Award-Winning Photos Highlight Drug-Resistant Tuberculosis

James Nachtwey's haunting photo

By VOA Khmer, Washington
Video Editor: Manilene Ek
15 December 2008

Tuberculosis, an ancient disease, kills 1.7 million people each year, almost all in the developing world. According to the Cambodian Ministry of Health's 2007 report, only three percent of Cambodia's TB patients die following treatment, while 90 percent recover. And health experts say the death toll is likely to grow because new drug-resistant strains have emerged.

Journalist James Nachtwey photographed people with tuberculosis in Cambodia, South Africa and other countries for this slideshow being displayed around the world. Health experts say tuberculosis (or TB) is preventable and usually treatable.

It kills one person every 20 seconds. Nachtwey's pictures are being distributed by a coalition called ACTION (for Advocacy to Control TB Internationally). Joanne Carter of ACTION in Washington says because of decades of neglect, TB has now developed into newer, deadlier strains. Some are extremely drug-resistant.

JOANNE CARTER: "Even though this disease kills nearly two million people every year, is the biggest killer of people with AIDS, there [are] half a million cases of drug-resistant TB estimated -- new cases -- every year. This issue is receiving very little attention and the hope is that these photographs could actually bring a much higher level of attention to tuberculosis."

Tuberculosis can be treated with powerful drugs, but many poor countries lack the means to detect the disease. Carter says the newest TB drug is 40 years old, there is no effective vaccine for adults, and diagnosing the newer strains is more difficult.

JOANNE CARTER: "In most of the developing world, the diagnostic test that we're using for TB is over a hundred years old, and so while it can detect standard TB, it actually can't detect drug resistance, it has more difficulty detecting TB in people who are HIV positive."

In countries with a poor medical infrastructure, experts say it is difficult to make sure patients continue taking their medications for the minimum six months. Rachel Nugent is with the Center for Global Development in Washington.

RACHEL NUGENT: "Many people who are diagnosed don't get the treatment or don't stay on the treatment. It can take two years to treat them, so it's very difficult to have expectations that somebody in a poor country with pretty bad health facilities is going to be able to continue treatment for a two-year period, and that means that they're going to die."

To view more of Nachtwey's photos and find out about the disease, visit www.xdrtb.org.

Lack of labs fuelling spread of resistant TB in Asia: WHO

3/19/2008

MANILA - Inadequate laboratory facilities in Asia and the Pacific are fuelling the spread of drug-resistant strains of tuberculosis, the World Health Organisation said Wednesday.

Many countries lack basic laboratory capacity to monitor and manage multi-drug resistant tuberculosis, the WHO said in a statement released from its Western Pacific regional headquarters in Manila

The WHO said less than one percent of multi-drug resistant TB cases were confirmed by a laboratory and officially reported in the region.

In 2006 only 600 of the estimated 150,000 drug resistant TB cases in East Asia and the Pacific were officially notified by a "quality-assured laboratory," the statement said.

Undetected and untreated, a TB patient can infect 10 to 15 people a year "simply by coughing or sneezing" and the disease can be spread by passengers travelling on aircraft, the WHO said.

"The spread of multi-drug resistant-TB is every TB programme's nightmare. One case can take up to two years to treat with drugs that have serious side effects and cost 100 times more than the regular regimen of drugs," it said.

"Outbreaks of multi-drug resistant TB are going unnoticed constantly," said WHO regional director Shigeru Omi.

"We are worried this silent epidemic could set us back years. We could lose the gains made in recent years," he said in the statement.

A recent WHO report based on surveys from 81 countries found multi-drug resistant TB is spreading faster and is more widespread than previously believed.

The WHO said Cambodia and the Philippines have only three laboratories each able to diagnose multi-drug resistant TB.

"Countries need to do more than upgrade laboratories," said Pieter Van Maaren, WHO regional adviser for tuberculosis and leprosy.

"Laboratories have long been neglected, suffering from a shortage of funds, trained personnel and quality assurance systems."

Nearly a half million new cases of multi-drug resistant tuberculosis occur each year worldwide, or around five percent of the nine million new cases in total, the WHO said last month.