Fighting Tuberculosis Amid Philippines War on Drugs.
At the treatment rehabilitation centers on Luzon, the largest and most populous island in the Philippines, residents live under strict rules. “They have this schedule where they have outdoor time, meal time, meditation time,” says MPH student Jillian Rausa. “They all have to keep their toiletries in a certain way. Their beds must be made perfectly every morning.”
Many centers have basketball courts and a place for religious services, but are short on the resources to diagnose and track recovery from tuberculosis—even though a portion of the residents at these government-run addiction rehab facilities are there not for addiction, but for tuberculosis.
“These facilities just happen to have their own clinics and staff, so the government of the Philippines decided to couple them with the TB program,” says Rausa, who visited three of Luzon’s six treatment rehabilitation centers as part of a research team from the College of Public Health at the University of the Philippines Manila.
In a country intensely focused on addiction and an escalating war on drugs, Rausa says tuberculosis is far from the minds of most, especially because rates of the disease are not increasing relative to the population. Still, Rausa says, TB is far from being eliminated.
The researchers are part of an effort funded by the World Health Organization (WHO) to evaluate tuberculosis care at rehabilitation centers in the Philippines. The project compares that care to the guidelines and standards of the WHO’s TB DOTS (Tuberculosis Directly Observed Treatment, Short Course), which the country recently adopted in its National TB Program.
For two months, Rausa traveled with the researchers to the treatment rehabilitation centers to interview staff and gather tuberculosis treatment data from 2013 through 2016, identifying the barriers to implementing the new guidelines. “We gauged how much more help these clinics need, to guide the government in their funding and maybe rethink their allocation of their finances into these clinics,” Rausa says.
The researchers found the WHO’s TB DOTS program is starting to work in the Philippines, with more patients being diagnosed and getting care. On the other hand, they noted care has to compete with addiction treatment for resources at these rehabilitation centers—often coming out on the bottom.
“It was very interesting to see what is allocated to drug addiction compared to what is actually allocated to TB treatment,” Rausa says, “because some of these centers are missing even the bare minimum of what is needed for diagnosing its residents.” Lack of access to appropriate testing means some residents are even misdiagnosed, Rausa says, finding themselves living in an addiction/tuberculosis rehabilitation center even though they no longer have TB.
“As frustrating as some of this research has been, I am very much fired up,” Rausa says. The child of Filipino emigrants, Rausa wanted to “give back” to the Philippines while gaining real-world experience from the practicum. Despite the issues the researchers identified, Rausa says seeing the benefits of the TB DOTS program is validating for someone preparing to enter the field of public health. “It’s exciting to be part of something that proves that the work you’re doing is worth it, and that there’s so much work left to do. I’m grateful for that.”
Jillian Rausa is taking over the SPH Instagram account from August 21 through 24 to share photos from the Philippines. Follow along at Instagram.com/BUSPH/.