Inside a dark hut, cut into a remote mountainside in Lesotho, a priest wearing a leopard-print cape and sitting on a throne-like chair led his parishioners in harmonies that filled the room.
Sweat dripped from the tip of his nose, and the still air was so warm that my cheeks burned. I wanted to escape outside for the promise of a breeze; but I stood still, almost transfixed by the sounds and images.
Then I noticed a woman sitting against a wall.
She sat apart from 20 people squeezed together on the dirt floor. I had met her the day before. Her name was Matsepe Lenkoe, and the remarkable thing about her was that for the past year she had been living a world away in the capital city Maseru receiving treatment for multidrug-resistant tuberculosis (MDR-TB). Seeing her, the thought crossed my mind that this would be an ideal place to catch MDR-TB – if an infected person coughed, any of us could be breathing in the bacterium during the hours that the priest would keep us.
I stayed in the hut. This was the beginning of a journey around the world to learn more about the global response to MDR-TB; and here, far from any town or road, in an impoverished country, I learnt my first lesson, with sweat trickling down my back: The Government of Lesotho had protected me and all the others that morning at the Jerusalem Church of Africa. Because it had decided that treating MDR-TB should be approached as an emergency; and because, in very short order, it had built a comprehensive programme designed to prevent the spread of TB and to treat those who had drug-resistant strains, we were safe. Thanks to this political commitment, Lenkoe was not only alive – she was no longer infectious.
This was quite remarkable. Still I wondered: Was she lucky?
There is no doubt.
The World Health Organization (WHO) estimates that as few as 10% of the roughly 500,000 people who contract MDR-TB every year receive treatment. And only 3% of the half-million were receiving drugs procured through the Green Light Committee, an initiative of WHO and the Stop TB Partnership that helps countries access quality assured drugs needed to treat MDR-TB.
It is early days in the global response to treating drug-resistant TB. For the past decade or more, many countries around the world have successfully built TB control efforts. Now they have to build on those efforts to control the more dangerous threat of drug-resistant TB – strains that cannot be cured by the most commonly used drugs.
Experts from the WHO’s Stop TB Department and the Stop TB Partnership warn that if countries do not act now to stop MDR-TB, the world will face an airborne contagion that will become increasingly untreatable and increasingly global. It will stop at no border, and it will infect much greater numbers of people. The early signs are already apparent: At the beginning of 2007, 20 countries reported cases of extensively drug-resistant TB (XDR-TB); at the end of 2008, the number had jumped to 55, in part because countries had started searching for cases.
In my travels over two months, I kept thinking back to similar trips that I had made around sub-Saharan Africa in 2003, when a few countries lucky enough to have leaders acknowledging a looming AIDS catastrophe had begun to figure out how to treat AIDS patients. In 2009, the situation is much the same for MDR-TB, an awakening both to the threat and to models that can control it even in the most challenging settings.
It was fascinating to watch those attacking the MDR-TB problem put in place these plans and then tinker with them day by day. No place did it exactly the same, each adapting models to fit their epidemic, their health-care system and their history.
Kazakhstan, concerned about people staying indoors and spreading infections during its long, harsh winters, expanded numbers of hospital beds available for patients, and has begun to install infection-control systems in hospitals to protect health-care workers. Lesotho has been training hundreds of community health workers (and paying them small salaries) to monitor patients in far-flung areas. And the Philippines was treating patients at open-air drop-in centres and allowing them to return to their homes instead of keeping them in hospitals.
The Philippines model, in fact, had produced an unexpected benefit – something I had rarely, if ever, seen before in covering global health for nearly two decades: communities of patients who looked out for each other.
At one MDR-TB clinic in Manila, I watched Antia Silverio, a 48-year-old who had just finished her MDR-TB treatment five months before, run errands for doctors, nurses and patients. She was one of more than a dozen ex-patients who also had become volunteers; she told me that she couldn’t leave – the caregivers had given her back her life, and now she wanted to do the same for others.
From my trips, there seemed little doubt that governments could beat this disease, despite the numerous barriers and obstacles. The question is, will they? In the stories that follow, you’ll learn about governments that did take actions and saved thousands of lives. They saved people such as Silverio, who spends hours every week simply sitting next to patients and encouraging them to take their medicine, even though they hated doing so.
“I tell them, ‘Look at me, I’m old, I’ve been really sick. If I did it, you can do it, too.’”
Is a patient a metaphor for a nation? If the Philippines can do it, can others as well? Global TB experts believe so. Now they need country leaders to prove them right.