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August marks the foundation of the time-honored Quezon Institute,
the country’s one and only hospital devoted to the care of
tuberculosis (TB) patients. I grew up literally in the shadow of its
Juan Nakpil-designed complex, since we live directly behind it. My
own parents were also employees of this hospital, as were other
parents in the community that built itself up behind this
institution.
The kids in the community I grew up in were
steeped in the tradition of public health and philanthropy. We even
conducted projects for the hospital patients, as did other students
in the schools bordering it. Practically, everything that went on
inside the hospital was food for thought in our neighborhood.
The disease must have been passed on from our
Spanish colonizers, as it was to the Latin Americans. The natives
were free from the social stresses of feudal Europe then, but when
the seasick colonizers came, they brought with them different
diseases plaguing highly stratified Europe, among them TB.
When the US colonialists came into our islands
and discovered natives fresh from a revolution against Spain dying
like flies due to tuberculosis and other diseases now known to be
poverty-induced, they immediately instituted a public health
program. They set up in 1910, among others, the Anti-Tuberculosis
Society, now the Philippine Tuberculosis Society.
TB was a constant scourge throughout the 20th
century. In the 1910s, when the population was five million, the
Bureau of Health estimated that 400,000 people were afflicted with
it and at least 26,400 were dying yearly.
The rapacity with which this disease kills can
be discerned by the profuse apologies Filipinism advocate Francis
Burton Harrison made. By the time the Commonwealth government was
inaugurated, at least 30,000 Filipinos died from this disease every
year.
The disease was perhaps the first to benefit
from an organized public health campaign and official development
aid. According to the Philippine Society of Health History, the
organized fight against TB started on July 29, 1910, when Mrs.
Martin Egan formed the Anti-Tuberculosis Society with the Bureau of
Health’s support. Their anti-TB program utilized visual materials
to educate the public on proper nourishment and hygiene, recently
invented moving pictures, a traveling exhibit by railroad car by a
Dr. Simpao, and profusely illustrated health bulletins.
That was the best they could do. TB drugs were
not available then, and if one contracted the disease, one was sure
of dying a slow consumptive death. Short of complications and
outright starvation, it takes a long time to die from the disease.
While a big number of the population might be infected (some
estimates run to as high as 50 percent), only one in 10 infected
persons can become an active case requiring prolonged treatment.
TB generated a lot of debates that confused even
those trained to treat it. In the early 1980s, some Marcos cronies
dreamt of demolishing the Quezon Institute, on grounds that the
disease can be cured through domiciliary or home-based treatment
(which is true), and that other hospitals could accept TB patients,
something they refused to do because it is highly contagious.
For QI patients and employees, however, the
issue was that their hospital was set for demolition without any
thought for those who would be displaced. The morality of this issue
was lost on some medical students of the University of the
Philippines. They even debated openly if they should help the
anti-demolition campaign. They eventually did, after a few weeks of
hesitation when different constituents of the Philippine General
Hospital threw in their support for their QI-based counterparts.
For Archdiocese of Manila’s Jaime Cardinal Sin
and other patient advocates, though, the main issue was the morality
of displacing patients and ignoring their real needs. He said Masses
weekly in QI. The hospital remains standing to this day because
thousands agreed with his simple Christian message of protecting the
sick patients and the poor and powerless employees of the hospital.
Tuberculosis is still a major health scourge, a
living proof that it takes not just medicines to lick it for good.
To date, the self-rated report card of the Department of Health
shows that while TB remains one of 10 leading causes of morbidity
and mortality (actually number six), significant progress has been
made in its control.
In 2004, the country exceeded global
epidemiological targets, achieving 73 percent case detection of new
smear-positives and an 88-percent treatment success rate. This was
made possible through 100-percent direct observed treatment system
(DOTS) implementation in the public sector and with the introduction
of the public-private mix DOTS strategy in 2003. Treating TB
requires massive infusion of social investments to fund expensive
detection measures and the purchase of medicines since the disease
can only be managed chemically). Funding is also needed for the
mobilization of community health workers (CHWs).
The CHWs are the real heroes of the anti-TB
campaign since they take the brunt of community surveys, case
finding and monitoring, following up cases, and assisting patients
in going to health centers, etc.
ngamolo@manilatimes.net
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