Tuberculosis: When Having the Cure Isn’t Enough

Tuberculosis is an ancient disease that's been with us for at least 10,000 years. We've found TB in Egyptian mummies, in ancient China and India, and in other animals like elephants, cattle, and parrots.

The disease is almost 100% curable with medicines that are half a century old, and it's highly preventable. Yet worldwide, TB still kills more people than any other infectious disease — including AIDS and malaria. Each year, we treat five million people, but we miss three million more who continue passing the disease to others.

Dr. Scott Kellerman is a pediatrician and public health expert from Northern California. Twenty years ago, he started a hospital in Bwindi, in Western Uganda, where TB is very common. In his effort to control the disease, he met with the AbuFumu — the traditional healers.

“The traditional healers said, you know, ‘You as a guy from America, you'll never be able to treat TB because you don't understand poverty, like, what can you tell me about poverty? And they said, We cannot tell you. We will show you.’”

They took Dr. Kellerman and his team out to the villages.

“They were sometimes hours walk away, people digging in the field. Had no resources, and they showed me a couple of TB patients. And they said, ‘How can these people get to the hospital? They leave their fields, their family doesn't get fed, they don't eat for the day, and you give them free medicines, you're really missing the point.’”

Their point is that people focus on their immediate needs — food and housing. The connection between a bacteria today and serious illness months or years from now can seem abstract.

In rural Uganda, people were often sick for months before getting diagnosed. By then, they'd become too weak to work, and their families would begin an economic downward spiral. Meanwhile, the sick person was also infecting others — children, neighbors, coworkers.

The first step is a quick diagnosis through symptom screening and contact tracing. In Western Uganda, everyone with a cough gets tested. People who test positive must take medicine every single day, usually for months. This requires what we call “directly observed therapy.”

“We've trained 550 of these AbuFumu traditional healers to be called village health team members,” says Kellerman. “Each one is responsible for 20-25 households — their eyes and ears and feet on the ground. They said if you feed these patients, we will go to their house every day and make sure they take the treatment.”

So, Dr. Kellerman's team provided food like corn and beans. And it worked. The number of people who were diagnosed but never treated used to be 70%. Now it's down to 10%. Not perfect, but it means hundreds of cases are being treated and countless others are being prevented. Much of this success was due to support from the now-defunct USAID. Without continued support, this program has an uncertain future.

– Dr. Michael Wilkes with a Second Opinion