Sunday, December 2, 2012

Tuberculosis: A disease caused by bacteria that float through the air, infect your body, and eat holes in your lungs so that you can’t breathe and eventually die.  Well, that’s the TB 101 version, but you understand; it’s nasty stuff.

Contrary to popular belief, both Romanian and often American, Tuberculosis (TB) is not solely reserved for the pages of dusty history books or tales of great grand-parents.  It is very much alive and well in much of today’s world.  In Romania, the last reported incidence of TB was 101 cases per 100,000 residents in 2011.  Though this rate has been slowly decreasing, the enormity of the problem is staggering.  For comparison, the U.S. incidence rate in 2011 was 3.9 cases per 100,000 people.  Even Hungary, Romania’s neighbor and other post-communist country has a rate of 18 cases per 100,000 in 2011.  Clearly, something is going wrong. 

TB is a social disease, meaning that one’s social and economic conditions have a strong influence on one’s chances of falling ill and of being cured.  AKA: The poor get sick more and recover less.  Many of the problems are wrapped up in the highly complex and corrupt political and health system.  Medication shortages, ancient diagnostic technology that requires up to 6 weeks for results, and improper treatment methods that breed resistance are common.  But beyond the red tape of bureaucracy, there lies many deep social issues.  Difficult physical and psychological side effects make it impossible to work while undergoing treatment so that many of the poor cannot afford to stay on treatment.  Addictions, lack of family support or childcare while loved ones are far away being treated in isolation, and malnutrition add to the struggle.  Plus, many in Romania, even patients, misunderstand the nature of the disease, how it can be passed on, and what are safe ways of supporting a loved one with TB rather than stigmatizing them.

Poster for Romania's Stop TB Campaign

As a pre-physician assistant student, I was interested in looking deeper into the state of TB in Romania.  This semester I have been blessed with the privilege to develop an honors project under the under supervision of Jonathan Stillo, a PhD student in medical anthropology who has been doing research and advocacy work on TB in Romania for 6 years.  (For more background info on TB or Jon Stillo, see the blog from Nov 17, 2010 titled “Tuberculosis in Romania”).  With his guidance, I have spent this semester reading WHO reports, sociological studies, and other reports covering the status of TB in Romania.  At the end of October, I was given the chance to travel to Bucharest (the capital) for a weekend to conduct interviews with doctors, patients, nurses, and the psychologist at Marius Nasta, one of the Romanian centers of excellence for TB treatment.  It was an incredible opportunity and, as I told Jon afterward, simply having the ability to go and speak to those who are living out the realities and frustrations of TB gave me a much deeper and more personal look into the system than I could ever gain reading a global health report.    

However, to do research for research’s sake, especially in the case of a national health crisis seems frivolous.   So, the latter part of this semester has been spent working on developing a project proposal that will aim to tackle things which are holding TB patients back from a full recovery.  The idea is to present the proposal to Romanian donors who express interest in wanting to give toward the TB cause. 

As much of our time here is focused on creating social change, especially through the model of IMPACT youth clubs, I wondered if there would be a way to apply the IMPACT model to TB.  Dana (founder of IMPACT) and Jon had mentioned wanting to develop a partnership for several years, but neither had the time to create a project.  However, I have a foot in both camps and so put on my thinking cap to come up with a way to bring together all my worlds that are fighting for the good of Romania. 

I am currently writing a proposal for a nation-wide IMPACT project that begins as a month of meetings where youth clubs around the country learn about the basics of TB and are then be given the chance to design and implement a service project that addresses one TB-related problem of their choosing. Projects might include TB education in local schools, advocacy campaigns, and social supports for patients and their families.  As a celebration at the end of all the projects, there will be a nation-wide IMPACT party/ TB conference, highlighting some of the top projects as well as bringing IMPACT students and partners from the STOP TB Partnership together from all across the country to engage in TB advocacy and education.

The hope is to, through a critical mass of people all over Romania, spread the word about TB and spark a desire in kids to take action and demand change.  Romanians standing up for other Romanians is at the heart of IMPACT, and the potential to bring about positive changes in the lives of TB patients brings me much joy.  I look forward with anticipation to see where this project will lead in the future.

Check out Romania’s Country Profile for TB by the World Health Organization here:

Read up on Jon Stillo’s new project for tracking medication shortages across Romania!  It just won a contest for funding through Restart Romania! :

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