Deep in eastern Cambodia, near the Vietnam border, is a lush rural landscape that has been ravaged by war. The U.S. secretly bombed here during the Vietnam War, and later Vietnam invaded to put down the brutal Khmer Rouge regime and occupy Cambodia.
Peace has finally come, but this quiet area dotted with rice paddies and rural workers is today the scene of a different kind of war: one to stop the spread of tuberculosis. TB is a deadly but curable disease that has taken hold in places like Cambodia, and throughout the developing world. The bacterium breeds where people live in poverty and in cramped quarters.
On the frontlines of this war is a top researcher from Harvard who has dedicated her career to taking care of refugees and children in Cambodia. Anne Goldfeld is a professor at Harvard's Immune Disease Institute. She also co-directs the Global Health Committee, along with her Cambodian medical partner, Sok Thim, a survivor of the Pol Pot regime that killed an estimated two million Cambodians in the 1970s.
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Working in the province of Svay Rieng, and in the capital of Phnom Penh, the two doctors have teamed up to provide early detection and long-term treatment for a population ravaged by TB, a disease considered all but eliminated in the West.
At the small Svay Rieng hospital, three hours from Phnom Penh, Sok and Goldfeld examine several young children who exhibit possible symptoms of TB. They need to determine whether it is in fact, TB, and quickly.
"She could develop meningitis and it could turn into coma," said Goldfeld of one young girl. "It could turn into disseminated TB ' -- tuberculosis that spreads beyond the lungs -- ' (and) she could die."
TB has taken hold in Cambodia, which has one of the highest rates of infection, and is ranked among the top of the World Health Organizations's high-burden countries.
For more than a century, there were precious few ways to make that critical diagnosis. The sputum --or spit -- test has been around for more than 100 years.
The disease, which was known as "consumption" because it attacked the lungs and left patients withered and wasted, spread like wildfire through crowded American cities. Highly contagious, it was spread by people coughing in unventilated spaces. While the disease largely disappeared as living conditions improved, TB is now storming back throughout the developing world, helped in part by conditions in the slums -- a perfect breeding ground for bacteria -- and, in Cambodia, medical infrastructure ravaged by decades of war. The disease tends to afflict the poor, the weak and those infected by HIV, whose immune systems cannot battle the infection.
To Goldfeld's frustration, even though TB kills nearly two million people every year, there have been no new drugs or reliable diagnostic tests in decades.