Archive

Disasters

When most Americans imagine Tuberculosis, they think of a disease that was active over 100 years ago.  They imagine people coughing, becoming frail and being sent to warm, dry climates as the disease progressed.  It was then often called “consumption” or “white plague”.  It is a bacterial infection that invades the lungs and destroys the lung tissue.  The bacteria can be spread when people cough, and is airborne.  

Bacille Calmette Guerin (BCG) is the vaccine that is now in use to protect against tuberculosis. It was first used in 1921.  BCG was first used as a vaccine in 1921. It was given to infants orally. Since 1921, this has been the standard treatment against TB and has been used extensively.  Today, it is estimated that more than 1 billion people have received BCG.  

A startling new finding has many people concerned:  Documentation of a “totally drug resistant strain of TB” has been found in India.  Last week, the World Health Organization convened to discuss these findings and to determine if a new classification must be added to the first TB description:  this new classification would be ‘totally drug-resistant TB,’ or TDR-TB. This means the disease has changed from one that could be treated with a six month course of antibiotics, to the emergence of MDR-TB, then extensively drug-resistant TB (XDR-TB). The most disturbing aspect of these new discoveries, says Lucica Ditiu of the WHO’s Stop TB Partnership, is the fact that drug-resistant TB ‘is a totally man-made disease.'”

Bacteria, while simple creatures, are highly adaptable and can evolve to resist the drugs meant to destroy them. Mycobacterium tuberculosis is no exception.  In many areas of the world, TB is a major problem due to lack of vaccination and inability of the people of certain countries to obtain the antibiotics needed to cure them.  To explain this new strain of TB as being man made:  if a person has access to the TB antibiotic, and begins taking the recommended course, then stops for whatever reason—lack of access to the medicine, becoming too ill to travel to obtain the medicine, or simply feeling better and stopping the course of treatment on their own—the bacteria still present in their bodies begins to adapt to fight the antibiotic introduced.  This leaves the person uncured of the original infection, and now able to transmit a new strain of the adapted bacteria to others. 

 Dr Zarir Udwadia, a specialist in TB at the Hinduja National Hospital in Mumbai, recently published a paper in the Clinical Infectious Diseases journal examining four cases of TDR-TB. He told Reuters that he has now seen 12 cases of TB where all known TB drugs were applied and none were successful. Three of the 12 cases are already dead.

The powerful TB drugs he tested on each patient, one after another, were first line treaments–isoniazid, rifampicin and streptomycin, and then a range of second line drugs like moxifloxacin, kanamycin and ethionamide. Each medicine did not work.

“If you add it all up, they were resistant to 12 drugs in total,” said Udwadia.

TB can lie dormant in a patient for many years before showing signs of infection.  As TB can now be considered an untreatable disease, the world needs to gear up for epidemic that may be crippling.

 

 

Advertisements

A survey by a York College anthropologist, Prof. Mark Schuller, showed that only a minority of respondents in Port-au-Prince think the UN Stabilization Mission (MINUSTAH) troops are a “good thing” in Haiti.

In describing the results, Schuller points out that more Haitians seem to think the presence of UN troops is a bad thing, and that this is especially true among women.  He also argues that MINUSTAH troops are not helping the security situation.

The results of this sur­vey pro­vide fur­ther con­fir­ma­tion that there is lit­tle sup­port for MINUSTAH in Haiti’s cap­i­tal city. A major­ity of respon­dents wish to see MINUSTAH forces depart within a short time frame and con­sider that the UN force should be held account­able for the mas­sive human dam­age caused by the intro­duc­tion of cholera to Haiti. Fur­ther­more, only a minor­ity of respon­dents con­sid­ers that MINUSTAH helps enhance secu­rity in their neigh­bor­hoods.

Why is MINUSTAH in Haiti?  The force was created in 2004 to deliver aid and maintain security.  It was re-authorized and expanded after the January 2010 earthquake, which killed about a quarter-million Haitians.

But Nepalese MINUSTAH troops have been blamed for starting the cholera outbreak there, as Schuller alludes in the above quote.  The Nepalese left their country for Haiti in 2010 at a time when cholera had broken out in their homeland.  The strain of cholera bacteria causing illness and death in Haiti was essentially identical to the Nepalese strain.  Originally, the UN denied that the Haitian cholera strain came from Nepal, but had to reverse itself later.

(I don’t agree with the finger pointing at Nepalese troops, or the UN.  As I argued back in November 2010, cholera is a disaster that signals a lack of resources and a failure of political will.)

Another problem:  MINUSTAH troops from Uruguay and Brazil have been charged with rape and other sexual violations in Haiti.  The most recent allegations, involving sexual exploitation of minors, were leveled just last month.

What should we make of international relief efforts in Haiti, then?  The Center for Economic and Policy Research reports that as NGOs leave, water quality is declining — a big issue, since the real cause of the cholera outbreak was the government’s inability to deliver clean water to the Haitian people.

If relief agencies withdraw, will Haitians get more autonomy but less safe drinking water?  And will MINUSTAH’s withdrawal, if it happens, help Haiti have the resources to provide the necessities of a healthy life to Haitian people?