Stigma fuels spread of tuberculosis

Just two days after 25-year-old Rushdi Abdullah was diagnosed with tuberculosis (TB), his family moved him into a room outside the main house. "They said I could only return when I got better. I now have a separate plate to eat from and new sheets on the bed. At night it is very lonely, because I am forbidden to watch television in the main house, and nobody comes into my room to see me," he said. While the shortage of adequate medical equipment and expertise continues to hamper the treatment of TB in northern Iraq, health-care workers say the associated social stigma has fuelled its spread. "Our public education campaign has tried to change the way people think about TB. Many people still don’t know enough and will do everything to avoid contact with a TB sufferer. We still have a long way to go," Dr Mufid al-Jaf told IRIN. "For women, it is even more difficult, and they often ask us not to tell their male relatives that they have tested positive for TB. They are afraid people will find out that they have had TB, and this will reduce their chances of getting married in the future," he added. Against a backdrop of inadequate nutrition, poor water and lack of sanitation, TB continues to impose a heavy burden of ill health in three of Iraq’s northern governorates - Dahuk, Arbil and Sulaymaniyah. At Arbil’s only TB clinic, funded by the World Health Organisation (WHO), Al-Jaf struggles to keep up with the number of patients seeking treatment. Since July 2002, the clinic has seen 307 reported cases of TB. "Most often, the patients are from the poorest parts of Arbil. Many of them leave it until the last minute before they seek medical attention. When they eventually do come for help, we find that the TB has progressed. All we can do then is provide them with the few resources we have to offer," Al-Jaf told IRIN. Indeed, resources at the clinic are limited. Although funds from the Oil-For-Food Programme financed the import of microscopes and allowed the renovation of the laboratory, most of the work is done manually using old-fashioned medical techniques. "With the equipment we have, we can provide patients with the first line of treatment. If, however, they prove resistant to the drugs, we are unable to administer advanced treatment. We just don’t have the appropriate medicine. Fortunately, most of the patients have recovered after the first treatment," he said. In an effort to improve treatment for TB patients, WHO has worked with the clinic staff on the Directly Observed Treatment Short Course (DOTS). Under the programme, therapy compliance is closely monitored. "Many of the TB patients continue to work even though they are extremely weak, Sheharizad Ghazi, the head of WHO in Arbil, told IRIN. "The DOTS strategy ensures that patients have access to the medicine by supplying the nearest local clinic in their area with the drugs. If the patients fail to turn up, health workers go to their homes or places of work to make sure that they take the drugs." Since the introduction of DOTS in April 2002, the recovery of TB patients had improved by almost 90 percent, she added.