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Sounding Off on FRONTLINE’s TB Silent Killer

Deadly drug resistance outstrips antiquated treatments worldwide

By Kathleen Bachynski

Published March 24, 2014

This month, the U.S. Centers for Disease Control (CDC) released new figures showing that rates of tuberculosis (TB) in the United States have declined continuously since 1993. While this is encouraging news, unfortunately the global picture is not so rosy. TB ranks as the second leading cause of death in the world from a single infectious disease, second only to HIV/AIDS. There are over eight million new TB infections every year.

Of these new TB cases, about 500,000 each year are resistant to multiple drugs. Known as MDR-TB, these drug-resistant cases are even more difficult to successfully treat. In fact, fewer than 3 percent of the world’s MDR-TB patients receive proper treatment that meets World Health Organization standards.

All these disturbing facts and figures highlight why TB poses such a prominent threat to global public health. Yet TB is often overlooked relative to its profound impact on population health. And here in the United States, where rates of TB are declining and affluent people are rarely afflicted with the disease, it can be easy to dismiss the risks. PBS FRONTLINE’s new documentary, TB Silent Killer, serves as an important and timely reminder that this infectious disease is no relic of the past, but a major 21st century challenge.

Filmmaker Jezza Neumann was inspired to make TB Silent Killer in part because he believes that statistics alone are not enough to convey the true human costs of this devastating disease. Neumann observes, “It’s very easy to dismiss a report. It’s very easy to push it to the side and stick your coffee cup on it. But giving somebody a visual report, a documentary where they have to see real people go through this, is really powerful.”

TB Silent Killer highlights the agonizing decisions patients and their caregivers face as they attempt to manage these side effects while completing the course of treatment.

Neumann chose to film this documentary in Swaziland, a nation at the center of the epidemic with the highest incidence rate of TB in the world. In 2011, the Prime Minister of Swaziland, Sibusiso Dlamini, declared TB a national emergency. Swaziland’s Minister of Health, Benedict Xaba, explained that “The magnitude of the tuberculosis problem in the country has reached such a proportion that it demands extraordinary action to contain it.”

By closely following the stories of several people suffering from TB, this documentary depicts some of the powerful social, emotional, and spiritual effects of this disease on people and communities. Although TB disproportionately affects marginalized populations, such as poor people, homeless people, and injecting drug users, anybody can contract the disease.

One such person is Nokubhega, a 12 year old who developed the disease and whose story is featured in the documentary. She contracted TB while sharing a room with her mother, who tragically died from the disease. In the film, she reflects that “This disease is bad because the way you get is just by people breathing on each other. Then it gets into a person and means they have to leave this earth.”

To prevent her brother from also contracting TB, and in order to receive treatment, Nokubhega must leave home and school and spend months as the only child in a hospital TB ward. This proves to be an incredibly difficult and isolating experience, demanding an extraordinary amount of resilience.

As part of her treatment, Nokubhega must undergo daily injections, without any breaks for holidays. TB treatment with currently available medications can involve taking as many as 20 pills a day. This means that patients may have to take 14,600 pills to complete a full two-year course of treatment.

The side effects can be physically and psychologically overwhelming. Some patients become too weak to work, potentially losing their source of income and becoming increasingly susceptible to depression and other mental health challenges. Patients can also suffer from permanent hearing loss, kidney damage, and psychosis. TB Silent Killer highlights the agonizing decisions patients and their caregivers face as they attempt to manage these side effects while completing the course of treatment.

We are still relying largely on century old diagnostic methods to identify TB and 40-year old drugs to treat the disease.

In Swaziland, TB patients must endure not only a dreadful disease and toxic side effects from treatment, but also terrible social stigma. Indeed, TB Silent Killer informs viewers that most victims keep their diagnosis a secret, to protect themselves against such fear and stigma. Unfortunately, this secrecy also helps enable TB to continue as a pernicious silent killer. In this context, the people featured in this documentary are displaying remarkable courage in allowing their stories to be told.

TB Silent Killer highlights the need for awareness and investment to combat TB. We are still relying largely on century old diagnostic methods to identify TB and 40-year old drugs to treat the disease. It can take over two months to get results using traditional diagnostic tests, which leaves a dangerous gap during which the patient is not receiving the right treatment. Furthermore, global investment in developing new treatment tools has declined.

Although this 21st century disease is evolving new forms of drug resistance, our response to TB is stuck in the 20th century. This poses serious risks. Even in the United States, with its overall declining rates of TB, the disease can quickly re-emerge among vulnerable populations. In 2013, Los Angeles experienced its largest outbreak of TB in a decade, with cases increasing mostly among the homeless.

What’s more, in this era of globalization, TB can spread across continents as quickly as an airplane can. By the end of 2013, cases of extensively drug resistant TB have been reported in 92 countries. As Dr. Neil Schulger, professor of medicine, epidemiology and environmental health science at Columbia Medical School and the Mailman School of Public Health, told Joshua Brooks, “If MDR-TB really takes off around the world, it’s going to far outstrip our ability to treat it.”

Public health workers should take passion and motivation from the people who courageously and honestly shared their struggles with this disease in TB Silent Killer. Tuberculosis is a major threat, but also highly preventable if we choose to invest in fighting it. As filmmaker Jezza Neumann reminds us, Nokubhega and others “have taken a huge risk in opening their lives out to us. And at the end of the day, their survival depends on change.”

Edited by Dana March

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The views and opinions expressed on this website are solely those of the authors and do not represent those of the Department of Epidemiology, the Mailman School of Public Health, or Columbia University.