Today is World Tuberculosis Day, a day set aside to beam attention on the disease. In this interview with our Assistant Editor, Chinwe Maduagwu, Dr. Olusola Adeyelu, a Senior Registrar with the Lagos University Teaching Hospital (LUTH) Idi-Araba, disclosed that the disease was silently and quietly killing Nigerians especially in the villages.
TNE: Let‘s start by understanding what Tuberculosis is. What is Tuberculosis?
Tuberculosis or TB is an infectious disease like malaria. However, the difference is that one (TB) is easily contagious, from one person to another. It affects people within a closed environment. It is a disease of a poorly organised society in the sense that it flourishes in environment of over crowding, poor nutrition or malnutrition.
It flourishes in environments where people who have it can easily transmit it through coughing and spread it to another person who does not have it because they are close and have substantial contact of approximately 8 hours a day. An example is a driver and his boss who are in an Air-conditioned car. If the driver has TB and is coughing, his boss will easily contract it and vice versa.
TB is commoner in barracks, prisons and in the third world. It is the 6th killer disease in the world. It used to be among the top three. Also 2/3 of people that have HIV will equally have tuberculosis and this is because they have very little or no immunity. TB works by affecting the same immunity that HIV has affected. They have a good partnership to evade and destroy. Significantly, anybody with HIV/AIDS comes down with tuberculosis.
TNE: Apart from the categories of people you have mentioned, who else can be at risk of developing or contracting Tuberculosis?
Anybody that is exposed to immuno suppression, whether the person is bleaching, taking steroids, a serious alcoholic, diabetic or has kidney problems, is disposed to developing TB.
TNE: What has bleaching got to do with reduction of immunity?
When you bleach, you are indirectly sending toxic materials to your kidney. The skin is the largest layer in every human being so if you peel it off when you spread toxic substances on body, you are lowering your immunity and the steroids and toxins go to the kidney.
When the kidney packs up all the immunoglobulin that should form resistance to infections will not be there. It’s the same thing that happens when someone ingests steroids.
TNE: What causes TB? How does someone get it before transferring it to others?
The organism that causes tuberculosis, micro bacterium tuberculosis, which is the one known to us, is found in every human. However, not everyone will manifest with TB. It manifests when a person is subjected to a very difficult situation ranging from war, famine, drought, anything that can reduce the immunity.
It may manifest as cough but not all TBs lead to coughing. For instance, if it’s in the testes, lungs, liver, stomach, brain, kidney or eye the person will not cough because it will not be irritating. It is only when it’s in the airway that it leads to coughing.
TB is quite systemic and can be found in any organ of the body as already mentioned. We all have it but not all will manifest unless subjected to very serious situations – not stress that I was sacked from work or I had a hectic day – those are stresses that we must go through.
Also, somebody cannot contract TB just by merely visiting a friend for two hours. For anyone to have it by a mere two hour visit means that individual’s immunity is depressed, maybe from pregnancy because pregnancy is a state of self induced immuno suppression; it’s not that the person is sick. Again the person with the TB must have a highly infections type.
To contract TB one would stay in the company of an infected person for a period of at least 8 hours daily over a period of time like a week or more or like bed partners. I have seen a case where a pastor acquired TB from his interpreter because they were both speaking into the same microphone.
TNE:You said TB can affect any organ and that not all TB would lead to cough. If someone has the non-irritating TB how would they know?
It’s just like any other disease. Because something has happened that is not supposed to happen in the body, it will elicit chemically generated input. When chemicals are generated they will make the person feel unwell. For instance, if it’s in the stomach, the person can develop diarrhoea or constipation. If you don’t go to toilet for four days especially if you are someone who goes regularly and in addition your stomach starts swelling, it will elicit reaction from you that you should go and investigate.
Even if you self medicate the problem still won’t go because you have not received the right treatment. Then you will go to a professional and through investigations the proper diagnosis would be made.
TNE:Earlier, you said that TB is the 6th killer disease in the world. Coming home to Nigeria, how serious a problem is tuberculosis?
It is a problem that is worse than pandemic. Pandemic means it’s a disaster, a mess, a big problem. We and some other parts of the world are said to have the worst form of TB that is the multi-drug resistant type. Others in the category include China, Russia, India. The major issue in the country is that there is no proper record.
However, a research carried out here by one of the doctors , sampling specimen from people sent from referral centres found out about 300 people having multi-drug resistant TB, which means that those people by merely smiling at you, you ‘ll catch something and what you are going to catch will be a very difficult disease. So it’s a very large burden of disease.
In fact, between HIV/AIDS and Tuberculosis we don’t know the one that is taking the lead. We have no data, no way of checking. Nobody can trace anything but a large number of people are dying quietly and silently especially in the rural areas. People die of undiagnosed diseases and they say it’s spiritual attack or that he/she swallowed something etc but it’s just a question of inaccessibility to healthcare facility and poverty.
Nigeria probably ranks 2nd after South Africa in the continent and the problem of South Africa is not TB per se but their HIV prevalence. Again, they also have better data system than Nigeria.
TNE: You’ve said that the problem of TB is worse than pandemic, yet not much is heard about it regarding interventions by government. Why is it so? Could it be that the government is not aware of the seriousness of the problem?
Government is aware of everything. But in Africa, Nigeria especially, government operates in absentia until someone close to a very important personality in government is involved then it wakes up. All the money being spent on HIV, hepatitis, malaria and the others are brought in by the white man.
Unfortunately government is only interested in looting. Again there is no data system and the data can’t be created by you and I. It can only be created by government through a very professionalised health care system. Anyway, the government is not interested.
TNE:The theme for this year’s World TB Day is; “Wanted: Leaders for a TB free world.” Is TB treatable?
TB is curable not just treatable. World Health Organisation says that it can be cured in 6 months but in this part of the world we treat for 9 months. TB is curable like Malaria and many other diseases that are curable. It is 100 percent curable.
TNE: Is there a possibility of reoccurrence?
Yes it can reoccur. It is called reactivation. This occurs when somebody who has had it after treatment is subjected to the same intense stress like war. For instance, with all the crisis going on in some parts of the north, there’s going to be a flourishing of TB but nobody cares. War, displacement, malnutrition, all these can lead to reactivation of TB.
The organism responsible for tuberculosis is very truculent meaning it’s very strong and doesn’t die easily.
Another thing that can bring about reactivation is the fact that many of the drugs we get to use are not necessarily high quality guaranteed drugs.
Again, after treating and prescribing drugs the doctor can’t be the one to monitor if the patient is taking the drugs. There should be a health worker responsible for that. This is known as Community Surveillance Contact Tracking. The doctor has prescribed but who’s to do the tracking? With all these you cannot expect the same outcome as someone in the united States.
TNE: Back to the theme, is it possible to have a TB free world?
Yes it is. After all small pox has been eradicated. Also, before now, they said pneumonia was the destroyer of men. But with modernisation and the development of the right drugs it has been dealt with in the developed world though we still see them in this part of the world. Smallpox was eradicated and it was as virulent as Ebola. TB can be eradicated; it depends on the focus of the government. If the will is there, everything is possible.
TNE: Earlier, you said TB thrives in overcrowding; If a member of the family is infected, how is the treatment carried out?
Is the individual treated at home or taken away to be treated?
Once somebody is diagnosed with TB, that person is isolated for a period of two or three weeks and if they take their drugs regularly within this period, that can’t infect any other person. Having done that, the other members of the family will be screened to know if they have been infected. It is possible to be exposed to a person with TB without being infected?
Where there’s a guaranteed level of isolation, the person can be allowed to be coming from home to take his drugs. But that’s not what to do, rather the person is taken to an isolated place like a hospital or primary health care and he takes his drugs every morning before food. He starts with four drugs and after 2 months it’s reduced to 2drugs for a period of 4-6 months.
Being exposed to Tuberculosis doesn’t mean you’ll manifest it. It’s only 10 percent over a period of 10 years of people that have been exposed who will come down with the disease.
TNE: What is the aim of having a day dedicated to Tuberculosis? What does it hope to achieve?
It’s just a way of creating awareness and getting people to talk about it. It’s a way of enlightening people and when there is enlightenment and people see the burden, they can be on the street protesting against irresponsible government insisting that it should not only make money available but monitor where the money is going.
Tuberculosis doesn’t deserve one day, it deserves a life time because it is a very debilitating disease. But the one day is adequate if properly utilized.