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Curing a Country

In Current Issue, Student Spotlight on October 29, 2009 at 11:31 pm

China’s Challenges in Controlling Tuberculosis

Jenny X. Chen ‘12, Contributing Writer

Courtesy Negi Images

I was let out of school early because I had been coughing, with a low fever of a hundred degrees. My mother said to sleep it off, that it would be okay. There was not much to do but grimace and wonder when the dizziness and breathlessness would end, when everything would around me would stop sounding so muffled, overshadowed by the loud, insolent thudding of an overworked heart. There was not much I could do but try to sleep it off.

Sometime, later that night, my illness went away. And, in a way, so did his. But, while I woke to a school day and a crying mother, lost in a phone call to China, my cousin never woke. And his mother has never really stopped crying.

Separated by some 7000 miles, the United States and China differ in more than just geographical location. Cultures change as we sidestep the time-zones, and the diseases of the world ebb and flow across the geographical and political borders. TB bacillus, a threat to life in China that is incomprehensible to most Americans, currently affects nearly one third of the human population of the world; 1 in 10 of those affected contract active TB. In China, TB is the number one cause of death due to infectious disease in adults.

My cousin was barely an adult, twenty-one with a persisting cough and a grimace. He told his mother he’d sleep it off for another week, that it would be okay, even when she suspected that it wouldn’t. But she didn’t argue; hospital visits are expensive and maybe it was just a cold.

In the West, those interested in “Global Health” often see health as a statistic, and a universal concept. A small number recognize that this is simply not true. There are definitions of health that are founded not only on a given individual’s field of interest, but also on the culture of such a person’s society. In this particular scenario, I was sick in North America because other people – my mother, my classmates and teacher – recognized my flu symptoms. My cousin in China, however, was not allowed the privilege of being sick; no one there would read it as such because to do so would translate directly into heavy medical costs that are seen as unjustifiable for someone so young. Interestingly enough, my family in China is by no means impoverished, living well above the poverty line; the costs of treatment, however, are often outside of what even the lower-middle class can afford.

So, if it all boiled down to money, then developed countries may be rightfully optimistic in their crusade for success in global health. In 1991, with financial backing, The World Bank, the Department for International Development of the United Kingdom, the government of Japan through the Japan International Cooperation Agency, the Damien Foundation Belgium, the Global Fund to Fight AIDS, TB, and Malaria, and other organizations in China implemented DOTS (Directly Observed Treatment, Short-course): a TB control strategy recommended by the World Health Organization that screened citizens for TB bacillus. Between 1991 and 2000, the program evaluated some 8 million people who exhibited the symptoms of tuberculosis, and the project was deemed highly successful; it cured 95% of new cases compared to the 52% success rate before the program had been implemented. Moreover, the program was deemed one of the most cost effective global health interventions ever used, costing only $100 for every cured patient. Approximately one life-year was saved for every $15-$20, with a rate of return of $60 for every dollar spent.

By 2005, DOTS had been implemented for over a decade, and the developed world had spent much of the latter half of it patting itself on the back for saving those 8 million people in the first ten years. While it was a substantial achievement, it is important to remember that over 1.4 million people in China still contract active TB every year. In 2005, my cousin became a statistic.

Courtesy Centers for Disease Control and Prevention Public Health Image Library

The obvious conclusion is that there is still more to be done. China is treating an illness with borrowed money. As altruistic as that may be of the developed world, there is still the untouched subject of how money factors into this problem at, not a global health or even national health level, but at the personal level.

Being told at the age of 15 that my cousin, the one who had always been a more obedient and quieter child than I, had died because he had denied his illness was something I could not understand. Growing up in North America, I had no way of understanding, at the personal level, what it meant to be sick in a family that was just starting to find financial stability. Treating TB using programs like DOTS may be beneficial when inspecting the raw data, but in some ways, it treats only the symptoms of a much larger illness. There are fundamental differences between health care in the West, and that in other places around the world. And, although it may be simpler to provide the financial backing to rescue a less fortunate country from one disease or another, it will not change the fact that the root of all the problems lies more often in their health care systems – institutions that cannot be revived through individual campaigns against specific diseases.

The heart of a country’s infrastructure can be found in its health care system as the overall health of a country depends on the health of its individual citizens. If the heart itself is failing, there is little long term wisdom in tending to the cough and other less menacing symptoms. If China’s health care system is insufficient to tend to the millions of people who don’t count themselves to be of the higher income class, treating the individual diseases plaguing the country may be only a temporary fix. Until this is recognized, we are only drowning out the beating of an overworked heart.

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