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Issue No. 29                       September 2-8,  2001                    Quezon City, Philippines







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DEMOCRATIC SPACE
Tuberculosis: An Index of the Country's Poverty

The following is a case documentation of the Network Opposed to Privatization (NO TO PRIVATIZATION)

The Department of Health tags August as LUNG MONTH.  August is the birth month of then Pres. Manuel L. Quezon who died of tuberculosis more than 58 years ago when it had no known treatment.   Half a century after the discovery of effective anti-TB drugs, tuberculosis continues to wreak havoc on the health of the Filipino people.

F.S,,  23, male, single, came alone all the way from Davao six years ago to try his luck in Manila. He ended up being a kargador ng banyera ng isda and living at the Trabaho Market in Sampaloc where he earned  P150 ($2.94) a day. Such a circumstance took its toll on his health.

In May of this year, he had blood-stained sputum and sought help at the Quezon Institute (QI).  He was diagnosed to have pulmonary TB and deformity of lumbar spine (kyphosis).  He was enrolled with the hospital’s DOTS  (Directly Observed Treatment Session) program that required him to go to this hospital for his daily medications.

Despite being sick, he still had to work each day to earn his daily bread. His condition barely improved. And by July 1, he was rushed to the emergency room of the QI.  In addition to PTB, he now had pneumonia

He had to be confined at the hospital. With no relatives in Metro Manila, he had no watcher.  He had no extra clothing while confined. Sometimes, watchers of other patients took pity on him and brought him food and clothing.  They also watched over him. With no work for the day, he had no income and could not buy the anti-TB and other antibiotics needed daily which cost about P50 ($0.98) daily.  He also could not pay for the hospital bill of P2,890 ($56.74) for his X-ray and laboratory exams.  After seven days of confinement, he died. 

Another TB case is that of R.S, 48, male, married who buys and sells junk materials.  His job provides him a very irregular source of monthly income which is equivalent to that of a worker earning minimum wage.  His wife works as a domestic helper in Saudi Arabia earning about P7,000 ($137.43) a month which she sends home monthly to tide over their remaining two children still studying in high school.  Their other two children are already married but often would run to them for financial assistance.

In 1998, R.S. had difficulty of breathing and was constantly coughing.  He went for consultation at the out-patient department of the Quezon Institute and was diagnosed to have pulmonary TB and was enrolled at the DOTS  program.  He improved a little. By July 1,2001, he had to be rushed to the emergency room of QI because he was already vomiting fresh blood. Aside from his anti TB medicines, he needed anti-hemorrhagic injections, monitoring of his blood levels via his blood exams.  He was advised to undergo a CT scan.  The doctors told him to prepare P100,000-P200,000 ($1,963.29-$3,926.57) for lung operation.

His family sought help from the hospital social service. Because he had a wife working abroad, he was classified as capable of paying and given only a 20 percent discount.  R.S. and his family did not know where to get the money needed for the operation.  He went home against medical advise..“I’d rather die at home than have my family be buried in debt,” he said.

C.V., 60, male, married is another diagnosed pulmonary TB case since 1994. He is a  pahinante at a trucking firm. He sought the local health center for free  anti-TB medication, but many times medicines were not available.  He could buy medicines only when the family had money.

His inability to take the required daily anti-TB medication did not improve his condition. He was twice confined at the San Lazaro Hospital for long periods. On his third confinement last July,2001,  Mang Crispin died after five days.

Of the three cases above, two are now additional statistics to the ever increasing number of TB deaths in the Philippines. There are a hundred more cases dying daily.  Tuberculosis kills 132 Filipinos daily, while some 100,000 Filipinos contract the disease every year. The Department of Health confirmed that TB is on the rise.

Like FS, RS and CV, the majority of TB patients are poor whose income is not sufficient to provide for their families basic needs.  Seventy percent of those afflicted with the disease are breadwinners. The majority of TB cases among adults are not adequately treated, thus the disease is easily passed on the their children which may explain why according to the World Health Organization, 39 percent of Filipino children are afflicted with TB.

Tuberculosis is a disease that can be treated for about P6,914 ($135.74), excluding doctor’s consultation fees.  One would need a chest x-ray to confirm diagnosis which costs  P100 at some government hospitals.  Most of the time, drugs are not available through the DOH DOTS program.  The patient is forced to buy the multiple drug therapy for the required six months which costs  P6,714 or $131.82 (Mercury Drug price). Another x-ray is needed at the end of the treatment. 

The average daily expense for the 6-month treatment is P38.41 ($0.75).  Most poor families can not shoulder this additional expense for the sick member of their family while still attending to their usual daily family needs.  In usual cases, the TB-breadwinner patient is also unable to work.  According to a study conducted by the Institute for Occupational Health Safety and Development last January 2000, 80 percent of patients are dismissed from their job upon diagnosis.

Tuberculosis remains to be a sensitive index of the nation’s poverty.  The Philippines is still a world class record-holder for tuberculosis.  It has the highest incidence rate in the Western Pacific Region and the 4th highest in the world. This disease still continues to be in the TOP 5 of the country’s leading causes of morbidity despite the advances of modern technology.


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