Unite to End TB and Lift Humanity
"She saved my life." So much tenderness.
"He saved my life." So much care.
"They saved my life."
I heard it so many times when I traveled to Moldova for the Stop TB Partnership to document efforts to end tuberculosis. It was so clear. Ending TB is not just about access to drugs. It's about human care and connection.
TB is an awful disease. It usually attacks the lungs, but can multiply throughout the body. It causes coughing, fever, chills, loss of appetite and the eventual 'wasting' that can lead to death. Mycobacterium tuberculosis is airborne, which means it can spread fairly easily. It exists just about everywhere in the world. About one third of us carry M. tuberculosis, but the vast majority of us will never develop active disease. TB is complicated, but generally, if your immune system is strong, your body will fight the bacteria and it will remain latent. You won't get sick. It's important to know that if you aren't sick, you can't spread TB.
But about 10 million people develop TB disease every year. In 2015, an estimated 1.4 million died of TB. In the last ten years, deaths from HIV and malaria have each fallen by about half due to better prevention and treatment. By contrast, deaths from TB have dropped by less than a quarter in the same period and progress has stalled. TB now causes the most infectious disease deaths in the world.
The people who develop TB disease tend to be the most vulnerable and marginalized. People who live in cramped quarters - like prisoners. People who have weak immune systems including those who are living with HIV. People who are homeless.
I meet Katerina on my first day in Moldova. She's in bed reading a book. She's 60 years old, and she has nowhere to live. She used to have her own apartment but someone swindled it from her. I'm told this is common in Moldova.
So she sleeps many nights here in this abandoned construction site in Chisinau. It's pretty bleak. There is no water, no toilet, and there's garbage everywhere.
Katerina had TB disease last year. This doctor, Valeriu Coada, helped her to get treated. He works with an NGO called Act for Involvement, and he travels every day to meet with people at risk of TB - to help get them screened and treated. Valeriu was a military man. He has a gruff tenderness and a rapport with everyone at this site. He cares.
Katerina's life is still pretty hard, but she's TB-free. That gives her a chance to get stronger. I hope she finds a place to live.
Outside of Chisinau, in a village called Mereni, Pavel was having a really hard time. He had multi-drug resistant TB which takes much longer to treat. His parents had died. He had nowhere to live. He felt lonely. He started TB treatment, but then stopped it. TB treatment takes many months. The drugs can be hard on the body and cause stomach pains. Like with many antibiotics, it's common for people to stop treatment once they start feeling better.
The rural town of Mereni isn't large - but it alone counted more than 140 people who had TB. A few years ago, the town council decided that people with TB couldn't be simply treated as "patients." They had to reach out and care for their often-complex needs. With support from Act for Involvement they formed a health committee including the mayor, town doctor, social workers and nurses. People with TB could be screened and treated, while receiving more support for housing, clothing, food and heating.
The deputy-mayor, Rushka, remembers Pavel as difficult. "When we tried to approach him, he would run away," she says. So she took a new approach and called him into her office to talk to him "like our brother." She told him about the services that were his right. The council provides him some pocket money, food and necessities like wood for fuel. He goes each day to the local clinic, where the nurse observes and supports him to take his medication.
As Pavel grew stronger, he could start to work in the fields surrounding Mereni to supplement his income. More importantly, he says the council members like Rushka "made me feel worthwhile."
"Their support has been almost spiritual for me. They've helped me to gain trust in myself."
"Now I'm having a healthy life. A beautiful life. For a man, health is everything."
Pavel says he feels a lot better. "I have my own place. I don't have to worry so much. I have help and support. I have more people in my life."
In another village nearby we meet Vera and Nicola. Vera invited us in and offered us something to eat and drink - typical Moldovan hospitality.
I spent maybe 45 minutes with this couple and obviously, I don't know them. But they seemed so unified, so happy with one another. They've been together for almost 30 years. When Nicola was sick with TB, Vera supported him unconditionally.
Like many Moldovans, Nicola went abroad to Russia to work in construction. While in St. Petersburg he lived in cold, cramped quarters with his workmates.
When he returned home in 2015, Nicola had a severe cough, and Vera suggested he see the doctor. A check-up found TB. Nicola started treatment right away, and adhered to an 8-month course of daily tablets. Vera supported him to continue treatment - and she and their six children remained healthy. "The hospital was very supportive too," says Vera. "They gave us Christmas gifts for the kids."
Now, Nicola has a clean bill of health. "Ending TB means I don't infect other people," says Nicola. "It's normal that I supported him to get well," says Vera. "We should stop TB."
The Act for Involvement staff accompanied me to visit many people. Their own commitment to support people to not only treat TB, but provide a shoulder, compassion and human connections was so clear. Mischa, a social worker said that for him ending TB meant saving a lot of lives. "Ending TB will increase the wellbeing of families. It's a fight for the health and lives of Moldovans," he says. "A lot of people have lost hope in Moldova. Ending TB would show what Moldova can do."
Olga and Ina of Act for Involvement share Mischa's views. Ina says a Moldova free of TB will be healthier for the next generation. "It will also free up resources we are using now to fight TB, and use them to strengthen our health and social systems."
Olga wants to see the day when there is no TB. "There is still a lot of work to do for many people who live in difficult situations," she says. "Ending TB takes someone close to support you. Someone who loves you. Having someone with you all the way."
These are just three stories from Moldova. From my travels in both Moldova and the Ukraine, I could show you many more.
March 24 is World TB Day. The theme is "Unite to End TB." There is a tonne of work to do to improve diagnostics, drug regimens, and ensure access to the tools that currently exist. This will take more money at a time and TB funding has been declining. But it's a great investment. TB treatment is not expensive. Every US$ 1 invested brings a US$ 85 return.
So bring on the money. Bring on the innovation. And please, bring on more people like those I met in Moldova.
Uniting to End TB means uniting with one another.
Uniting to End TB is uniting for our humanity.
With thanks to the Stop TB Partnership, the PAS Centre, Act for Involvement and Speranta Terrei in Moldova.