Postcard from Bishkek

As well as being the Day of the People’s Revolution, yesterday was also marked in Kyrgyzstan as World Tuberculosis Day.

Ever since 1982, March 24th has been designated as a day dedicated to build public awareness about the global epidemic of tuberculosis, (TB), and efforts to eliminate the disease, although the World Health Organization, (WHO), that are now responsible for coordinating activities to mark the day, only adopted the event in 1996.

March 24th was chosen as it was on this day in 1882 that Dr. Robert Koch astounded the scientific community by announcing that he had discovered the cause of the disease: the TB bacillus.  The discovery opened the way toward diagnosing and curing tuberculosis which at that time was raging through Europe and the Americas, causing the death of one out of every seven people.  Sixty five years earlier, it had responsible for a quarter of the deaths in England.  His discovery was deemed to have been so important by the scientific community that Koch was awarded the Nobel Prize for medicine for it in 1905.  

The situation may be better today, but it is still estimated that TB causes the deaths of approximately 1.7 million people a year – that’s just under 5,000 a day.

The infection rates are, apparently, pretty stable in percentage terms, but due to the increasing population in the world the actual number of cases is rising year on year.  In fact, it is estimated that about one third of the world’s population is infected with new infections occurring at a rate of about one-a-second.  Most of those cases of infection are to be found in developing countries where living conditions are poorer and more conducive to the bacteria which cause the disease and where immunities are often depressed for a number of reasons.  In some Asian and African countries, some 80% of the population test positive to the presence of the TB bacillus in tests as opposed to less than 10% in the United States.

TB is an ancient disease, and evidence of it has been found in human remains over 9000 years old.  In the past it has been known by a number of names, most notably “consumption”, (which relates to the fact that one of the classic symptoms is weight loss).  Other names have included scrufola, wasting disease, white plague, (reflecting the pallor that the patient’s skin often adopts) and Koch’s Disease, (after the good doctor who first identified the bacillus as the cause of the disease).

Amongst the other symptoms of the disease are severe coughing, often accompanied by blood tinged sputum, fever and night sweats.

The TB Bacillus is easily spread by coughs and sneezes in in the spit of an infected person.  It is particularly easily spread amongst people living in crowded and unsanitary conditions.  The presence of the TB bacillus in the body, however, does not necessarily mean the disease will develop and most infections are, in fact, latent with only about 10% of cases progressing to an active stage.  If left untreated, however, the disease will then go on to claim 50% of its victims.

The disease can be treated, although it involves a long and complex course involving a combination of antibiotics.  There is a growing resistance in strains of the bacillus to antibiotics, however, and the approach preferred by the medical profession is one of prevention rather than treatment.  Fortunately, Dr. Koch’s discovery has allowed us to develop tests to detect the bacillus and also vaccines.

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This year, in a press release to mark the day, the International Committee of the Red Cross (ICRC) declared that attempts to stem the spread of tuberculosis across the globe are likely to fall well short of what is needed unless authorities in affected countries significantly increase their efforts to stop the deadly disease from breeding inside prisons.  As a result of overcrowding and poor nutrition, TB rates in many prisons are 10 to 40 times higher than in the general public.  The ICRC has been fighting TB in prisons in various parts of the world, including Central Asia, for more than a decade, either directly or by supporting local programmes.

In recent times I have seen several articles on this topic in both the local media and the internet sites of several international agencies, and it seems that there is a real problem amongst the prison population in Kyrgyzstan.  Amongst the general population, the incidence of TB, (that is the number of actual cases of TB as opposed to the infection rate), stands at about one person in a thousand.  In fact, it has fallen slightly in recent years, although “the epidemiological situation remains tense,” according to the Ministry of Health.

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I always take a keen interest in the stories relating to TB.  I have a personal interest.  My mother had the disease when I was born and was hospitalized almost immediately after her confinement.  My father once told me that she was so seriously ill that they “drew the curtains on her twice”, thinking that she was about to die.  She eventually lost a lung to the disease, however this never seemed to slow her down in later life.

I have also known two other people who have contracted the disease: one was a fellow student when I was at college and the other was a pupil at the school where I was teaching.  On both occasions I had to be screened in case I too had been infected, but, fortunately, the Chest X-rays revealed nothing.

Maybe it is because of this personal interest, but I feel a little saddened that the day is overshadowed in Kyrgyzstan these days, because March 24th has become a holiday commemorating the Tulip Revolution of 2005.  Although I understand why it is important for Kyrgyzstan to mark this anniversary, I can’t help thinking that it might have been better to spend the day thinking about this terrible disease and how it can be defeated.

Tags: Calendar, Expat, Health, Kyrgyzstan, Reminiscences