Increase in TB cases worrying, doctors say

Iraqi doctors say they are concerned over an increase in Tuberculosis (TB) cases in the southeastern city of Amarah, fueled by a shortage of medicine and poor living conditions. The disease, which has been under control in the area for more than 50 years, has been rising steadily since the conflict in 2003. A survey on living conditions, released by the UN and the Iraqi government in May, stressed that standards had seriously deteriorated over the past two years with poor access to clean water and adequate healthcare. Health experts are now concerned about a rapid increase in cases over the past four months. The number of cases in the city, located in Missan governorate, some 360 km south of the capital, Baghdad, has reached 400. "The spread of TB after more than 50 years is something worrying. The total of 400 cases is a huge number in relation to the population of Amarah and the number is increasing daily," director of the chest diseases hospital in Amarah, Dr Hameed Jassim, said. TB is caused by bacteria and usually attacks the lungs but can affect almost any part of the body. It is treated through DOTS, which involves a course of a variety of powerful antibiotics taken uninterrupted for six to eight months. This treatment also stops the development of multidrug-resistant strains of TB. Some 20 years ago, the disease afflicted nearly 20 percent of Iraq's population but efforts by the country's Ministry of Health (MoH) and the World Health Organization (WHO) bought that figure down to 2 percent. Jassim said cases in Iraq could not be cured through treatment alone. “Poverty, high population, dust, unpaved streets and absence of health awareness expands the circle of the disease,” he explained. Most patients will not admit they have the disease, especially those from rural conservative societies, as they feel embarrassed. This is due to misconceptions about the way in which TB is caught, relating to close contact between men and women. “I did not tell my family that I have TB, I told them something else and they believed me because they are simple people. If I tell them they won't speak to me. I cannot work now to support my family and I sent my wife and son to her parents home afraid that they will catch the disease,” construction worker, Salim Muhammed said as he lay in his bed. “The government is not improving the health system and our lives are worsening. The treatment can be found only in private pharmacies that suck our blood due to high prices and I don’t have money,” he added. Local pharmacy owner, Dr Hadi Hassan, said most patients in need of drugs were from poor suburbs in the area, adding that the normal course of treatment costs at least US $500, which most families could not afford. According to Hassan, the medicines most requested were Rifampicin, Ethambutol and Pyrazinmide but they are not found easily. "When TB reaches its chronic and advanced stage it will spread to other parts of the body and causes failure of the lungs that leads to death of the patient, especially if there is a shortage of drugs for treatment," a local doctor, Qassim Mohammed said. "Our procedures to face TB are weak due to the lack of the required medical equipment and laboratories. We need mobile X-ray vehicles and we only have a few medical labs and X-ray units in rural districts,” Jassim explained. WHO officials for Iraq said a special health team would be sent to the area to supply drugs and assist in controlling the spread of the disease. But they added that poor hygiene in many areas in the south was opening doors for the spread of diseases previously under control during the rule of Saddam Hussein. "I have been psychologically affected, because I feel as if I am untouchable. I only recently discovered that I had TB and it is advanced now and my relatives and friends will not visit me. I am waiting for death without drugs and love and support,” Nadia Raheem, 38, said.