In the past year two different Spanish journalists passed through the TB Department in Kampong Cham, reporting in El Pais, one of Spain’s leading daily newspapers, about Medecins Sans Frontiere’s work. The earlier report dated 22 October 2014, “Cambodia Advances in the Fight Against Tuberculosis” by Ana Salva, is longer and more difficult to copy / translate, but the link for those interested is http://elpais.com/elpais/2014/10/21/planeta_futuro/1413906960_427611.html.
The most recent article includes this fantastic series of photographs and accompanying commentary by Manu Mart, who visited last month. These appeared in El Pais last week. I put the Spanish commentary through Google Translate so it may not be precise. The direct link to the Spanish article is below.
The Multiresistant Cambodia
The Image of the Sick
Lung x-ray of a healthy person (right) versus a patient with pulmonary TB (left). Cambodia rank second in the world in terms of TB prevalence of the disease, with 800 people per 100,000 having active TB. 60,000 people develop TB each year. The existing health system only identifies 25,000 to 30,000 of these cases, which is a huge gap in the detection of the disease.
Tuberculosis spreads from person to person through the air and is caused by bacteria which mainly affects the lungs. When a person with active pulmonary TB coughs, sneezes or spits, the bacilli are expelled into the air. A person only need inhale a few of these bacilli to become infected. When the disease becomes active symptoms include cough, fever, weight loss, night sweats and more, which can be mild for many months. As a result patients are slow to seek medical attention, while passing the bacteria to others. Over the course of one year an infectious patient can infect 10 to 15 others who he/she maintains close contact with.
The Waiting Room
Patients wait their turn to be seen at Kampong Cham Hospital, a town 130km from the capital Phnom Penh, where Medecins Sans Frontieres has a diagnostic and treatment unit where it has worked for 20 years. Before patients receive a comprehensive survey, staff take their blood pressure and check their temperature. This assists in determining if the patient may or may not be infected. Staff and patients wear masks due to the high risk of contracting the disease.
A few degrees of fever can be key in identifying the presence of disease in a patient, in this case a girl. Many cases occur in rural areas and patients do not go to the hospital until their disease is well advanced. Last year, MSF launched it’s program Active Case Finding (ACF), a small mobile van with which they can access remote areas, home to about 80% of the Cambodian population, to identify and refer TB patients.
Chan Lammaq, 30yo, is infected with Multidrug Resistant TB (MDRTB), a variant of the disease requiring more lengthy and costly treatment with greater side effects. Since 22 December 2014 Lammaq, a mother of three, has been in hospital. Two of her children now stay with their grandmother and do not visit because they think they may have HIV. This causes an immune suppression which makes their risks associated with exposure to TB worse. Social stigma attached to the disease is one of the problems patients face and is another reason people present to health services late, as they try to hide their illness.
Sey Seang Mey
Sey Seang Mey, 20 years old, went to the hospital because during the last year she experienced two of the clearest symptoms of TB: cough and fever. X-rays showed a lot of fuid in her lungs. In the photo, a medical team is preparing to perform a puncture to remove this fluid so that she can breathe normally. A sample of this fluid will be sent to the laboratory for examination and to confirm whether or not she has the disease.
In the picture, Ngin Yim undergoes a blood test. Among the elderly in Cambodia, like her, the prevalence of TB is three times higher than among the general population, so MSF have developed a screening among those over 55 years to identify those infected and thus prevent transmission of the disease.
Keo Phalli, 25 years old, is infected with Multidrug Resistant TB (MDRTB). She must take a combination of up to four different types of drugs. For Phalli the disease is especially serious as two intestinal operations have left her bedridden for four years. She weighed 22 kilos and her life was endangered. In recent months she has gained some weight and some improvement in her condition is evident.
Hoon Honc Sring
Hoon Honc Sring, 45 years, was sick with MDRTB until 2014, when she completed 20 months of treatment and was completely cured. In her case, she had family support and recovered at home, which encouraged her to continue treatment. She is still weak, but gradually making a normal life and has returned to doing odd jobs at the school where she taught before contracting the disease.
Cambodia has still not reached their UN Millenium Development Goal targets, but TB prevalence, incidence and mortality have improved over the last ten years. Later this year MSF will leave it’s program in Cambodia as they expect the government to invest more resources against the disease. Since 2014 it spent only about 4% of it’s national program budget (about $30 million). The country’s health system has improved since the devastating civil war which affected the country into the late 1990s, but Dr San is not too optimistic. “The quality of care we have undertaken will be hard to match in our still-weak health system. There is a strong awareness in the country, of the seriousness of Tuberculosis in Cambodia”.
Copied as directly as possible from
La Multiresistente Camboya
El Pais newspaper
18 March 2015