The taming of TB

News Article
The taming of TB
Thursday, 18 l 03 l 2010 ; Source: Mind Your Body, The Straits Times
By April Chong
Since 1960, Singapore has managed to reduce cases by 87 per cent. But mutant strains of TB germs resistant to drugs are a worry. APRIL CHONG reports Tuberculosis (TB) was a big problem in post-war Singapore. The disease’s transmission was high and few effective testing and treatment options were available. In the 1950s and 1960s, there were easily more than 5,000 new cases here every year, with 307 per 100,000 people coming down with the disease in 1960. The Singapore Anti-Tuberculosis Association (Sata) was set up in 1947 by philanthropists. In the years that followed, Sata’s vans went to various kampungs to take chest X-rays. Dr K. Thomas Abraham, the chief executive officer of the association’s successor body, Sata CommHealth, said: “In those days, throw a stone and you’d hit someone with TB.” In the 1970s and 1980s, treatment became more effective as TB-zapping drugs and various types of regimen were better developed. By then, health-care facilities were also shaping up. TB treatment is now readily available, with more than half of the patients being seen at the TB Control Unit at Tan Tock Seng Hospital. Serious defaulters – those who fail to follow the daily treatment regimen at polyclinics or the TB Control Unit – have to stay at the Communicable Disease Centre located near the hospital. With TB figures having gone down since the 1950s and 1960s, Sata went into promoting community health, including smoking cessation, health education and health screenings. It was rebranded as Sata CommHealth last year to reflect its widened range of services. However, its focus is still on lung health, said Dr Abraham. In Singapore, TB figures have dwindled compared to population size – from 307 cases per 100,000 people in 1960 to 40 cases per 100,000 people in 2008. This works out to a reduction of about 87 per cent. However, there were 1,451 new cases in 2008, the first increase in a decade. Doctors say it is too early to tell if the blip in the 2008 figure indicates a TB comeback here. Worldwide too, awareness of the disease has increased and incidence rates have been falling slowly. However, it is the threat of multi-drug resistant TB that now looms as current conventional drugs become increasingly unable to handle mutant strains of TB germs. The drugs in use today were developed in the 1970s, so more research is urgently needed to find medicine that can handle the evolving disease, said Associate Professor Sonny Wang, the director of the TB Control Unit at Tan Tock Seng Hospital.
THE COUGH THAT WOULD NOT GO AWAY Businessman Kingsley Koh, 62, did not think he would contract a disease like tuberculosis (TB). A sprightly man, he does not drink or smoke and he jogged or took brisk walks up to three times every week. His only medical condition was high blood pressure. However, after a business trip to China in January last year, he came down with a cough that would not go away. Visits to his regular family doctor did not seem to help either. Still, he dismissed it as simply a persistent cough until it became more serious in April. By then, he was coughing so badly it affected his sleep. An X-ray then confirmed that he had TB and he was warded at Tan Tock Seng Hospital for four days. “I was in shock. Why did I get such a disease? I had always taken care of my health,” he said. After he was discharged, he had to visit the polyclinic every day for injections for two months. His visits to the polyclinic were later reduced to three a week. His treatment regimen stretched over nine months during which he had to take a cocktail of pills. During this period, the father of a 28-year-old daughter said he and his wife slept in different rooms. He often left the windows open to ventilate his house. His portion of food during meal times were kept separate to reduce the chances of passing the germs to his family. Mr Koh kept to his medication routine religiously. When he finally completed the treatment last month, he was elated when he was told that he was clear of the disease. “I was very happy that I’d won the battle,” he said. Having experienced the disease first-hand and the treatment it entailed, he now advises employers to be more understanding should their staff members contract the disease too. Instead of dismissing these employees, bosses should assign them other chores if their work is affected during the treatment period, he said. “They will be cured in the end,” he added.