural poor live without sufficient food. "If you are infected by the cough of someone with pulmonary TB, you have a one-in-ten chance of developing the disease in your lifetime, if you are healthy and have a normal immune system - otherwise your chances are much higher," explained Van Belle. "It's very contagious. In fact, I'm probably infected, but I haven't developed the disease because I'm healthy. The problem is, people here are malnourished, so they have a weak immune system and they are susceptible to chronic infections. They develop TB much more quickly," she explained. DEFAULTERS INCREASE DRUG RESISTANCE Some Angolans have developed a resistance to the drugs used to treat the disease because the medication was not administered properly. Sometimes resistance stems from the war years, when many TB sufferers on treatment failed to complete the course due to the fighting. "That just created resistance and really made the problem much worse," said Van Belle. Child TB patients should receive at least six months of DOT, while adults need two months of DOT, followed by six months of daily treatment at home. DOT means that they get to take their medicine every day under the supervision of a health worker, but monitoring is proving to be a major headache. Many patients have to walk for hours to reach the nearest health post, and are unlikely to make the journey once the treatment starts working. If they fail to finish the treatment, they not only harm their chances of recovery, but also increase the level of resistance to the drugs among the general population. Francisco Longenta thought he was cured last November, but just two months later he started coughing again, experienced severe chest pains and steadily lost weight. By March the pain was too severe, so he walked the 10 kilometres from his home to Camacupa for a second consultation. "I was told that I have TB again. It's a problem of resistance to the drugs, so I have to restart the treatment, stay here for eight months and get treatment each day," he said. This time Longenta will stay in the Camacupa hospital and receive a more complex combination therapy of five drugs because the sickness is more severe and contagious the second time around. He is one of around 30 TB patients admitted to the hospital. Another 110 patients come to the facility every day, or visit one of the six health posts in remote areas, where trained medical staff distribute medication free of charge. Doctors believe the solution to the TB problem lies outside the medical arena. "Tuberculosis is a disease of poverty - it can only be got rid of by improving living conditions, making homes less cramped, and making sure people are better nourished to fight off the bug," said Asa Eriksson, an MSF doctor in Camacupa. Van Belle agreed: "There is certainly a need [for more TB projects]. There are more TB sufferers who need proper management. However, the issue is more funding, as the international community is starting to indicate that it is time the government takes its responsibility to cover all the health needs of its population. Meanwhile, what will happen to the patients while a political settlement is sorted out? I hope it won't be too late for the patients, as the TB programme needs more staff, more equipment and more money to adequately cover the needs of the TB patients," she said.