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.