Taking the Cure

KIRIBATI: Every year approximately 100 million people are infected with tuberculosis or TB. Eight million develop active or infectious TB, and about two million die. The burden of this curable disease is particularly heavy on developing countries. In the western Pacific region 3.8 million cases were recorded in 2004. Of the countries in this area, Kiribati has the highest incidence.

Woman holding medicine containers The small island nation of Kiribati in the Pacific is experiencing a TB epidemic. There's been about 200 reported new cases each year since 2000, mainly among adults.

'You wouldn't think that TB would be a problem in a country that has more than enough fresh air to blow away infected droplets,' says Dr Takeieta Kienene, Coordinator of the Kiribati Tuberculosis Epidemic Control Project. 'But the thing about TB is it thrives in crowded living conditions. Parts of Kiribati, especially South Tarawa, are very densely populated. Up to 20 people live in one house. And it only takes one infected person in a house not very well ventilated and there's a fair bet the others will become infected too.'

Australian assistance through the AusAID-funded epidemic control project includes constructing a new TB ward at the old hospital site in Bikenibeu, and helping Kiribati to recruit, train and mobilise community health workers. 'Kiribati is following a highly effective TB management strategy recommended by the World Health Organization called DOTS [Directly Observed Treatment Short-course],' says Dr Kienene. 'As soon as someone is identified as having the disease that person is admitted to hospital for two months intensive treatment. Once a patient returns home he is treated every day for four months by a health worker.'

Four specialist nurses travel the country identifying TB cases. They're backed up by a team of 15 health workers who manage the post-hospital home treatments. Armed with medications this group sets out each day on motorbikes to visit patients in their villages.

About TB

Tuberculosis - also called TB - is primarily an illness of the respiratory system and, as an airborne disease, can spread quickly in densely populated areas and poorly ventilated homes, usually by coughing and sneezing.

The resulting lung infection is called pulmonary TB. However, other parts of the body - for example, lymph nodes, intestines, and bones - can also be affected and this is called extrapulmonary TB.

'Compliance is a big problem. People often start out taking their medicine regularly - that's the medicine they're given when they're released from hospital - but then they stop or forget as they begin to feel better.

We've since decided the best system is not to send them home with any medication, as we used to do under the old TB treatment regimen.

Now we'd rather our community health workers give it to them on their daily visits. That way our health workers can watch each patient swallow the tablets and be confident the right dose is being taken at the right time. This is the crux of the DOTS strategy. It's the only way we can be sure we're curing TB.'

Above: Community health workers set off on their daily run dispensing medicines and checking patients recently discharged from the hospital's TB ward. Photo: Lorrie Graham

2007