The Tuberculosis War: Fighting the Spread of TB

Limited resources and poverty fuel the epidemic in India, Cambodia.

ByABC News
December 14, 2010, 3:41 PM

Dec. 17, 2010 — -- 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.

This story is part of ABC News' "Be the Change: Save a Life" initiative, a year-long series of broadcasts and digital coverage focusing on global health issues.Click here to watch the special and click here for Nightline's coverage of tuberculosis in India.

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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.

The clinics are located in convenient place such as local Hindu temples. And ASHA follows up. Every time a patient comes in for drugs -- about three times a week -- he or she has to press their fingerprints into the computer that reads out data about treatment. If a patient misses a dose, ASHA is alerted and they go find the patient to make sure they take the pills.

ASHA now has more than 100 centers around India, and its TB treatment is remarkably cheap. A $25 donation to ASHA will pay for one patient's entire course of treatment for non drug-resistant TB. The WHO's Stop TB program has a similar program worldwide.

Success can be measured in human terms. Every time a patient like 12-year-old Golshan is cured, that's a big step toward choking off a largely but incredibly dangerous epidemic. Golshan had been misdiagnosed by a medical practitioner who called himself a doctor (CLICK HERE for video of Dan Harris confronting the practioner). Her parents, who get by doing menial work at Golshan's school, say they gave him their savings. He then ended up sending her to a public hospital, where she was ultimately diagnosed with TB. Now she is being treated at an ASHA clinic a short walk from the school.

Golshan is now just weeks away from finishing her treatment. She is looking forward to continuing school, living a long and healthy life, and doing what she loves best -- dancing to music from Bollywood.