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Government wants law ammended to force compliance

By Giff Johnson MAJURO, Marshall Islands (Marianas Variety, Feb. 1, 2010) – In the wake of an escalating outbreak of drug-resistant tuberculosis in the Marshall Islands, the government’s Minister of Health is asking the parliament to amend a law to allow the director of health to have the power to quarantine people who do not voluntarily comply with TB prevention requirements.

Introducing the legislation, Health Minister Amenta Matthew said the current system requiring public health officials to take a person to court requires a lengthy and difficult process that does not adequately prevent spread of contagious diseases.

The Marshall Islands has confirmed 10 drug-resistant TB cases, and overall has the highest rate of TB in the Pacific at over 190 per 100,000 population. The rate in the United States is four per 100,000.

Drug resistant TB has developed as a "result of non-compliance to medications due largely to patients’ refusal to take their medicines regardless of efforts by the Public Health physicians to conduct home visits and counseling," she said. "Currently, there are patients who continuously move around the community with TB disease posing the threat of exposing others to the disease."

It costs $170,000 per patient for medications to treat drug resistant TB, causing a major drain on limited government resources, say health officials.

A hearing in the High Court this week tended to confirm the Minister’s point, as public health officials took a patient to court for failing to take TB treatment and remain in isolation. The judge, lawyers, witnesses and defendant were required to wear facemasks to prevent TB spread, but the court session ended without immediate result allowing the patient to remain in the community.

Under the proposed amendment, the director of public health will be given broad power to quarantine individuals who are deemed to be a threat to the health of others.

Matthew called the court process "lengthy" and said the health of the public would be better served if the director of public health had the authority to bring patients into treatment and isolation as required to prevent health threats to the community.

The amendment would eliminate all language requiring the ministry to go to court, and instead proposes new language giving the director of public health authority to "impose on any person or related property, health care measures which may include testing, treatment, isolation or quarantine to prevent the spread of or exposure to disease that is a threat to the public."

Matthew explained the intent of the bill, which "attempts to address the current multi-drug resistant TB situation in the RMI."

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