MELBOURNE, Australia (Radio Australia, Jan. 27) - An old medical problem is on the rise in the Pacific – tuberculosis - and awareness programs are underway in some countries.

Luisa Tora, a young Fijian woman, spent two months in hospital, suffering a bout of tuberculosis, or TB.

"I was in hospital and these friends came in with sort of T-shirts over their faces," she says.

"They weren't sure whether it was cool to come and sit right next to my bed or whether they should sit across the room and talk to me. So which is why since I left I've played the total poster girl and mentioned it as much as possible.

"It's been really good - you see the shock on people's faces. It's a good way of getting awareness out there. But as far as I can see at least in my age group and even in the general population there isn't very much information out there about TB."

Tuberculosis is an infectious disease that's common around the world. But many people are unaware that rates of TB infection are increasing in Pacific island countries.

"Tuberculosis is an old disease and people know tuberculosis," says Janet O'Connor, originally from Kiribati, works as the TB Control Specialist at the Secretariat of the Pacific Community in Noumea.

"They just don't know that it is a problem and that tuberculosis burden has increased, particularly in the Pacific. So I think the awareness of the tuberculosis as a disease is there - its just the burden, and the increasing burden, that is now affecting a larger population of the region that I think a lot of people are trying to get a grasp of.

"People are getting more scared about HIV and dengue because they're acute - dengue being an acute disease and HIV being an incurable disease. I think that scares more people than tuberculosis."


Tuberculosis is an airborne disease, says Ms O'Connor.

"When a person with tuberculosis, who has an infectious tuberculosis, coughs, the germ is released into the air and it forms a droplet Then a person who is exposed inhales that germ is in the droplet and that's how the person gets infected.

"The disease develops when the person who has been exposed has a decreased immunity for some reason - like due to cancer, due to HIV or due to other medications that he's been taking that suppresses his immunity - and that's how a person then can develop this disease."

ou don't have to have a serious illness to catch TB. Young people can be at risk if they don't look after their health, as Luisa Tora from Fiji discovered.

"I'd been losing weight for some time," she says. I was in final year of university sorry, I was in second year, and I was staying up late, partying with everyone else, you know, not getting enough rest. Then I started getting chest infections that I thought were related to my smoking.

"I'd go in and I thought it would be a back ache and because I'm tall and I'm always have back aches and I went to see two or three different doctors and they diagnosed me with totally different things and mostly loaded me up with painkillers.

"But in the end I woke up in the middle of one night and had to wake up my partner and get her to take me up to the hospital. They did an x-ray. I wasn't supposed to see the x-ray but I saw that half of my lung had this huge grey shadow on it. And they didn't tell me at the time either - they just told me to take my x-ray up to the Tamavua hospital - to P.J. Twomey hospital where they treat TB in Fiji.

Immune system "The thing about TB - it's about your immune system. If your immune system is really shattered, you've not been eating well, you've not been sleeping well, that sort of thing, you'd be prone to pick up anything. But if someone walked past who was infected, it would essentially latch onto your lungs and you'd start to regress pretty quickly. You'd lose your appetite more than you already had, and you're slowly breaking down really.

"But most people in the population do get some sort of exposure to TB spores because it's out there. You know, people don't always know sometimes that they have it in them but because they're healthy the spores don't get an opportunity to take a hold in your lungs. So in fact a lot of people would have TB spores in them already, so its a good idea to stay healthy!"

Health officials suggest that if you have a chronic cough that won't go away after more than 3 weeks, even after treatment, it's worth going to see a doctor for a check-up.


Doctors can do a number of medical tests, such as testing your sputum - that's the gunk you cough up - to see if you have the germ that causes TB. A second step may be to check your lungs with an x-ray.

As TB can affect people with weakened immune systems, it's a serious problem for people living with HIV - that's the virus that attacks a person's immune system and leaves them vulnerable to other infections.

Around the world, TB is now one of the leading causes of death amongst people living with HIV. With the AIDS epidemic spreading in the Pacific, monitoring and controlling TB is an crucial role for public health officials.

In 1999, the western Pacific meeting of the World Health Organization - the WHO - declared a "tuberculosis crisis" for the region.

Pacific rates

In 2000, Australia's rate of notified TB cases was 1 per 100,000 people. The same year for PNG, the number was 47 per 100,000. And according to the SPC's Janet O'Connor, these rates are increasing in the Asia-Pacific region.

"We classify tuberculosis into smear-positive, which is infectious and all types of tuberculosis," she says.

"Now when we look at those two categories, Philippines is showing the highest and Kiribati.

"You know, within our own little Pacific region - Kiribati is second highest, then come to Palau, Tuvalu, Marshall Islands, Papua New Guinea and we go down the list.

"The highest being Palau right now, which is over 100, about 110, Kiribati about 86 then we come down to Marshall Islands at about 60 and this is in the smear positive cases. The least is of course Australia and New Zealand and some countries that have not reported TB because they have not had a control program in place.

"So one of the things that we're trying to do here at SPC, in collaboration with WHO, is we're trying to establish a recommended strategy that is called Directly Observed Treatment - Short course, it's known as DOTS strategy. This is a cost effective recommended strategy that is known to control tuberculosis effectively in the world.

"Now in the region - here in the Pacific region - we're trying to establish that strategy and there's only about just over 50 per cent of countries within the region that have established that strategy."

WHO involvement

Together with the WHO, the Secretariat of the Pacific Community is working to support the improvement of national TB programmes in selected island countries.

Dr. Malakai 'Ake, Chief Medical Officer for Public Health in Nuku'alofa, says Tonga has had a steady number of cases in recent years.

"The number of cases here in Tonga has been stable on 20, under twenty you know, twenty and down. Our TB statistics show that the TB population here in Tonga is mainly in the adult population," he says.

Tonga's health ministry uses a variety of ways to get the TB message out to the community.

"We do awareness programs on radio, TV, sometimes in the local paper and sometimes we do health education and awareness programs at the village level," he says.

But public health budgets face a range of priorities, to inform the community about nutrition, malaria or the HIV / AIDS epidemic.

As a former TB patient, Luisa Tora from Fiji feels that health authorities should continue to talk about tuberculosis, to raise community awareness.

"I think that governments should look at it because it's not very difficult," she says. "You sit people down and explain to them this is how you can get it and this is how you don't get it, and that's just basic information going out there.

"It needs to be broken down a whole lot more, because people aren't stupid. If you explain in really simple English or whichever vernacular that you need to be healthy, you need to sleep well and you need to eat your vegetables - and whatever message you come up with it gets across and people are more familiar with it because its a lifestyle thing.

"Like HIV and AIDS still hasn't sort of sunk into people they still don't get it - but they do get malaria and they do get tuberculosis. At the moment I see the Fiji government and they celebrate World TB Day every year and they do this whole spurt of ads but then for the rest of the year you don't see anything else. So there's a definite need to do things.

"What the Fiji Times did when I first came out was ask me to write a story which I did and so there needs to be more of the media initiatives that way as well. It's a holistic kind of thing - I think everyone needs to play a part including those people who've been to hospital and know better and know how to treat it. They should just talk about it and remove all the stigma that surrounds it."


In many countries, people have talked about TB as a disease of poverty, and there's often a stigma talking about it.

SPC's Janet O'Connor agrees that there's been some stigma, but that shouldn't stop people seeking treatment.

"Tuberculosis is still stigmatized in many of these countries and so part of the community education is to reduce that stigma and to try to educate people - that it's a curable disease, it is so infectious that it even affects not just the poor people but everyone who is exposed to the disease in a population.

"It's not an easy thing to do because you know, it is still stigmatized, but we realize that community education is very, very important. One of the things that we try to educate people about is if the person is infectious, once the person is on treatment, the infectiousness decreases within weeks, at least within the first two weeks and so they are safe. So this is one thing that we're trying also to promote in the community and especially to employers, to institutions, so they understand and they feel safe to continue the employment of people with the disease."

Ms O'Connor says community education programs need to be geared to Pacific realities. In countries like Kiribati and the Marshall Islands, people have large families, with many people living at close quarters.

"Culturally, Pacific islanders prefer to live in extended families and it's very common to find a household that has at least 30 - 50 people," she says.

Extended families

"This is three generations in a house, and so this kind of crowdedness in a household is very good for tuberculosis transmission.

"So what we try to advise people in those settings - we can't ask them to live in nuclear families, because that's not culturally acceptable, but to try to decrease the rate of transmission by opening windows, encouraging a lot of ventilation, and sunlight - a lot of sunlight into the house - because the ultraviolet ray in the sunlight kills the tuberculosis bacteria."

Dr Malakai 'Ake of Tonga says that the new DOTS program is working to make TB care much easier.

"With the DOTS program, we tend to hospitalize only the people who are non-ambulant, and we only admit them for a few days. Once they become mobile they are treated at home. In that case, there's very few stigma, the stigma is getting out because people find out that TB is just like any other disease.

"There's no need for them to be isolated and they're treated in their own home. The people - we're only treating them for six months. The nurses or one of our healthy workers goes down on a van every day and gives them the medication at their homes. That really sends a message home to the people that TB is just like any other disease and they should come up, once they get the signs and symptoms, they must come up and get the treatment."

January 27, 2003

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