Indonesia: The thinker: Tackling tuberculosis
Yesterday was a good day: I told a patient of mine that she was free of tuberculosis (TB). She could stop taking medications she had been taking for six months — medications that cured her while putting her at risk of potentially serious side effects. She smiled broadly and shook my hand, thanking me effusively.
Yesterday was a bad day: I diagnosed two patients with TB, checked on the progress of three patients on TB treatment, and reviewed the chart of one patient to look for improvements after putting him on treatment for multidrug-resistant TB.
As a pulmonologist working at a public national lung health reference hospital, I see a lot of TB patients. Daily, I am confronted with the fact that TB is still a major health concern in Indonesia. With an estimated 460,000 patients who were diagnosed with TB in 2013, Indonesia ranks fourth in the world for TB burden. This burden includes not only new patients, but also 730,000 existing TB patients and 67,000 people who lost their lives to TB in that year. Almost 7,000 of these TB patients suffer from the multidrug-resistant strain of tuberculosis, which requires longer and more expensive treatment than drug-sensitive TB. Not only that, MDR TB patients also have to contend with potentially more toxic side effects of the medications, as well as the psychological toll the prolonged treatment regimen takes on them.
The outlook is not all bleak. The National Tuberculosis Program is on track to continue implementing systemic improvements to drive TB numbers down. For example, there has been a 34 percent drop in the rate of TB patients diagnosed in the last five years, as well as a 31 percent reduction in the mortality rate of TB patients. These improvements have come about through measures such as the implementation of standards for diagnosis and treatment, extensive training of health personnel, building laboratory capacity, and strengthening processes for obtaining and distributing drugs. Therefore, the public sector is shaping up to be competent and skillful in diagnosing and treating TB patients.
However, the same can not yet be said about the private sector in Indonesia. Many private physicians still do not adhere to national standards in diagnosing and treating TB patients. Delays in TB diagnosis and treatment not only lead to poorer health in the patient, but also to poorer public health. Because TB is transmitted through air, untreated patients can infect others in their households or workplace. Or, patients with inadequate treatments develop drug resistance, leading to more serious consequences for themselves and people within their surroundings.
Fortunately, numerous endeavors have been started to raise the standards of TB care by private physicians. For example, the NTP, assisted by medical professional societies, has sponsored trainings in international standards of TB diagnosis, treatment, and care for private physicians. Efforts are also underway to establish a TB-specific certification for providers. The steady build-up of such projects provides a much-needed momentum to advance the quality of care delivered by physicians in private practice.
However, this is not enough. The NTP and the medical profession must be supported by the other members of the community. Most of the funding in Indonesia TB control has been from external donors. Even as NTP crafted a strategy to shift to internal funding, we must demand more from ourselves. TB advocacy, communication and social mobilization can get a huge boost through the participation of Indonesian celebrities. The more financially fortunate among us can follow the example of their foreign counterparts and establish funding mechanisms to fight TB. Use the spotlight for good.
Until all of us are engaged in this fight, the disease will still be a menace to Indonesians. Come join me in this movement, so I can look forward to better days.
By Dr. Erlina Burhan
Dr. Erlina Burhan is a faculty member of Universitas Indonesia’s Pulmonology and Respiratory Medicine Department and heads the clinical expert team on multidrug-resistant TB at Persahabatan Hospital in East Jakarta.
Source: Jakarta Globe