Two Epidemics Collide
Photos and Story: Tristan Bayly
A version of this story was originally posted on the Challenge TB Website.
In the 1940s, antibiotics became available to treat TB and, in combination with social and economic development, allowed many Western countries to reduce the incidence of TB to a very low level. For many other countries across Africa and Asia, though, the “end” of the TB epidemic remains a dream rather than a reality.
For many TB patients, the disease can be attributable to factors such as poverty, malnutrition, HIV infection, and diabetes. Diabetes triples the risk of TB and can worsen its effects, and TB can cause problems with controlling blood sugar levels in people who have diabetes. The number of people with diabetes is increasing, with the most dramatic increase in low- and middle-income countries that are undergoing rapid economic, social, and lifestyle changes. This is leading to an increasing number of patients with diabetes-associated TB, which is threatening the progress made in the global fight against the disease.
Challenge TB is confronting the two epidemics by introducing comprehensive guidelines on the care and treatment of both diseases and by implementing a series of publicity campaigns to highlight the symptoms and problems each one brings.
The city of Sylhet in northeast Bangladesh has a population of around 4 million, an estimated 360,000 of whom have diabetes. In 1997, the Diabetic Association of Bangladesh founded the Sylhet Diabetic Hospital, a nonprofit hospital that provides specialized diabetic care and awareness programs.
On any given day, the hospital is a hive of activity and the waiting rooms are full of people waiting for check-ups, seeking help on monitoring their blood sugar levels, or looking for guidance on managing their diet.
Minara, 55, is one such patient. She came to the hospital with her son Sumon. Minara had been diabetic for 25 years and things were under control under relatively recently, when she developed a cough and fever that kept her awake at night. At the same time, she also started having problems with her blood sugar, which fluctuated up and down unpredictably.
She went to the hospital, and an X-ray revealed she had TB. She is on a six-month course of treatment to fight the disease, and it is working. Her cough and fever are gone, but she is still weak, and her blood sugar is not under control. Like so many patients, she is poor and cannot afford the testing strips she needs to monitor her levels on a daily basis. Getting the right nutritional balance on a low income is also difficult, as inexpensive staples like white rice can raise blood sugar levels. Her levels were ok at this visit, but her doctor provided advice on when and what to eat so she can keep it that way.
Across the country in the 700-bed Diabetic Association of Bangladesh Birdem Hospital in Dhaka, 35-year-old Gopal arrived for a check-up. He was diagnosed with TB three months ago and came to the hospital after getting sick and seeing an advertisement on TV describing his symptoms. He had to stop working for a few months until the treatment took effect and his symptoms went away. He is now back selling fish in the market and can once again support his wife and young child.
There is a lot of stigma surrounding TB. Patients feel shunned and isolated when they are forced to withdraw from their communities and keep their disease a secret.
Gopal hadn’t told the other fish sellers in the market where he works, and he said he probably never will. Now that he is being treated and is no longer infectious, what they don’t know won’t harm them now, he said. Asked if he believed that he would make a full recovery, he said “inshallah [God willing], it’s in his hands now.”
At Birdem hospital alone, Challenge TB support has enabled the screening of more than 2 million diabetes patients for TB and the provision of TB counseling for more than half a million diabetes patients.
About this story:
Challenge TB is a USAID-funded project that aims to prevent the transmission and disease progression of TB, improve patients’ access to TB care services, and strengthen TB platforms. Management Sciences for Health (MSH) is part of the consortium implementing the project and leads the project’s activities in Bangladesh.