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Feature: Nation slowly tackling specter of tuberculosis

"Government rules tend to be inflexible. There are many rules regarding the condition that must be met before someone can be declared destitute and receive aid."

Wang Kwei-feng, tuberculosis care and prevention section director at the Center for Disease Control

"Do I have to take so many?" asked an old man to his tuberculosis outreach worker who brings him his pills every day.

In his weakened state, the man requires rests between swallowing each pill. His outreach worker stayed with him until he finished them all.

This story was recounted by Wang Kwei-feng (王貴鳳), tuberculosis care and prevention section director at the Center for Disease Control (CDC).

Wang said more than 400 outreach workers provide treatment to tuberculosis patients all over Taiwan as a part of the Department of Health's (DOH) big push to cut tuberculosis cases in half by 2015.

This year alone, the DOH has allocated nearly NT$1 billion (US$30 million) out of its budget on tuberculosis care and prevention, with NT$180 million going towards directly observed treatment short courses (DOTS).

"The program just came online this year, so it's too early to see any improvements," said Chou Chih-hao (周志浩), deputy director-general of the CDC. "But there is an international consensus, and support from WHO, that the DOTS approach is the best way to deal with tuberculosis."

In addition to the DOTS program, measures taken by the CDC to curb tuberculosis include BCG (Bacillus Calmette-Guerin) vaccines administered to more than 90 percent of Taiwanese children, free tuberculosis-related programs for all, including those who did not pay their National Health Insurance premiums and compulsory hospitalization for those deemed to be an infection risk.

"Initially, the compulsory hospitalization lasts about two weeks," said Chou. "After that, patients are allowed to go home, where they are tracked by outreach workers. If they don't take their pills, however, then it's back to the hospital."

Bai Kuan-jen (白冠壬), a doctor at Wanfang hospital who has worked extensively with tuberculosis sufferers, said the draconian measures are designed to combat a formidable foe.

"Tuberculosis bacteria grows slowly and has different levels of persistence," he said. "Interrupted treatment can result in the development of resistance, making the disease far more difficult to tackle."

Some patients end up with multi-drug resistance, and may become all but incurable while capable of passing on the more virulent strain of the bacteria, he said.

Despite the rising specter of AIDS, tuberculosis remains Taiwan's deadliest infectious disease and the 13th leading cause of death overall.

According to the statistics office at the DOH, 970 people died of tuberculosis last year.

The elderly and patients with AIDS, both growing demographic groups, are particularly vulnerable to tuberculosis, said Chou.

On the ground-level, Wang said, the official and non-governmental organizations are working in tandem to support tuberculosis patients in their long and often economically onerous recovery.

"In the early days, outreach workers and local health workers down south would help patients with money out of their own pockets to buy food, or go out of the way to give patients rides to the hospital in their own time," Wang said. "It was very touching ... but not a solution for the long term."

Wang's section received NT$600,000 from the National Tuberculosis Association and NT$180,000 from the Taipei Dental Association.

"Those funds go straight to tuberculosis sufferers in need," she added.

Wang said that since tuberculosis strikes most among the economically marginalized, many families are put into hardship by the disease.

"Government rules tend to be inflexible. There are many rules regarding the condition that must be met before someone can be declared destitute and receive aid," she said. "This is where non-governmental organizations can step in and really make a difference in patients' lives."
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