There can be few more challenging and imperative goals in the field of child health than to beat the cruel scourge of tuberculosis. Australia must help PNG – and other countries in the region – tackle this modern plague to save lives and livelihoods, and protect children’s futures, Nigel Spence writes.
Grace* is 10 years old and battling tuberculosis (TB) for the second time in her life.
This young girl arrived at a small district clinic in Papua New Guinea’s Central Province earlier this year so weak and wasted she couldn’t walk. The clinic is a basic shack, typical of many across PNG. There are just six staff to provide support for around 15,000 people, some of them travelling up to six hours by boat for medical attention.
Grace spent two months at the clinic receiving daily injections for her TB. “I thought I was going to die,” she says. “It was painful and hurt the most in my neck.”
Grace is among one million children globally who will contract TB this year. More than 140,000 children like her will die from this entirely curable and largely preventable disease.
TB has devastating impacts on children in developing countries like PNG. Many children do survive, but with their bodies and minds profoundly damaged after the bacteria infiltrates their bones or brains.
The luckiest recover at substantial cost to their education. Family incomes are undermined as parents spend time away from their homes to care for sick children over months or even years of treatment, which can shatter already fragile livelihoods.
Children account for 26 per cent of detected TB cases in PNG but this is likely to be a fraction of the real story. In PNG, as in other TB-endemic nations, there are formidable challenges to the diagnosis and treatment of paediatric cases, with the disease frequently misdiagnosed or overlooked.
When Grace first came to the clinic two years earlier, she was lucky enough to be seen by a health worker who had been trained by ChildFund to detect and treat TB. Grace was started on a treatment of tablets that needed to be taken for the next six months. But when she started to feel better, her mother stopped giving her the tablets and a few months later, Grace was sicker than ever.
This is a common story. TB drugs can have a rapid effect on how people feel, but unless they are taken for the full duration, they won’t provide a cure. Worse, they give the TB bug the chance to fight back and progress into a drug-resistant form of the disease.
PNG is already recording outbreaks of deadlier drug-resistant strains of TB. Referred to by some experts as “Ebola with wings”, this modern-day mutation is much harder to treat and has the potential to have catastrophic consequences within and beyond PNG’s borders.
Finding effective solutions to address the TB epidemic in PNG is not impossible, but requires far greater levels of cooperation and determination, nationally, regionally and across agencies.
Building on the key principles outlined in the World Health Organization’s End TB Strategy, it is vital that the PNG healthcare system is strengthened to address the shortage of skilled frontline health workers and to move from a passive to an active case-finding model. This requires improved detection methods, increased community awareness of the disease and its symptoms, and sustained healthcare support for patients.
Innovative solutions in the area of medical research and development will also play an important role in reducing caseloads. Already, new TB vaccines are being trialled, improved pharmacological treatment products are available, and the roll-out of GeneXpert diagnostic machines is delivering efficiencies in TB testing and treatment.
More broadly, it is crucial to address the social and economic conditions that perpetuate the spread of the disease in PNG. Poverty, poor nutrition, inadequate housing and overcrowding in urban areas provide the ideal conditions for TB to thrive.
Australia is well positioned to play a powerful role in assisting our nearest neighbour to tackle this disease, and ultimately eliminate TB as a public health risk. Through increased, well-targeted aid and by leveraging Australia’s significant research and industry capability, we can help contribute the resources and strategies needed to win the TB war.
*Name changed to protect privacy