Friday, August 27, 2010

PTS at 100: Continuing the fight against TB

EVEN BEFORE Magellan set foot on these islands in 1521 and long before scientists pinned down the bacillus that caused tuberculosis (TB), Filipinos already had various names for the disease. The Kapampangans called it malalangi while the Ilocanos called it sarot. The Tagalogs called it sigan while the Visayans called it anos. The tubercular patient in the Visayas was called anoson.

In present-day 21st century Philippines everybody just says TB.
There seems to be no record of the natives’ attempts to fight the disease before and during the Spanish era. It was only after the Spanish-American War or the beginning of the 1900s that TB began to interest health authorities. And it had to compete with deadly pestilences of that time, such as the bubonic plague, smallpox, cholera and dysentery, that exacted a dramatic toll on populations all over the world.
TB was (and is) more of a silent killer. Many historic figures, consumptive saints among them, died of the lung disease. The Philippines’ own president, Manuel L. Quezon, succumbed to the disease in 1944 while the country was fighting a war and lay in ruins. But the name Quezon not only lent a real face to the ailment, it also opened the door to TB patients who would otherwise have languished in penury and pain.

The imposing landmark, the Quezon Institute (QI), that stands on a sprawling prime lot in Quezon City (donated by the Ortigas family) is testament to this. But before QI, there was its founding organization, the Philippine Tuberculosis Society (PTS) that operates QI and PTS clinics in the country.

This year is the society’s 100th in operation. The non-stock, non-profit PTS is the pioneering institution in TB prevention, control and treatment in the Philippines. Its corporate predecessor, the Philippine Islands Anti-Tuberculosis Society, was founded in 1910, antedating both the Philippine Commonwealth (1935) and the republic (1946).

QI’s beginnings date back to 1918 when 14 nipa huts for TB patients were built in the area where it stands now. The place was called Santol Sanatorium and it operated on the belief at that time that isolation, bed rest, fresh air and nutritious food were the effective cure for TB.

Quezon recognized the threat that TB posed on Filipinos. In 1934 he signed RA 4130 establishing the Philippine Charity Sweepstakes Office (PSCO) to support PTS. QI, the tertiary hospital dedicated to TB, was built not long after.

Today, the PCSO and PTS/QI—along with the Department of Health—continue to work together. (The PSCO now occupies a significant portion of the QI compound.) With the threat of the drug-resistant incarnations of TB intensifying in the new millennium, PTS cannot let its guard down.

Until 2000, PTS operated 52 chest clinics throughout the country. Financial factors and advances in the DOTS (directly observed treatment short-course) led to the reduction of the number of clinics to 11. PTS continues to participate in the National Tuberculosis Control Program of the DOH. In the last two years PTS has been taking steps to revitalize itself and be in step with advances in TB control.

PTS has downsized its QI operations. It is looking at the American Lung Association as a model and is investing in research, training, advocacy and education. It also intends to promote mass health screening and lobby for relevant health measures. PTS has expanded its services to prisons where TB is prevalent among inmates. DOTS is still among its important contributions to TB control.

A long way from the time when the country’s most famous TB patient, Quezon, had to seek treatment in a foreign land and eventually die there at the age of 66, Zeneida Quezon-Avancena, the surviving daughter of the late president, continues to head PTS.

TB is still considered a global emergency. The DOH is reported to be aiming to attain the millennium development goal (MDG) of reducing TB deaths by 50 percent in five years or by 2015 even as a World Health Organization official has been quoted as saying that the “Philippines has a long way to go” in detecting, treating and curing highly infectious TB patients.

According to a PTS report, the number of TB deaths is an average of 75 Filipinos every day. Although curable, it is the sixth among the leading causes of mortality and morbidity in the Philippines.

TB is a contagious disease that spreads through the air from infectious patients. According to WHO, each person with active TB disease will infect an average of between 10 to 15 persons every year. But not all who are infected will get the disease. Only those with weakened immune system could get the disease.

Some grim WHO facts:

Someone in the world is newly infected with TB bacilli every second.

Overall, one-third of the world’s population is currently infected with the TB bacillus.

5-10 percent of people who are infected with TB bacilli (but who are not infected with HIV) become sick or infectious at some time during their life. People with HIV and TB infection are much more likely to develop TB.

WHO estimates that the largest number of new TB cases in 2008 occurred in the Southeast Asia Region, which accounted for 34 percent of incident cases globally. However, the estimated incidence rate in sub-Saharan Africa is nearly twice that of the Southeast Asia Region with over 350 cases per 100,000 population.

An estimated 1.3 million people died of TB in 2008. The highest number of deaths was in the Southeast Asia Region, while the highest mortality per capita was in the Africa Region.

August, the birth month Quezon and also the month he died, continues to be Tuberculosis Awareness Month.