By: Clydette Powell, Medical Officer, Division of Infectious Diseases
We need a game changer that puts innovation for Tuberculosis diagnosis and treatment at the forefront of our global health agenda. Unsanitary and unhealthy realities bred by third world conditions provide the perfect opportunity for this ancient disease to continue to spread through vulnerable populations. There is one vulnerable population in particular that is greatly affected by this disease and often go unnoticed: children. We don’t have a good estimate of the disease burden in this population; we only know that the numbers of cases continue to increase, or go undiagnosed and untreated or improperly treated;
- the current diagnostic test dates back to 1907 and is fraught with challenges;
- newer laboratory diagnostic tests in the pipeline are largely not being tested in this vulnerable population;
- the “preventive” vaccine we have been using is based on “technology” which is 90 years old;
- that vaccine has limited efficacy and does not protect against the most common form of the disease;
- the most recent drug to treat this population was developed in 1967;
- a full course of treatment consists of up to 1,000 pills, and more if drug resistant;
- this population continues to experience disability and death from complications of this disease;
- those who have this disease often acquire it from household contacts, that is, those closest to them – those who are more likely to be diagnosed and treated; yet, few public health staff trace those contacts;
- preventive measures, which are safe and available, are generally not applied to the vulnerable ones in those households with this disease. Is that fair and just?
So, what is this problem that cries out for a game change? It is childhood TB. Tuberculosis.
Yes, that neglected disease that has been around since 6000 BC. A disease that Moses described as the “fiery consumption” among the Israelites, that knocked downed Incans, Egyptian pharaohs, many in the world of the fine arts, and the wife of one 20th Century American president.
Meet Ka-quarta. An eight year old Angolan boy, whose name loosely means “Wednesday’s child.” Do you recall the rhyme ”Wednesday’s child is full of woe”? Ka-quarta has TB of the spine. That makes him full of woeful TB. He lives away from his rural village family and stays at the local hospital where each day he receives many pills, injections and one meal a day. He will do this for up to one year. Yet, he is hardly full of woe in the other sense of the word.
Flashing a smile, he met me at the entrance to the hospital in Benguela Province, extending a hand from beyond the deformed spine that shortened him, slowed him down and made him an unwelcomed standout in the crowd. He offered me a hospital tour, beginning with the wards he knew best: the TB wards. It was in these wards that Ka-quarta lived, slept and ate with other adults. For one whole year. For 1,000 pills. He hoped for a cure, to someday stand taller than he was, now squatted by the gross deformity of his spine. He hoped to play soccer, to keep up with his friends, to be able to sit in a chair and lean back without his spine arriving much sooner than the rest of his thin frame.
Ka-quarta is the best advocate on two legs for fighting childhood TB. Without a single word, his body tells the community why we need to fight this disease in children. The next time I visited Angola, I sent Ka-quarta a little doctor’s kit, complete with a plastic stethoscope and a play X-Ray viewing box, that conveniently displayed an image of a set of lungs. I am rooting for Ka-quarta to be the local TB specialist, when he grows up in both years and stature, if not the authority on childhood TB for his country. Why not?
So what about you? How about that game change? How about taking some first steps towards eliminating childhood TB? Or would you like us to serve you up 1,000 pills starting today?