Improper treatment means TB will remain major killer

Improper treatment means TB will remain major killer

Fitri Wulandari, The Jakarta Post, Jakarta

Tuberculosis (TB) will likely continue to linger as a major
health problem in Indonesia, as eliminating the disease is being
hindered by a lack of information and improper treatment,
according to two lung specialists.

Despite the government's efforts to combat the disease, TB
remains a major killer in Indonesia because the public is not
well-informed about the disease and its treatment, the two lung
specialists said over the weekend.

An integrated anti-TB program called the Direct Observation
Treatment Short Course (DOTS), adopted by the government in 1999
to reduce the prevalence of the disease, has not yet been
implemented effectively, they said.

DOTS, which has been recommended by the World Health
Organization (WHO), consists of five components -- political
commitment of the government, diagnosis by smear microscopy,
well-organized distribution of TB drugs, directly observed
treatment and good reporting and recording systems.

"Many people do not know much about TB due to the limited
availability of publications on what the disease is, how to treat
it, why it is important to follow strict treatment, why it is
contagious, etc," Pradjna Paramita, a lung specialist of the
Jakarta-based Gatot Subroto Army Hospital, said.

TB treatment conducted by doctors frequently resulted in the
death of patients, Pradjna said, adding that such incidents would
not necessarily occur if the patients had adequate knowledge on
the disease and the importance of strictly abiding by doctors'
orders.

TB, an infectious disease attacking the lungs, has been known
for 600 years. It made a comeback in the 1990s, forcing the WHO
to declare TB a global epidemic in 1993.

WHO estimates that 2 million people worldwide die of TB every
year. The spread of the human immunodeficiency virus (HIV), the
emergence of a new strain of TB, and global population movements,
including refugees, have helped propel the disease's global
epidemic.

In Indonesia, TB infection has been worsened by a prolonged
economic crisis, which started hitting the country in 1997.
Ethnic conflicts that create millions of internally displaced
persons raise the number of low-income bracket people who are
most vulnerable to the epidemic.

WHO ranks Indonesia third on the list of countries suffering
from a high incidence of TB, after India and China, with 140,000
deaths annually and 500,000 new cases found every year.

TB, which spreads through the air, does not only exist in
densely populated and poorly sanitised slum areas but also in
high rise luxury buildings that have bad air circulation.

To be cured of TB, a patient has to undergo a strict treatment
of at least six months by taking a full course of correct dosage
anti-TB medication.

Information about TB and its effective treatment should not be
just for the layman but also doctors and paramedics, Pradjna
said.

"There are many doctors, especially those in remote areas, who
do not fully understand DOTS or know how to treat TB patients
effectively," Pradjna said.

Rita Rogayah, another lung specialist, echoed Pradjna's
remarks, saying the effective implementation of DOTS, supported
by a good education campaign on TB among the public and health
officials, are the keys to combating TB successfully.

Rita said the public health centers (Puskesmas), the
spearheads of the public health service, could not run DOTS
effectively because of a lack of human resources.

"We don't know when Indonesia will be free from TB but if we
can implement DOTS effectively, we might have hope," Rita said.