This is the third installant in our series looking back at RESULTS' delegation to Cambodia a few weeks ago. The parliamentary delegation looked at how the country is improving the health and education of its population. Jess Kuehne, Health Advocacy Officer at RESULTS, describes Cambodia's approach to finding and treating people with TB within some of the country's poorest and most vulnerable communities:
Some of you may remember the story in the news recently about London homes having to be evacuated due to a burst water main causing sewage to flood the streets. Those affected described the flooding as “revolting”, “stinky” and “pungent”.
This experience was horrible and disgusting enough to make it newsworthy in the UK, something many would consider to qualify as intolerable living conditions. As unacceptable as the situation sounds, having your home surrounded a sea of raw sewage is the reality for some of the poorest communities in Cambodia: Steung Meanchey is a poor community on the outskirts on Phnom Penh. The village sits directly on top of a sewage lake – houses have been built on stilts and planks of wood create narrow walkways between peoples’ homes. Raw sewage flows beneath and round the village. The stench is overwhelming, yet children leap and run across rickety wooden boards that threaten to give way at any minute.
Unacceptable, you might ask? It is daily life for the 110 families that live in this community.
It is here that tuberculosis, the long-forgotten disease of the past, continues to flourish, thanks to risk factors like cramped and overcrowded living conditions and poor nutrition. Added to this is the lack of access to health services that stops individuals who are sick from seeking treatment.
Despite these deplorable conditions, a programme supported by an initiative called TB REACH is improving the health of the population that lives here. One of the aims of our trip was to examine how Cambodia is dealing with its extraordinarily high rate of TB. To put into perspective the sheer scale of the TB problem here – Cambodia successfully managed to halve its TB rate over the last decade, but it still has one of the highest rates of the disease in the world.
The World Health Organisation estimates that of the nearly 9 million people who become ill from TB every year, nearly one third are ‘missed’ by national health systems. This means that roughly one out of every three individuals with TB is never officially diagnosed or treated and continues to spread, suffer and die from the disease – Cambodia is no exception. This is where TB REACH comes in - it had funded over 100 projects in 44 countries aimed and supports new and innovative approaches to find and treat those who otherwise don't have access in TB care.
In Steung Meanchey, rather than waiting for individuals to seek out health services, we saw health workers go door to door interviewing households to see if any individuals displayed symptoms of TB. If they had symptoms, the health worker would collect a sputum sample from the individual, place it in his or her cooler box, and transport it back to the lab for testing. If the person turns out to have TB, they are provided treatment free of charge in their home until they recover.
While the approach of actively finding people in Cambodia who have TB doesn't sound ground-breaking, it is this sort of alternative approach that has helped Cambodia make inroads against what remains one of the world’s top infectious disease killers. Bringing health services to those who otherwise have difficulty accessing them means that people are diagnosed sooner and put on treatment faster, which improves their chances of recovery and stops them continuing to transmit the disease to others.
TB has long been the forgotten child in terms of the top poverty-related disease, as international attention is usually focused on the other top two killer infectious diseases – malaria and HIV/AIDS. The UK Government should continue the leadership it has demonstrated on malaria and HIV/AIDS and apply it to TB by supporting innovative programmes like TB REACH that are taking the initiative to drive out TB. Only then will we finally be able to consign this ancient disease to the pages of history.