MEDLIFE Nurse Janet pounded on the flimsy metal door to the small house and waited- No response. She tried again. Nothing. “SeÃ±or!” she yelled. “Hola SeÃ±or! Estamos con la organizaciÃ³n de MEDLIFE.”
It is hot, the sun is shining for the first time in weeks. We wait. She tries knocking again. Where were they?
We were looking for a teenage boy who had come to a Mobile Clinic complaining of respiratory issues. MEDLIFE doctors had told him he needed to get tested for Tuberculosis. Had he? We didn’t know.
Tuberculosis is a highly contagious and often deadly lung infection that is rapant in the Pueblos Jovenes where MEDLIFE works and disproportionately affects people living in poverty worldwide. It spreads quickly in enclosed areas where one is in close proximitiy with an infected person. For example, the interior of the combis, small crowded busses used to get around Lima, are ideal for the spread of Tuberculosis. Many buses even have signs asking passengers to keep windows open to stop the spread of Tuberculosis, but oftentimes they still remain shut.
The infection can remain dormant for months or years in someone’s lungs before becoming active, contagious and symptom causing. Symptoms can begin mild, but typically progress to lethal if active TB is untreated. MEDLIFE doesn’t offer Tuberculosis testing onsite at clinics both because it is difficult and because all public hospitals offer free testing and treatment centers.
If this boy we went to find really did have active TB, he had could have spread it to his entire family and countless other people by now if he hadn’t started treatment.
Janet sighs and begins asking passerby for the family’s wherabouts. Eventually she discovers that the boy’s mom runs a fruit stand in a nearby market. We walk up the stairs to the top of the hill and find the market. We eventually find her surrounded by piles of grenadilla, mandarinas, and pineapples in her stand. The boy’s mom has no idea who we are- immediately the lines on her face deepen and take on the shape of concern and sterness that only the face of a worried mother can have.
Her son hadn’t told her anything about visiting the MEDLIFE clinic. He hadn’t told her anything about possibly having TB. “Vamos!” she said and we took off towards the house. She was sure he was there, and she was going to find him.
We hadn’t come to give him treatment or pay for it. He could get that for free at public hospitals. We had come to make sure he was getting treatment, following proper precautions to avoid spreading the disease, and was following the directions with the antibiotics. The only thing MEDLIFE occasionally pays for is medicine to help with the stomach issues some patients experience when taking TB medication, to make compliance with the treatment more likely.
If a patient begins taking the antibiotics and then decides to stop before finishing all of the medication, the TB bacteria can become resistant to the antibiotics and the disease can begin progressing again. If this happens, they will be spreading a strain of TB that has adapted a resistance to that antibiotic. There are many strains of antibiotic resistant TB now, and some are very difficult to treat because they are resistant to many different antibiotics.
The situation we were in was making it obvious why it was necessary to actually visit TB patients and make sure they are getting proper treatment.
We put on our masks outside the house to avoid becoming infected if the boy did indeed have TB, but the mother, she didn’t have one. As his mother storms in shouting his name he sheepishly comes out of the back of the house sporting a mop of disogranized hair, a white t-shirt and pajamas. He looks like he just woke up to his worst nightmare. We must have been very intimidating, showing up in surgical masks with his unhappy mother.
He remains quiet as Janet and his mother explain the situation. You could have cut the tension in the room with a knife. Janet questions him about how he has been feeling, each question ends in a debate between him and his mother over to what degree he exhibits each symptom. The mother seems to think he is downplaying his symptoms and has been sick. The boy says that he simply forgot about it and is fine.
A friend of his who has TB had been coming to the house for months so they could study together. Their pile of books was sitting on the table as we spoke. His friend had told them he wasn’t contagious since he had been taking the medication long enough, but if he had decided to stop taking the medicine because he felt better, or forgotten too many doses, he could have become contagious and passed anti-biotic resistant TB to them.
That is the problem with trying to control the spread of TB in places like the pueblos jovenes; lots of people with weak immune systems living in close proximity to one another with a lack of education and many barriers to access healthcare are extremely vulnerable to the spread of TB.
TB is not just a problem in Lima´s Pueblos Jovenes, but all over the world. In 2013, 9 million people around the world became sick with active TB and there were around 1.5 million TB-related deaths worldwide. The rate of TB has been declining around the world and in Peru due to efforts from governments and international health organizations, but is still a significant problem. In Peru, the per capita rate of active reported TB infections has declined by about 72% between 1990 and 2013, according to the World Health Organization. 67% of patients who began treatment were treated successfully.
No one knows how many people have latent TB since those with latent TB do not have any symptoms. The United Nations public health agency estimated in its 2013 report that about a third of all active TB cases are unreported worldwide.
Antibiotic resistant TB, on the other hand is on the rise globally and has been called a public health crisis by the world health organization. Patients with drug resistant TB must take multiple drugs daily for as long as two years. Making this happen is extremely expensive and difficult.
One of the only ways to stop the spread of antibiotic resistant TB is to ensure patients follow it in the first place, and don’t create new strains of resistant TB. To do that sometimes you have to go out and see them in person.
The boy and his mom promised to go and get a test. Janet says she will stay in touch. Hopefully he will actually go this time. I have a feeling this time around his mom will make sure of it.