By Ivan Mwebaza
Archbishop Desmond Tutu once used the oxymoronic phrase “TB is the child of poverty - and also its parent and provider” to describe the tight connection between poverty and tuberculosis. In other words, all he was communicating is that poverty begets tuberculosis and vice versa.
Put it simply, one is at increased risk of falling ill of tuberculosis when they are poor, and this will leave them poorer that they will be at more increased risk of falling ill of tuberculosis again. This cycle of tribulations would always continue in perpetuity unless deliberate efforts are taken to address both tuberculosis and poverty together.
Unfortunately, most (if not all) eradication campaigns are more ardent at curing the patients of the disease and pay little attention to helping them escape the yoke of poverty. This approach, one would argue is more like treating the symptoms without addressing the vicious cycle of aetiology.
The part of Archbishop Tutu’s observation that poverty begets tuberculosis is a well-established fact. For it is an airborne infection that is spread through fine droplets created when a sick person coughs or sneezes. These droplets concentrate in dwellings that are crowded and with poor ventilation systems, and such conditions are only common in the impoverished sections of society.
Moreover, it would be those families with no financial means that would keep ill members at home without seeking professional medical attention. Indeed, tuberculosis is also a disease of the malnourished and affects those who are the least privileged and living at the fringes of society.
However, the other part of his observation that tuberculosis begets poverty is a fact that is rarely mentioned and may somewhat require voluminous explanations to drive home. The aloofness to this fact is majorly propagated by our wrong assumption that tuberculosis patients don’t suffer significant economic drawbacks given that treatment is always offered free of charge. A few research findings have highlighted the economic impact of tuberculosis on families.
The treatment course for the disease would always take about six to eighteen months depending on how responsive it is to the medicines. Those on treatment are usually unable to continue working consistently due to drug side effects. This whole situation is aggravated by the fact that almost 64% of tuberculosis patients are men, who are always the household breadwinners.
I should not waste ink and paper (and your time) lamenting about obvious financial burdens like money spent to make journeys to the health centres, and implicit medical expenditures. Indeed, the World Health Organization (WHO) estimates that such expenses, termed catastrophic costs, on average eat away 50% of the household's annual income.
There is scientific evidence that people who have ever suffered from tuberculosis are more likely to suffer from the disease again. Indeed, they are thirteen times more likely to fall ill of tuberculosis than someone who had never suffered from the disease. The suppositions to this state of affairs are of course always skewed towards accusing their body’s biology.
Perhaps it is high time we started thinking in favour of the idea that the first bout of tuberculosis leaves these people poorer and more susceptible to subsequent bouts. If that sounds too anecdotal to act on, then we may start with acting on what is universally agreeable, which is that the ultimate cure of tuberculosis would also necessitate curing these patients of poverty.
I am by no means insinuating tuberculosis eradication campaigns should also take on the overly titanic task of fighting poverty. All I am saying is that they can help their patients recover from the disease by giving them medicines, and from poverty by teaching them income generating skills.
The idea of skilling survivors has yielded tangible fruits in HIV eradication campaigns, and in cancer survivors who are trained to acquire new skills in case they lost a body part (for example a lower limb) that was so vital in executing their previous skill (for example driving).
There have been commendable efforts to mitigate losses and costs incurred by tuberculosis patients. WHO had proposed interventions like cash transfers via government funded grants, food packages through World Food Program (WFP), transport vouchers, and support to individual social service needs. The challenges to such interventions are as clear as day i.e., source of funding and sustainability. They also have a blatant limitation whereby they would address the short term needs of the patient (catastrophic costs) without addressing the core issue of perpetual poverty.
By sending these people back home with skills that can help them uncouple the yoke of poverty from their necks, we may achieve alot more towards eradicating the tuberculosis scourge than if we continue sending them back with tins of tablets alone.
Or at least we may reduce the chances of seeing them coming back to the treatment centers.
The writer is a PhD fellow at School of Medicine, Case Western Reserve University