TODAY, SUNDAY 24 MARCH , is World Tuberculosis Day. In Australia, tuberculosis (TB) has largely been eradicated and is at a negligible incidence of six cases for every 100,000 of population.
So, apart from humanitarian considerations for countries less fortunate, why should TB concern Australia?
It’s said that one can walk from Australia to Papua New Guinea at low tide, and PNG has a staggeringly high incidence of 346 TB cases per 100,000, with numbers rising. (There has been a 42% increase in the last decade.)
Furthermore, 33% of new and retreatment cases in PNG are of the heinous drug-resistant variety.
So will PNGs problem become Australia’s? Evidence suggests that it will.
Earlier this month, PNG national, Catherina Abraham died of TB in a Cairns hospital.
Hailing from Daru, she was in Australia on a tourist visa when admitted to hospital 10 months ago. Her intentions for making the trip were clear – she knew she was sick. Her friend had died of the disease. An Australian hospital was her last hope.
Catherina’s TB was the mutant strain of the disease known as Extremely-Drug-Resistant Tuberculosis (XDRTB). Being resistant to so many of the treatment drugs, it transcends and surpasses the category known as Multi Drug Resistant TB (MDRTB) and elevates the prognosis to near incurable.
Catherina had completed 10 months of a two-year treatment program that would cost the Australian taxpayer between $500,000 and $1 million. Catherina’s doctor, Steven Vincent, said her death was “not unexpected”. I’d like to think Catherina’s death would have been peaceful – but I know better.
Treating such a robust strain of this disease takes a cocktail of drugs that are potent and highly toxic – the side effects are severe. At the World Conference on Lung Health in Kuala Lumpur late last year, one presenter remarked that treatment for drug-resistant TB made chemotherapy for cancer seem like “a walk in the park.”
It is defaulting on treatment (not finishing it) that is responsible for the emergence XDRTB and MDRTB: they are man made diseases. In this, PNG is culpable – apathetic management of the disease has been rife.
The directly observed therapy, short course program (DOTS), that combats defaulting by ensuring that sufferers are observed taking their medication, only operates in 9 of 27 provinces.
In Goilala in the Central Province, where TB is rife, all but one of the 15 aid posts in the district has closed. Many closed when TB sufferers were in the middle of treatment, creating unwilling and unwitting defaulters. Clinics in PNG often run out of drugs – creating defaulters.
And TB is not confined to any particular part of PNG even though the Western Province is getting the bulk of Australian publicity and funding.
Late last year, there was a confirmed case of XDRTB and six cases of MDRTB in Madang, for instance.
But it is TB in Daru that’s making Australia most nervous because of it proximity.
The decision to close clinics on the (Australian) Torres Strait Islands of Saibai and Boigu was in an effort to contain the epidemic within the boundaries of PNG and to prevent PNGeans from Daru and other parts of Western Province breaching the border and crossing to the Islands for treatment in Australian medical facilities.
And although AUSAID has subsequently contributed $31 million to the TB program in Daru, Australian Federal MP Warren Entsch, whose electorate includes the Torres Strait islands, has observed that these aid programs are “riddled with corruption.”
Indeed. In PNG almost everything involving substantial amounts of money is riddled with corruption.
That’s why, even though Catherina Abraham was from Daru, she did not rate her chances there and chose to enter Australia, hoping that she wouldn’t be turned away. She wasn’t.
Catherina did not arrive in Australia by boat across the Torres Strait – she took an aircraft.
How many other people did she infect on the plane to Australia and where are they now? TB is a highly contagious, airborne disease and spreads easily in such confined spaces. This is how epidemics start.
The next worse strain of TB is Totally Drug Resistant TB (TDRTB), the way PNG is going about managing its TB epidemic, it’s only a matter of time. Then God help us all because when PNG sneezes, Australia catches a cold.
Dr Susan Merrell was an invited fellow of the National Press Foundation of Washington, to the World Conference on Lung Health convened by the International Union Against Tuberculosis and Lung Disease in Kuala Lumpur last November