Seven years ago, when I was a municipal physician, I met Gerry Capistrano. He had tuberculosis—TB for short, and soon became a regular in my clinic. This in itself was unusual in my experience with TB patients: they come and see you for only a few weeks, and stop coming once they get better.
But Gerry was an unusual case. He had every reason to go see me often, because his present problems are a result of his past mistakes. Gerry has multidrug-resistant TB or MDR-TB, a severe condition where his TB has become resistant to the two most powerful antibiotics for TB: isoniazid and rifampicin.
Today, Gerry is a frail man who stays at home, first because no company wants to employ him, and second, even if he did get employment, his body is too weak to work. He is supposed to be in his prime. Ten years ago, he was a graduate of Hotel and Restaurant Management, and had plans of working overseas as an hotelier. But that came to an end due to unfortunate circumstances.
“I got TB when I was still 22, malakas pa ang katawan ko ’nun,” says Gerry.
“Nagpagamot lang ako kasi sabi ng kompanya namin, dapat daw mag-gamot ako dahil may nakita daw silang TB sa x-ray ko,” shares Gerry. “The company refused to pay for my medicines, so I had to get them from the health center. The health center wanted me at first to visit them everyday to take my medicines, but I explained to them that I had to be at work by 8 in the morning, so they later allowed me to get medicines good for a month.” But by the third month, Gerry got tired of going to the health center, especially when his symptoms were resolved.
TB in the Philippines
Tuberculosis is a deadly and debilitating disease. It is caused by the resilient Mycobacterium tuberculosis, which commonly infects a person’s lungs, and may spread to other parts of the body. For decades, it has remained a major public health threat in the Philippines, with the latest data from the Department of Health showing that TB ranks sixth among the leading causes of death and illness in the country. According to the World Health Organization, the Philippines is ninth worldwide among countries with the most number of patients with TB.
At the start, TB does not cause any symptoms, and many infected people may be walking around, infecting other people through coughing or sneezing, without them knowing it. As the disease progresses, the patient develops a long-standing cough, some with blood-tinged sputum, and other symptoms such as fever, night sweats and severe, progressive weight loss. If untreated, TB continues to ravage the body, eventually becoming fatal.
Unlike other bacterial infections, TB does not respond well to conventional antibiotics. It has to be treated with a cocktail of four antibiotics for several months. Because of this, many people do not complete the months of treatment. When a patient stops treatment, all the bacteria are not eradicated, and the ones that remain bacteria have a high likelihood of developing resistance.
When these resistant bacteria flourish, the result could eventually be MDR-TB—and treatment becomes more difficult the second time around.