Commentary Contributor: Dr Henry Welch
On 24 March 2015 we observed World TB Day with this year’s theme being “Reach, Treat, Cure Everyone”. Amazingly, we still live in a time where there are an estimated 9 million new TB cases annually, and nearly 3 million cases potentially go undiagnosed, untreated or unreported. Like many developing nations, Tuberculosis (TB) continues to plague Papua New Guinea (PNG), impacting the lives of children, adolescents, young adults, and the elderly. Looking at the burden of disease in PNG including the sheer number of cases, the strain on the health infrastructure particularly human resources, the emerging drug resistance, coupled with the cost and challenge to diagnose and to treat – I am concerned for the future of the people and the economic impact and success of PNG’s rapidly growing economy. I also see a way forward.
Shortly after joining Baylor International Paediatric AIDS Initiative (BIAPAI) I moved to PNG in 2013 to work as a paediatrician with the University of Papua New Guinea School of Medicine and Health Sciences (UPNG-SMHS). This unique public-private partnership (PPP) between the PNG National Department of Health (NDoH), UPNG, and Baylor College of Medicine-Texas Children’s Hospital is sponsored by ExxonMobil, and aims to impact the health infrastructure at the base level – by supporting the sole institution tasked with training the future doctors for the country. For me every day has been an amazing learning experience navigated by some of the most generous and capable people in the world. When I first started my work in the hospitals and clinics the prevalence of TB and its effect on young people and their family was profound. Clinicians, nurses, and ancillary staff work tirelessly to provide the best treatment possible in the face of overwhelming odds. It is abnormal if a day goes by where we don’t admit a child to the TB ward. There are days we’ve admitted up to 7 children, many with devastating and life-long complications of TB, such as meningitis, an infection of the brain which can cause permanent brain damage.
According to the World Health Organization (WHO), PNG is ranked second in the Western Pacific Region after Cambodia in terms of estimated TB prevalence, incidence, and mortality. Rates of Multi Drug Resistant (MDR) TB are increasing, and there is the emergence of extensive drug resistance (XDR) in the country. In PNG, nearly 12% of children with TB die. The reasons are many and complex, including malnutrition, poverty, and the difficulty of providing services to the rural areas of the country.
Just last week a 12 year old boy was admitted to the hospital with TB, after having symptoms for more than 3 months. The pediatric doctors in training wasted no time promptly identifying, diagnosing, and implementing appropriate treatment. Reviewing him today we were happy to see he is getting better and taking his medicines. Before moving onto the next patient we noticed a new caregiver sitting in his bed, it was his 21 year old sister. When she looked at us, you could see massively enlarged neck glands, and when we probed further, she too was having symptoms of TB for the last 2 months. When asked why they didn’t come sooner, she explained they live far away in the village. She has a job selling vegetables in the local market and it is difficult for her to leave her family, let alone afford the bus fare. Additionally, she said she had to leave her newborn behind under the care of her grandmother – who on further questioning also has signs of TB. This is an example how TB affects the entire family, and are the type of stories you encounter every day.
While the task to reach, treat, and cure everyone seems daunting, there is little doubt it will be accomplished. I say this after seeing the leadership and initiatives at all levels of government, including the NDoH. The NDoH continues to step up its response against TB, procuring medicines and diagnostic equipment, providing technical advice, and partnering with various stakeholders throughout the country. The challenges remain, but the commitment and capability all the way from the local healthcare workers to senior levels of government will win out in the end.
The U.S. Health Team is one of the stakeholders working closely with the NDoH, The Global Fund, and other partners to encourage a stronger response to this issue. We will continue to call for a global effort to find, treat and cure all people with TB and accelerate progress towards the goal of ending TB by 2035. Thank you for allowing me to contribute.
About the author
Dr. Henry Welch is a Clinical Associate in Paediatrics with the Baylor College of Medicine in Houston, Texas, USA. Dr. Welch works in Papua New Guinea as a Consultant in Paediatrics & Internal Medicine. He is seconded as faculty to the Division of Paediatrics at the University of PNG School of Medicine & Health Sciences (UPNG-SMHS), and at the Port Moresby General Hospital. As faculty at UPNG-SMHS, he assists training medical students and post-graduate trainees in Paediatrics. Clinically he serves as the Senior Medical Officer for the Paediatric Tuberculosis ward, and is active in the management of severe malnutrition. Dr. Welch holds degrees from the University of Wisconsin-La Crosse (BS) and received his Medical Doctorate in Israel at the Ben-Gurion/Columbia University Medical School for International Health. He completed his internship and combined residency training in Internal Medicine-Paediatrics at the Tulane University School of Medicine in New Orleans, Louisiana, USA, where he also served as Chief Resident.