Sameera (14) is living with tuberculosis: Four years ago she was sick herself and now she is praying for the cure of her friend Hanna. This is not self-evident since TB bacteria develop resistances. Sameera is supporting the doctors of DAHW in their fight against the spread of this deadly danger.
There is only a glass panel separating the two girls – it prevents them greeting each other with a heartfelt hug, but Sameera and Hanna are close to each other anyway. They understand each other without the usual games, which are normal for girls of that age. Sameera is 14 years old now, and four years ago she was suffering from tuberculosis. Now, her 10-year-old friend has it.
At the hospital in Rawalpindi the staff of Aid to Leprosy Patients (ALP) are treating leprosy and TB patients from the northern areas of Pakistan with the help of the German Leprosy and Tuberculosis Relief Association (DAHW). Some weeks ago the doctor in charge, Dr. Chris Schmotzer, admitted Hanna to the hospital.
TB examination – Sameera accompanies her patients to the doctor in charge, Dr. Chris Schmotzer.
But there is a serious difference between Sameera’s and Hanna’s treatment: Sameera did not stay at the hospital for a long time and she was sent home very soon after admittance. She returned three times a week to take her drugs and, sometimes, for an examination. And at that time this screen through which she can see her friend today was not there: then no patient was isolated and only standard treatment was given.
In just a few years everything has changed in Pakistan: the numbers of cases of TB have been increasing continuously, but the numbers of patients with resistant TB bacilli have been growing especially rapidly: more than 13,000 persons have contracted the multi-resistant form of tuberculosis (MDR-TB) just like Hanna. Several drugs in the standard therapy do not have any effect on these bacteria.
Special medicines have to be provided for these patients – medicines with severe side-effects that are also extremely high in price. “The standard therapy is costing on average 50 Euro per patient, with MDR patients these costs increase to round about 1,000 Euro, sometimes it can even be far more,” explains Dr. Chris Schmotzer.
Not only are the drugs especially expensive, but the treatment itself also entails high expenditure, the doctor knows. “We cannot afford to let patients with MDR-TB leave the hospital before they are completely cured. The risk of infection is just too high!”
For Hanna this means that she will be for approximately two years in the isolation ward of the old leprosy hospital at Rawalpindi where nowadays there are clearly more TB than leprosy patients. She will be snatched from her normal life, without her family, and unable to meet her friends for two whole long years.
Hanna got infected by her mother who, for her part, was infected by her husband.
At least there is even a school in the hospital: However, teachers and students must wear a special mask and stay out of doors because sunlight kills the TB pathogen within seconds. Hanna only is allowed to see her sister and the three brothers – like her friend Sameera – through a glass panel or under the hot sun. The risk of spreading the disease to her brothers and sisters is just too high.
It is the living conditions of poor people in the slums of mega-cities in Pakistan that are the basis for the steady dissemination of tuberculosis and the rapid development of resistance. “If we release patients early, some of them will discontinue their therapy as soon as they feel better again,” Dr. Schmotzer knows from long-standing experience. “But we cannot blame these people. Most of them have not been to school and do not know anything about infectious diseases. Moreover, they have to be outside all the time to find a job as a daily labourer so that the family will have something to eat in the evening.”
Praise from the Doctor – Sameera is proud of being able to help in the fight against tuberculosis.
Discontinuing therapy as a result of poor living conditions, this is not an isolated event in Hanna’s family. Her father had tuberculosis some years ago and discontinued his therapy – with his five children he could not afford not to go to work in the early morning three times a week. After taking the drug for a short time, he felt better again; he felt strong and had to provide for his family.
So the TB bacteria in his body became resistant against the standard drugs and proliferated again. When he died from tuberculosis he had infected his wife with these resistant bacteria. Finally, due to the crowded housing Hanna also got infected by her mother.
“This was a signal for us to isolate patients with MDR-TB,” the resolute doctor says. “We must break the chain of infection once and for all, otherwise we will be overrun by this dangerous variety of a disease that is already fatal in its original form of appearance.”
A German company made it possible. ZF, one of the biggest component suppliers for the car industry, situated at Friedrichshafen and Schweinfurt, has its own programme called “ZF helps”. Workers can donate their overtime to this programme. “ZF helps” donations financed the equipping of the isolation ward and the first three years of its maintenance.
However, many people in Pakistan also donate some of their working time, especially former patients of the hospital at Rawalpindi. Whenever Sameera is not at school, nor busy with homework or visiting her friend Hanna, she searches for people with the typical signs of tuberculosis in the slum area where her family is living. After a short training, Sameera knows what signs she has to look out for – a persistent cough that will not go away, weakness in the body, frequent tiredness and weight loss.
A sad farewell: Hanna waves to her friend Sameera through a glass pane.
Today she has brought with her three women who are now being checked for TB. “In my experience, in most cases the suspicion is confirmed,” says Dr. Schmotzer about the efforts of her volunteer. “Sameera particularly knows what she has to look for, and in the slums TB is spreading as the flu in Germany in winter.”
The multi-resistant TB is a herculean task for the health services in Pakistan. More public education, better living conditions, a better match of drug-intake services and working time, more treatment facilities for resistant TB, more voluntary helpers, more medical staff, more financial means must be provided in order to get the infectious disease under control in this country which is among those countries with one of the highest TB burdens in the world.
Hanna and Sameera know that tuberculosis can be cured. They look forward to the day when Hanna can return home again.
Co-author: Jörg-Henning Meyer
back to the Annual Report 2008
