Tuberculosis, The disease of the poor

On a warm May morning, on the lawn of the German Medical Services clinic, Hussun watches as her young daughter coughs painfully. The coughing started a week ago and did not stop so Hussun took her daughter to see the local doctor, who then refer them to this leafy compound. From their home in the hilly dusty outskirts of Kabul they’ve walked an hour and a half to get here. And they’re still not sure why they’re here. All they know is that all around them in this lawn under the breezy shade of the trees are children crying and coughing.
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These children suffer from an epidemic long forgotten in the West. Called the “disease of the poor” tuberculosis is a respiratory disease that preys on the weak and hungry. Because of its two decades of civil strife Afghanistan is easy prey. The United Nations health agency the World Health Organization says every hour three Afghan will die from this disease, and every ten minutes an Afghan will become sick with TB. Two-thirds of all tuberculosis cases are women.

Yet there is hope. By working closely together two United Nations agency are saving thousands of lives. Since 2001 World Health Organization has cured patients and controlled tuberculosis with its Directly Observed Therapy, Short-Course (DOTS) strategy, where doctors supervise and monitor their patients’ intake of medicine for eight months. DOTS is tricky because if the patients drop out before the completion of the eight months they will develop a virulent and unstoppable strand of tuberculosis called drug-resistant TB. So in 2003 WHO enlisted the help of the United Nations food agency the World Food Programme (WFP), which provides food to TB patients. Together WFP and WHO have created one of the most successful TB programs in the world.

“Eighty-nine percent of our TB patients recover fully, and less than three percent of TB patients dropped out of DOTS in 2004,” says Dr. Sevil Huseynova, who runs WHO’s tuberculosis program. She says DOTS now covers 81 percent of the country.

“I’ve visited numerous health centers around Afghanistan and many of the TB patients I’ve met have told me that they might not have finished their eight months of treatment without the incentive of food aid,” says Charles Vincent, WFP’s Country Director. “It is wonderful to think that most of those men and women are now fully recovered and once again healthy enough to take care of their families.”

“TB patients have been very co-operative – and a large component of the success is because of the food,” says Dr. Reto Steiner who runs the German Medical Services tuberculosis clinic.

After waiting three hours at the German Medical Servics clinic Hussun and her daughter can now see Dr. Reto Steiner, a fluent Dari speaker who has been treating Afghans for 33 years now. One of Dr. Steiner’s assistants takes a sputum sample of Hussun’s daughter; another questions her; another takes a chest x-ray. By mid-day the tests are done, and Hussun and her daughter begin their hour and a half trek back home. The tests are rigorous, and Hussun must come back again tomorrow to see whether her daughter has the disease.

Najiba, a middle-aged mother of eight, remembers how sad she was when Dr. Steiner first told her she had tuberculosis. It’s now one in the afternoon at the leafy compound, and Najiba is waiting in line for the WFP food along with dozens of patients. Eight months ago Najiba felt pain all over her body, and coughed a lot. She came to Dr. Steiner’s clinic, and when she learned she was sick she worried for herself and her family: she had five boys and three daughters, and her husband only made three dollars a day as a baker. Dr. Steiner told her not to worry: WHO had a cure, and WFP would give food for herself and her family. Everyday for two months Najiba endured the hour-long hot crowded bus ride to get here, and swallowed a fistful of tuberculosis drugs under the doctors’ watchful eye. After a month she started feeling a lot better, and says if it weren’t for the food she would have quit after a month. To help feed her family Najiba came back every two weeks to take the TB drugs under Dr. Steiner’s supervision.

The World Health Organization’s Dr. Huseynova explains how essential the WFP food is for TB patients. Not only does it give patients the incentive to come for all eight months of treatment but also nourishes them so they can fight the disease. “Tuberculosis is known as the disease of the poor,” says Dr. Steiner. “Not only do the poor have to fight TB – they also have to fight hunger.”

By the clinic’s warehouse one of the workers Khalil, a lanky middle-aged man, is sorting the food into piles – the small bags of salt from the large bags of wheat and yellow chickpeas from the cans of vegetable oil. Khalil looks at his list, and says this afternoon 108 TB patients will come pick up their monthly food ration. The food distribution will last only an hour: everyone co-operates, and wheelbarrows of food sail out of the warehouse and into the hands of eager families.

As Najiba and her two young sons put their food into a wheelbarrow and cart it away she says that this food alone will feed her family for two weeks. The disease has been long gone from her face: Najiba smiles brightly, and her eyes are lit.


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