Monday, October 29, 2012
An innovative tuberculosis control program in Tijuana will run out of money at the end of the year.
TIJUANA, Mexico Tuberculosis kills more than 1.25 million people worldwide every year. It’s one of the leading causes of death.
For years, the city of Tijuana has struggled with a high TB rate. A San Diego-based non-profit has been helping health officials fight the disease throughout Mexico.
But the program’s funding runs out at the end of December.
The bacterial infection known as tuberculosis has been been traced as far back as the age of Egyptian mummies.
Today, the public health arm of the United Nations keeps close tabs on the disease.
Dr. Jacob Kumaresan is executive director of the World Health Organization’s New York office. He said the disease continues to take its toll.
"Tuberculosis still accounts for several million cases per year, approximately 9 million cases per year," the epidemiologist explained. "And of this, many of them die, and most of them are in the developing world, in Asia and Africa. So it is still a significant problem worldwide."
TB can be cured. But the treatment involves a number of antibiotics that must be taken for at least six months. People often start feeling better in a few weeks, and then stop taking their medication. Kumaresan said that’s when multidrug resistant TB can develop.
"And this is a very serious problem," he pointed out. "So you have to make sure that you account for every patient, manage them properly, and ensure that after six months, they have been treated, and they are completely free of the disease."
That kind of case management is a challenge in Tijuana, where poverty is widespread, and public health resources are limited.
There are about 800 new cases of TB every year in Tijuana. That’s more than in any other part of Mexico.
The Centro De Salud in downtown Tijuana is where most TB patients go for care.
The TB clinic is housed in a separate building on the property, with its own ventilation system.
The clinic’s Dr. Concepcion Corona Rubio has been treating TB patients for 18 years.
"There are a number of factors that predispose our population to tuberculosis," the clinician said. "Here in the community, there are a lot of immigrants, a lot of people who abuse drugs, and this is driving up the number of people who test positive."
Dr. Corona said some immigrants come to Tijuana already infected, and then move into poor housing.
"Cramped places, poorly ventilated, crowded immigrant shelters: these kinds of places facilitate the transmission of the disease," he said.
Since 2004, San Diego-based Project Concern International has given Tijuana’s fight against TB a major boost. Director Blanca Lomeli said their program, Solucion TB, has helped change the way public health officials look at the disease.
"So instead of focusing on X amount of people infected, just looking at the statistics," Lomeli explained, "Instead of looking at that, you look at the individuals, and try to identify why people are getting infected, why people are getting the disease, why they’re abandoning treatment, etc., and you design the program around that.”
Solucion TB has helped fund the hiring of public health workers who go to patients' homes and make sure they’re taking their medicine. It’s also encouraged more widespread TB testing to get people diagnosed earlier in the disease process.
Dr. Paris Cerecer Callu heads up tuberculosis services in Tijuana. He said Solucion TB has helped the health ministry integrate its TB program with efforts to control HIV and diabetes. People with these diseases are at higher risk of getting TB.
"This project has also helped us find people at high risk who we hadn’t identified yet," Cerecer said. "What’s more, they provided training for the medical community and public health workers who deal with TB patients."
But funding for Solucion TB, which comes from the U.S. Agency for International Development, ends in December.
Program director Blanca Lomeli hopes public health officials in Tijuana will keep up the fight.
"What we have learned with TB is that when you stop investing resources in the disease, things go, you know, back up in terms of, they get worse. So that’s what we hope doesn’t happen," she said.
A new president and health secretary will soon be in place in Mexico. Whether they’ll maintain the campaign against TB remains to be seen.