The stench filled our nostrils and assaulted our taste. I treaded carefully on top of wooden slats
that threatened to give way to a stew of green and brown water. All around me children squeezed past me, easily finding footing on the narrow wooden structures that create walkways in between their homes. I wondered how often someone lands in the pungent brine that lay below our feet.
Built on top of a lake of raw sewage, the Steung Meanchey slum on the outskirts of Phnom Penh in Cambodia is an example of how desperate people will find any place to live and make it home. Families have built their homes out of wooden stilts and metal sheets that hover precariously above a toxic sea. It is here that tuberculosis (TB), one of the world’s oldest diseases, is rife and continues to threaten the lives of families and communities.
I recently travelled to Cambodia with RESULTS UK to learn about how key global health issues affect development. TB remains one of the world’s top infectious disease killers and continues to claim 1.3 million lives every year. Yet when we think of some of the world’s biggest global health challenges we often think of two of the world’s other leading infectious disease killers – HIV and malaria. TB is usually the forgotten one – considered outdated, a disease of the past.
During my trip to Cambodia I was able to see first-hand that this is not the case. TB continues to affect some of the world’s poorest and most vulnerable communities. TB most severely affects individuals between the ages of 15-54 – the most productive years of a person’s life. TB is a cause and consequence of poverty, and yet it remains low on the list of diseases we feel we need to respond to with a sense of urgency.
Cambodia makes up a large portion of the global TB burden. Although it has managed to halve its TB rate over the past decade, it still has one of the highest rates in the world: 27 times higher than that in the UK. In light of it’s tragic past under Khmer Rouge rule, Cambodia’s high TB rates come of little surprise. Khmer Rouge rule completely decimated the country’s infrastructure, including its hospitals and health centres. Fewer than 50 doctors were left practicing from a former workforce of around 600. The scars of the three and a half years of the genocide are not fully repaired.
The Steung Meanchey slum we visited demonstrates how difficult it is to control TB when some of the country’s poorest and most vulnerable people lack access to TB diagnosis and care. It underscores how important it is to develop new and innovative ways to find and treat people with TB who otherwise continue to spread, suffer and die from TB.
This is where a pioneering initiative called TB REACH comes in. We visited a programme funded by TB REACH and led by the Sihanouk Hospital’s Center for Hope. Community health volunteers accompanied TB health workers door to door to actively find individuals with TB and put them on treatment. The TB workers interviewed individuals about their health, and if a person displayed any TB symptoms they would cough up a sputum sample which the TB worker then transports back to the lab for testing. The TB test and any subsequent TB treatment needed are all provided free of charge. Rather than waiting for people with TB to come to a health centre, actively finding and treating people with TB is what breaks the cycle of transmission.
If we truly want to eliminate one of the world’s oldest diseases, we have to be more aggressive in how we tackle this epidemic. The UK Government has a strong history of supporting multilateral organisations like the Global Fund to Fight AIDS, TB and Malaria, which is currently the biggest international funder of TB programmes. However, more can be achieved by supporting innovative programmes like TB REACH. Only then will we be able to drive out a disease that has killed more people than any other in history.
Photo credits: (C) Nick Axelrod/Results UK