POST
PRODUCTION
SCRIPT
4 Corners
INTERNATIONAL EDITION
2012
Rise of the Superbugs
42 mins 10 secs
©2012
ABC Ultimo Centre
700 Harris Street Ultimo
NSW 2007 Australia
GPO Box 9994
Sydney
NSW 2001 Australia
Phone: 61 2 8333 4383
Fax: 61 2 8333 4859
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Précis/Publicity: Antibiotics are the wonder drugs of modern medicine. They've allowed doctors to save and extend life by killing infection and enabling ground breaking surgery. But imagine a world where antibiotics don't work - that would be a place dominated by superbugs, bacteria that don't respond to antibiotics. Scientists say this would end many modern medical procedures and they claim the threat is greater than we realise.
Four Corners reporter Geoff Thompson looks at the rise of superbugs, visiting the hot spots around the world where the misuse of antibiotics is creating a breeding ground for these bacteria and he tells the horrific stories of those who've contracted infections that can't be controlled. He also reveals that Australian health officials are making decisions that could open the way for a deadly superbug to infect Australians living in the far north of the country.
"...Every time we take an antibiotic we're giving the bug a chance to become a superbug ... the more of us that take antibiotics inappropriately, the greater the chance in the community a superbug will come."
And that's exactly what's happening in India, where antibiotics are not restricted in their use. As a result a new superbug, New Delhi metallo-beta-lactamase or NDM-1, has evolved. Not only is it deadly in its own right, it's also capable of genetically modifying other bacteria to make them superbugs.
Superbugs like this have infected people who've been injured in accidents while travelling overseas. In other cases, apparently healthy people return from abroad only to discover that a simple medical procedure effectively unleashes the bug. In one instance, a healthy middle-aged man went for a prostate biopsy. The procedure was done successfully but one day later he became desperately ill. A superbug, possibly contracted while travelling overseas, had moved from his bowel into his bloodstream making him critically ill.
And Australia is in a region that is particularly vulnerable. The country is also one of the highest users of antibiotics in the developed world, with 22 million scripts a year.
It now faces the grim prospect of a return to the pre-antibiotic era when often the only way to defeat infection was to remove it surgically.
Crowded Asian street GEOFF THOMPSON, REPORTER: The human race has always been at war with bacteria. But the development of antibiotics in the 1930s and ‘40s gave us the upper hand over the bugs that were killing us. 00:13
Suddenly we were superhuman. 00:36
PROFESSOR LINDSAY GRAYSON, AUSTIN HOSPITAL: Prior to that they were used to bacterial meningitis 100 per cent mortality; bad pneumonia, 30 per cent mortality; appendicitis or ruptured bowel, 100 per cent mortality, 00:40
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital unless you had surgery. The only cure really was surgical intervention to cut the infection out. 00:52
Hospital rooms Music 00:57
PROFESSOR DAVID PATERSON, UQ CENTRE FOR CLINICAL RESEARCH: Antibiotics allowed us to do things that no-one could've dreamed of doing historically. They've allowed us to transplant organs, they've allowed us to undergo chemotherapy, they've 01:01
Prof Paterson. Super:Professor David PatersonUQ Centre for Clinical Research allowed us to receive therapy in intensive care units when we're critically ill. 01:11
CU Antibiotics Without antibiotics none of those advances in human medicine would be possible. 01:17
Aerial. City/Traffic Music 01:22
PROFESSOR MATT COOPER, UQ INSTITUTE OF MOLECULAR BIOSCIENCE: We've still got the upper edge. Clearly antibiotics still work, but it's the 01:27
Prof Cooper. Super:Professor Matt CooperUQ Institute of Molecular Biology speed of change that concerns me. Twenty years ago this wasn't an issue. Today it's a real issue. Infectious disease kills more people than cancer. TB kills 5,000 people a day. 01:32
Crowded Indian street So if we don't start to act soon and start to put our pedal on the gas pretty soon, within another 20 years we could be in serious trouble. 01:44
Fast motion. Crowded street GEOFF THOMPSON: We've deployed our antibiotic defences far and wide while the bacteria have kept up their counter-attack. 01:52
Petri dishes with illuminated bacteria They adapted and evolved. 01:59
Antibiotics Now even our last precious antibiotics are surrendering to the rise of the superbugs. 02:03
Beclu interview JOEL BECLU: I was feeling good, no problem, no symptoms, no nothing. I was feeling really great! 02:15
Photos. Joe GEOFF THOMPSON: As his 60th birthday approached Joel Beclu was feeling fit and enjoying semi-retirement. 02:19
His career in Australia as a stage technician was winding down in favour of travel through Europe and spending a year in Bali with his partner Roseann Schoch. 02:28
During a brief return to Australia he thought he'd better get a check-up. 02:39
JOEL BECLU: Getting 60, you think better to have a good check-up, so I did, went to a doctor and 02:45
Beclu interview among the check-up was the prostate check-up, and felt a hard lump there and said 'You better to go to urology'. And I went to urology and they say, 'Oh you better to have a biopsy done'. 02:51
Hospital room GEOFF THOMPSON: It's procedure undertaken by tens of thousands of Australian men every year. 03:01
Animation of the taking of a prostate sample A special device passes a thin needle through the wall of the rectum to take a prostate sample. To prevent infection antibiotics are taken. It's usually over within an hour. 03:08
Dissolve to Photo. Beclu lying on hospital bed JOEL BECLU: The procedure was on Friday morning. By Saturday to Sunday night, two o'clock, that's when I started to shiver. 03:22
Beclu interview And so I thought 'Okay, well I've got the infection, better to go to hospital'. 03:31
Ambulance/Hospital sequence We took the ambulance to the hospital and discovered that the preventative antibiotic didn't work and infection was spreading in my body. 03:34
Photo. Beclu lying on hospital bed GEOFF THOMPSON: The infection spread from Joel's prostate to his shoulder, spine and hip.JOEL BECLU: The first pain was in the collarbone. That was the very first one I noticed. Then the 03:45
Beclu interview lower back pain started to come and the hip - right in the hip joint, ah very, very strong pain. The pain was really horrible. 03:57
Photo. Beclu lying on hospital bed GEOFF THOMPSON: Standard antibiotics had no effect. Joel had a superbug. 04:04
Hospital corridor JOEL BECLU: I think within ten days the pain in my collarbone was so bad that they decided to operate, to do a scraping of the abscess in the collarbone. 04:10
Beclu interview And then I basically lost touch with reality for about a month, because of the painkillers. 04:19
Beclu on weights machine GEOFF THOMPSON: Joel spent three months in a hospital bed on rare antibiotics imported from overseas. His body wasted away. Now he's trying to regain his strength while fighting off the last of the infection.JOEL BECLU: Obviously it has been a progress because 04:24
Beclu interview I'm standing up and I can talk to you and whatever, which I wouldn't have been able to do a mere month ago. A month ago I was in pain and screaming in my bed, so it has been a big progress. 04:42
Beclu undergoing physiotherapy GEOFF THOMPSON: Somewhere in his travels, Joel had consumed a virulent strain of E. coli bacteria. It survived harmlessly inside his gut until it was unleashed by the prostate procedure. 04:51
Joel Beclu and Roseanne Schoch looking at photos of when he was in hospital ROSEANNE SCHOCH: I knew that it was a strain of E. coli they hadn't dealt with before and that they were trying their very best to try and find something that it would respond to and that would have an effect. But 05:06
Beclu and Schoch. Super:Roseann Schoch I wasn't sure at times whether it was going to work, or that his organs would cope with the bacteria and the antibiotics and everything else, and that he would come through it, actually. GEOFF THOMPSON: Did you fear for his life?ROSEANNE SCHOCH: Yes. At times I didn't know that he was going to, to make it or not. 05:22
Asian railway station/Crowded train PROFESSOR LINDSAY GRAYSON: Now we know that people who've returned from overseas in some of these hotspots where resistance is very common and it's in the food supply and it's in the water supply - because of misuse of antibiotics, mostly, in those countries - 05:43
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital that we've had a whole string of men after their prostate biopsy now getting superbugs into their bloodstream cause it's- we've introduced it into their prostate not knowingly and it's then spread into their blood and then they've got incredibly sick. 06:00
Lab/ Plane taking off from a busy airport Music 06:14
GEOFF THOMPSON: With one billion people now travelling the world each year, bacteria are more mobile than ever before. 06:27
Aerial. Busy street crossing And so are superbugs. 06:35
Thompson to camera on street. Super: Geoff Thompson They are born when we abuse antibiotics - and we're doing that across the globe. 06:36
Aerial. Sydney city PROFESSOR MATT COOPER: Every time we take an antibiotic we're giving the bug a chance to become a superbug. So if you think about you in the community, you know, 06:42
Prof Cooper. Super:Professor Matt CooperUQ Institute of Molecular Biology the more of us that take antibiotics inappropriately, the greater the chances in the community a superbug will come. 06:54
Aerial. Sydney city PROFESSOR LINDSAY GRAYSON: Australia I think out in the community is pretty bad. It rates seventh in the world for overuse of antibiotics per capita. 06:58
Australian city railway station Australia's like many of the other developed countries. We saw development and wealth 07:08
Prof Grayson equalling ability to use antibiotics, and we lost the plot in terms of realising well, most sore throats are due to viruses. They're not going to respond to antibiotics but 'I want my antibiotics'. 07:13
City aerial/Bug in Petri dish Music 07:24
Indian city general views GEOFF THOMPSON: It's the Indian subcontinent which is proving to be a superbug's perfect Petri dish. 07:28
Antibiotic abuse is rampant here. 07:37
DR ABDUL GHAFUR: In India, antibiotic overuse is a serious problem. There's no antibiotic policy in the country... 07:43
Dr Ghafur. Super:Dr Abdul Ghafur And but of course there are many countries where there is no antibiotic policy, but I'm concerned about my country and there is no antibiotic policy. 07:50
Indian pharmacy Music 07:56
CU Antibiotics GEOFF THOMPSON: India mass produces antibiotics and sells them cheaply. The drugs are available over the counter without prescription. 08:00
Rubbish dumps near polluted river Waterways and even the soil are contaminated by waste from antibiotic manufacture. On top of poor sanitation and chronic overcrowding, it's fertile ground for antibiotic resistance. 08:08
PROFESSOR DAVID PATERSON: There is a general principle in treatment of infections - the more we use any antibiotic, the quicker the bacteria are going to become resistant to it. So if we have a situation where 08:25
Prof Paterson. Super:Professor David PatersonUQ Centre for Clinical Research antibiotics are used in agriculture, where they're available over the counter, where in hospitals there's very little control over their use, clearly in that environment there's going to be a more rapid spread of resistance. 08:36
Indian hospital operating theatre Music 08:51
GEOFF THOMPSON: When more and more patients in Indian hospitals began dying from untreatable infections, local microbiologists began to ask why. 08:55
Laboratory/Bug in Petri dish Working with international researchers they identified one of the most dangerous superbugs the world has ever seen. They called it New Delhi metallo-beta-lactamase or NDM-1. It's a gene that can turn bacteria once easily destroyed into untreatable killers. 09:05
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital PROFESSOR LINDSAY GRAYSON: The NDM bug is really scary because when you only have to drink one or two of those bugs. And they don't have to multiply in themselves, they just have to spit out the little bits of genetic material that make them superbugs and then they convert all your healthy bacteria into superbugs. So it's a bit like putting a red t-shirt into the washing machine of white shirts. And the t-shirt itself doesn't have to multiply, it just has to leach out this stain and it changes all your white shirts into red shirts and converts them into, you know, a superbug. 09:29
Dr Ghafur into lift GEOFF THOMPSON: India's researchers were shunned at home for bringing the country into disrepute and threatening a multi-billion dollar medical tourism industry. Chennai-based Dr Abdul Ghafur is one of the few Indian doctors prepared to speak out.DR ABDUL GHAFUR: We need wartime measures. 10:03
Dr Ghafur We can't wait and watch. What we need is, we need urgent wartime measures to rationalise the antibiotic in all countries. Governments should take initiative and ask the medical community to use the antibiotics very sensibly. The Government should bring in strict laws to rationalise the antibiotics in countries, there must be strict antibiotic policies on one end. On the other end, governments should talk to pharma industries to stimulate the research on antibiotics. 10:23
India. Train crosses bridge DAVID RICCI: The drugs that they were treating me with seemed worse than the infection because the infection I didn't even know it was there unless they told me. 10:52
Ricci interview But apparently it was so dangerous that they had to go to that extreme levels of treatment. 11:01
India. Trains. Men cross tracks/People walk along tracks GEOFF THOMPSON: David Ricci travelled to India last year to volunteer in the slums of Calcutta. A walk to an orphanage one morning changed his life forever.DAVID RICCI: Me and my group kind of stayed like a single file line and I was in back of it and so we didn't hear the train coming. And it like hooked my right sleeve and kind of thew me in front of the train 11:07
Ricci interview and hit me, ran me over and my leg got caught under the wheel. So I'm directly underneath the train kind of head first. 11:33
Train It pulled me probably about thirty metres or so before it stopped. 11:40
Ricci They had to back the train back over my leg 'cause it was kind of stuck up in the wheels kinda. And they pulled me out and something punctured my lower abdominal region and it was probably about, you know, yea long. And there was a lot, a lot of internal bleeding. And my femoral artery in my thigh started spraying and gushing blood all over me and stuff and I was in shock, obviously, instantly. 11:47
Train platform GEOFF THOMPSON: Miraculously, a passer-by managed to stop the bleeding. David Ricci was bundled into a cycle rickshaw and taken to a local clinic.DAVID RICCI: They started just 12:11
Ricci putting water all over my leg and just kind of washing off all the dirt and the filth. Because when they pulled me out of the train, they set me in the trash because that was kind of the only place not on the tracks that they could put me. And so, you know, I was just covered in filth and this black gunk all over me. And so they were washing all that off and then he took out like a big leather bundle of knives and untied it and pulled out like a big medical knife and just started cutting my leg off. 12:27
Excerpt of report from King 5 Television, showing David in recovery. Super:King 5 Television GEOFF THOMPSON: David was in so much pain those first few days that he didn't want to live. Within a few weeks he was in a hospital back in the United States. Blood tests confirmed he still faced a danger even greater than being hit by a train and losing his leg.DAVID RICCI: A couple of days later they came in, you know, all suited up and they're like 'Uh sorry, 12:55
Ricci we kind of need to quarantine you 'cause you have a lot of dangerous infections that we haven't seen before and we need to figure out how to treat this before we can do anything else'. 13:18
Bacteria in Petri dish GEOFF THOMPSON: David was infected with several types of NDM-1 bacteria.PROFESSOR MATT COOPER: So what's happened with NDM-1 is this particular gene has been able to jump around very, very quickly. 13:26
Prof Cooper. Super:Professor Matt CooperUQ Institute of Molecular Biology It likes to get out and about, if you like. S o it's jumped from one bacteria to another, it's jumped from one country to another very, very quickly. And that's why it's quite a dangerous bug, the NDM-1 gene that's in all these different bacteria. The other key thing, of course, is there's only really one antibiotic left now that can kill this NDM-1. 13:38
Prof Cooper and Thompson don lab coats and protective goggles and enter lab GEOFF THOMPSON: To date, Australia has dealt with fewer than 10 cases of infection by NDM-1 type bacteria. The superbug is kept inside tightly secured laboratories like this one at the University of Queensland. 13:56
Indicating five bacteria cultures in a square Petri dish PROFESSOR MATT COOPER: When you look at one of the superbugs, it's the same type of bacteria but this one has acquired those genes, the NDM-1 gene. What you can see now is these powerful antibiotics that were being used before just aren't working at all. The bacteria is just ignoring them and growing quite happily in the presence of antibiotics. The one in the middle here is the only one we've got left, Colistin, which can kill this particular superbug. 14:13
GEOFF THOMPSON: So will this superbug eventually defeat that antibiotic too? PROFESSOR MATT COOPER: Yes it will. We haven't seen that in Australia yet, but overseas there are some cases where this particular bacterium is resistant to all antibiotics, including this one in the middle.GEOFF THOMPSON: So you're only really buying some time?PROFESSOR MATT COOPER: Yes, we are. 14:35
Colistin bottles Music 14:50
GEOFF THOMPSON: Colistin was the only drug that worked for David Ricci. It was abandoned decades ago because it was too toxic. 14:54
Ricci walking with stick DAVID RICCI: I was only able to be on it for so long before my kidneys and my white blood cell count and everything started dropping and they had to they had to pull me off right before you know most of my organs were unretainable. And so 15:03
Ricci interview at that point they figured that it had worked because they didn't see any signs of infection - there was no fever, no irritation around the site and so they figured that, 'Well I guess the infection's gone'. But they left a track open in my leg which we cleaned out every day and it was just causing extreme pain like, like it was worse than India. It was a ten out a ten pain and I would just scream every single morning. 15:16
Pumpkins/Ricci with mother Music 15:41
CHERYL RICCI, DAVID'S MOTHER: You would just see every day, he would just go down you know downhill and very pale and lethargic. And at times 15:43
Cheryl Ricci. Super:Cheryl RicciDavid’s mother I felt like I was losing him but it was from the antibiotics. And they didn't even know if they were going to work. So it was it was a hard time, really hard time. 15:50
Still photo of David and one of his doctors DAVID RICCI: And you know my doctors were like all right 'He shouldn't still be in this much pain, what's going what's going on in there?' 16:00
Ricci interview So they surgically went in and looked and it was all black and infected. So they're like 'Oh, well it's back'. 16:05
Bacteria in Petri dish Music 16:11
Austin Hospital exterior GEOFF THOMPSON: The tenacity of infections like NDM-1 threaten not only individuals but the very future of modern medicine. 16:15
Examining bacteria under microscope PROFESSOR DAVID PATERSON: I think the worst nightmare for a hospital would be that not only is there an outbreak of these particular infections, but they become entrenched; they're an ongoing problem for decades to come. 16:23
Prof Paterson. Super:Professor David PatersonUQ Centre for Clinical Research That really changes the whole game in terms of ability to deliver high quality medical services, to deliver transplantation or chemotherapy or intensive care medicine. 16:38
Austin Hospital exterior Music 16:49
GEOFF THOMPSON: Melbourne's Austin Hospital faced this challenge last year when it agreed to accept a patient infected with a superbug. 16:54
Photos. Komilionis holidaying in Greece Nick Komilionis picked it up while holidaying in his native Greece. 17:04
NICK KOMILIONIS: I've been in the last five years, three times to Greece. I have beautiful time, beautiful country for holiday, 17:10
Komilionis interview, with Noula nice weather. I enjoy myself 80 days, the last ten days I come sick. 17:18
Photo. Komilionis in hospital GEOFF THOMPSON: Nick ruptured his bowel and required urgent surgery. He was soon overcome by infection.NICK KOMILIONIS: I feel tired. 17:27
Komilionis interview Outside 38, 40 degrees -- hot. I like to be, to put me five, ten blankets. 17:39
Photos. Komilionis in hospital PROFESSOR LINDSAY GRAYSON: In the end he was in hospital in Greece for six months, three different hospitals, multiple operations to save his life and ended up with lots of abscesses inside his abdomen, 17:51
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital but was finally stable enough. I mean, Nick is -- he's a tough nut, you know, and he was well enough to get airlifted back to Australia. We knew that he had these superbugs in his bowel but also in all these abscesses. Essentially, they were untreatable. 18:02
Isolation ward, Austin Hospital GEOFF THOMPSON: At the Austin, Nick was kept in strict isolation.NOULA SETTINELLI, NICK'S DAUGHTER: There was precaution taken and 18:18
Nick and Noula. Super:Noula SettinelliNick’s daughter it was a harsh time for the family. Dad was quite, you know, isolated and was in quarantine for the length of time he did stay at Austin which the family felt --we felt for him. 18:25
Doctor with Petri dishes of bacteria Music 18:37
GEOFF THOMPSON: Doctors struggled to find a combination of antibiotics which could kill Nick's superbug without killing Nick. Just like NDM-1, this superbug was sharing its antibiotic resistant gene with other bacteria.PROFESSOR LINDSAY GRAYSON: Now what's interesting is, this is a strain also from the patient. 18:41
Prof Grayson shows Thompson bacteria in Petri dish And this is a different bug, it's called an E. coli, and previously this was sensitive, and you can see in this case that it's also growing quite well -- just carefully look. You can see it's pink though.GEOFF THOMPSON: And that agar is full of antibiotics as well?PROFESSOR LINDSAY GRAYSON: Full of antibiotics. 19:01
GEOFF THOMPSON: It's become a superbug?PROFESSOR LINDSAY GRAYSON: So what's happened is that this klebsiella strain has transferred its resistance gene to normally sensitive E. coli and turned this into a superbug and this is from the same patient. 19:18
Komilionis into operating theatre GEOFF THOMPSON: In the end the infection could not be stopped. The only cure available was from a time when antibiotics did not exist. Nick's bowel was removed.PROFESSOR LINDSAY GRAYSON: We were still not able to get on top of all his abscesses and so in the end, there was a long discussion with the surgeons to say 'Look, maybe we should go back to the pre-antibiotic way of doing things and just cut it all out'.In the end, we said to him 'Look, 19:32
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital there's a 50 per cent chance you're going to die on the table, on the operating table. If you don't have the surgery you probably- you're dying in pieces'. And, mean my view was he had maybe a three per cent chance of living for another six months. 19:58
Komilionis at home with Prof Grayson And this was this was just for him, let alone all the risk to the greater community, you know. So essentially we had to take a pre-1940s approach to cure him. 20:17
Prof Grayson But that's an example of where we're headed. Unless we do something about this, there'll be more of him for sure. 20:30
Komilionis at home with family around table NICK KOMILIONIS: Now I feel like before, exactly. 20:36
Komilionis interview I can tell you - more better. Now I not for nothing, I do everything. I see the doctor sometime in hospital. I can say 'Thanks, you saved my life'. 20:44
Komilionis family NOULA SETTINELLI: It can happen to anyone. It happened to my dad, it certainly can happen to anyone that travels or that's away from home, and, yeah, it is a scary thing. And if surgery wasn't an option, then we'd have nothing 21:04
Nick and Noula and we wouldn't have my father today. So it's a worry and it's scary, yep. 21:16
Photo. Australian city street at the turn of the 20th century and hospital wards GEOFF THOMPSON: At the beginning of the 20th century, tuberculosis was Australia's biggest killer. Antibiotics helped bring it under control. 21:26
Thompson by sea in PNG to camera Today Australia's rate of this bacterial infection is one of the lowest in the world. Indeed, it's easy for us to believe that TB is a disease of the past. 21:36
But here in Papua New Guinea - right on Australia's doorstep - not only is TB thriving, but superbug TB has already crossed the border. 21:46
Exterior of Cairns Base Hospital Music 21:56
GEOFF THOMPSON: Most Australians wouldn't know it, but superbug TB bacteria are living here at Cairns Base Hospital. 22:01
Cathrina in hospital They're surviving inside the lungs of this young woman from Papua New Guinea.CATHRINA: How I got this TB, 22:10
Cathrina interview like it's an airborne disease and like people you talk with... like, you stand with somebody and talk, like you don't know that the person got sick. 22:21
GEOFF THOMPSON: Cathrina is currently Australia's only known case of Extensively Drug Resistant Tuberculosis or XDR-TB. 22:32
CATHRINA: There's many people for TB and some are dying for TB. 22:41
Cathrina in isolation ward GEOFF THOMPSON: It's her fifth month inside this isolation room which she's very rarely allowed to leave. Negative air pressure keeps the disease contained. 22:46
Nurse enters isolation ward Anyone entering must wear a mask.NURSE (speaking to Cathrina): So these here are the tablets...DR STEPHEN VINCENT, THORACIC SPECIALIST: She's on medication at the moment, pretty stable but unsure as to what the outcome's going to be in the next months and years, as 22:58
Dr Vincent the cure rate is fairly low and there's about a 40 per cent chance of death from this disease despite treatment. 23:12
Cathrina takes tablets GEOFF THOMPSON: Dr Stephen Vincent is a TB specialist based in Cairns.DR STEPHEN VINCENT: We've got a lot of cases of drug-resistant TB in Papua New Guinea and now we've got Extensive Drug-Resistant TB -- 23:19
Dr Vincent which wasn't even around 10 years ago and now it's worldwide. And Australia has a case currently up here in Cairns and also there was a case I think two years ago. And I believe it's about three or four cases of Extensive Drug-Resistant TB in Papua New Guinea at the moment, so if you don't get onto these early and it gets into the population, that's, that's the disaster. 23:29
Aerial. PNG. Plane landing Music 23:51
GEOFF THOMPSON: To understand why Cathrina came to be receiving treatment in an Australian hospital, we went to Papua New Guinea. The rate of TB infection here is about 50 times greater than Australia's. 23:59
Travelling to Daru About 3,000 people die from TB in PNG every year - around one every three hours. 24:14
Scenes of busy streets in Daru We travelled to the island of Daru - the dirt poor capital of PNG's Western Province. 24:23
Thompson walks with guide to visit Cathrina’s father GEOFF THOMPSON: This is the father of the woman in Cairns? GUIDE: Yes.GEOFF THOMPSON: It's here we found Cathrina's father Abraham.ABRAHAM: So I was really upset. So I was really worried about her. She was losing weight fast. 24:30
Abraham interview At my own expense I had to take her to Saibai. It cost me a lot of money and... just because I love my daughter and I want her to get better. So I had to take her to Saibai. 24:43
Map showing the islands of Saibai and Boigu GEOFF THOMPSON: At their closest points, the Australian islands of Saibai and Boigu are only 5 kilometres away from mainland PNG - a ten minute ride in a speedboat. 25:02
Speedboat with passengers Unfettered two-way travel is permitted for locals under the terms of the Torres Strait Treaty.DR STEPHEN VINCENT: People don't realise but there's about 50,000 movements back and forward between Torres Strait Islanders and the PNG nationals due to traditional purposes. 25:13
Dr Vincent. Super:Dr Stephen VincentThoracic specialist So there's no gate there. It's a porous border. 25:29
Boigu Island health centre GEOFF THOMPSON: For the past seven years Australian doctors have staffed TB clinics on the islands. 25:34
Doctor treating PNG patient at island clinic They treated infected people from Papua New Guinea. 25:39
But in June this year the clinics were controversially closed. With help from AusAID, PNG is now trying to manage its TB patients on its own. 25:45
Dr Moke interview DR RENDI MOKE: I would say that we are doing much better now than it was before. 25:55
Daru Hospital GEOFF THOMPSON: Daru Hospital is the main centre for TB treatment in PNG's Western Province. Dr Rendi Moke is the chief physician.DR RENDI MOKE: We are more than confident that we can take on board all the patients that have been handed over to us, and the current patients on the ground. 25:59
Dr Moke interview We have the capacity with very good support from people, our stakeholders, very good support from AusAID, very good support from World Vision. 26:16
Dr Rendi Moke greets patients as he walks down the hospital corridor GEOFF THOMPSON: Built in 1963, Daru Hospital is badly rundown and always busy. Dr Moke leads us through to the outpatients clinic, where suspected TB sufferers are first diagnosed.DR RENDI MOKE: Any patient we suspect may have 26:24
Daru Hospital isolation ward TB and is coughing, we isolate them and give them a mask to prevent transmission to our staff as well as other patients. 26:44
Thompson with Dr Moke in hospital GEOFF THOMPSON: So this is the first line - when people first come to the hospital they come here? DR RENDI MOKE: Yes, this is the point of entry, if you like, to the hospital.GEOFF THOMPSON: So far AusAID has spent about one and half million dollars improving this hospital. 26:52
Inside hospital It's part of an 11 million-dollar aid package over four years aimed at boosting TB services in the Western Province. 27:04
Dr Moke indicates the chest area of an illuminated X-Ray DR RENDI MOKE: So this is typical of a TB chest X-Ray... GEOFF THOMPSON: The money has helped pay for a new X-Ray machine and training to use it. 27:13
Dr Moke shows Thompson diagnostic machine DR RENDI MOKE: This is our GeneXpert machine. It has four slots...GEOFF THOMPSON: Within two hours this new machine can determine resistance to one of the six types of TB antibiotics.But it still takes months before multi or extensive drug resistance can be confirmed by a laboratory in Brisbane.DR RENDI MOKE: Yeah, well it may take more than two months 27:23
before we can know that. But it's a control because these patients that we diagnose here, we take them and we isolate them while we initiate treatment. They are given a face mask and we isolate them in our TB wards so it reduces the chances of transmission and right then they are commenced on drugs. 27:46
TB wards/ Patients wearing masks GEOFF THOMPSON: Dr Moke showed us around Daru Hospital's TB wards.DR RENDI MOKE (to patients): Wear your masks, please. Wear your masks.GEOFF THOMPSON: Here the concept of isolation is a loose one. 28:04
DR RENDI MOKE: We encourage them to wear masks and they are expected to wear masks when they are in the ward to prevent cross-transmission. 28:14
And we also encourage our staff to wear the masks as well. 28:23
Dr Moke wearing mask We discourage guardians from coming here. If they are to come, they are to come with masks.GEOFF THOMPSON: So everyone here's meant to wear- wears a mask? DR RENDI MOKE: Yes, we expect them to wear masks, okay? TB patients. 28:26
Patients By wearing masks it prevents transmission by 50 per cent.GEOFF THOMPSON: Makes a big difference?DR RENDI MOKE: Makes a big difference. 28:40
Bulldozer on new TB ward site GEOFF THOMPSON: Outside, Dr Moke explained the very beginnings of the hospital's brand new TB ward. It's also being paid for by AusAID and is expected to be finished next year.DR RENDI MOKE: It will be 22 bed space ward and it will be 28:46
Dr Moke and Thompson on verandah six isolation for drug resistant TB, including MDR TB and XDR TB, and 16 bed will be general TB, those sensitive TB. 29:08
Unmasked patients in TB ward GEOFF THOMPSON: When Dr Moke left we returned to the TB ward. Most patients were now unmasked and the special isolation room for extensively drug resistant patients was suddenly empty. 29:18
Sister Konga in TB ward SISTER KONGA, NURSE: From the 15th month of her treatment...GEOFF THOMPSON: From the Sister in charge we learned that one woman in this multi-drug resistant ward was actually suspected of having Extensively Drug Resistant TB. 29:34
So which one of these girls is XDR? SISTER KONGA: Antonia.GEOFF THOMPSON: Antonia is XDR?SISTER KONGA: Yes, suspected.GEOFF THOMPSON: And why is she in the MDR ward? 29:46
Super: Sister Konga SISTER KONGA: Because in the isolation room we've got only four beds available in the isolation room... 29:56
Antonia GEOFF THOMPSON: Is that a bad idea for infection?SISTER KONGA: Of course it is because if she's confirmed XDR then she can spread it to the other patients. 30:03
Anton Narua in TB ward GEOFF THOMPSON: Anton Narua is the deputy president of the region's local government. He's just learnt that two of his nieces are here with TB. One of them is Antonia - the girl with suspected XDR-TB.ANTON NARUA: That's why I'm saying they're all going to die. They should separate them but they're all mixed up together. 30:15
Narua interview I know my two girls are going to die. They're definitely going to die. There is something wrong which I can't- I can't- I can't explain. It happened to a lot of people. My two girls are going to die. 30:38
Travelling by boat to Sigabaduru GEOFF THOMPSON: Anton Narua is also concerned about the fate of villagers living far away from Daru, along PNG's southern coast. 30:56
Narua and others in boat He took us to meet the people of Sigabaduru. It takes two hours and the fuel costs $350. 31:06
Arriving at Sigabaduru That's way beyond the means of people used to making quick trips to islands like Saibai, where Australia's TB clinic has shut its doors. 31:15
Thompson with Councillor Salee COUNCILLOR KEBEI SALEE: Over there is Saibai, just only about four nautical miles from here - sea nautical miles.GEOFF THOMPSON: It's very close. And how long does it 31:24
Super: Councillor Kebei Salee take you to get there each day?COUNCILLOR KEBEI SALEE: It takes me only 10 minutes across by 60 horsepower outboard motor. 31:32
Sea ambulance GEOFF THOMPSON: AusAID has provided a sea ambulance to help bridge the distance between outlying villages and TB services in Daru. It cost about half a million dollars. 31:38
It's meant to travel up and down the coast dispensing TB drugs and checking on the sick. Since it was delivered in May, Sigabaduru's villagers say it's only visited them twice. 31:49
Village meeting VILLAGER: I'm Mr Beri (phonetic) from Sigabaduru community and I would like to raise a concern on a shutdown of the TB clinic on Saibai island. 32:03
GEOFF THOMPSON: The community of Sigabaduru is not happy about the closure of Saibai's TB clinic or the service it's getting from the new sea ambulance. 32:11
VILLAGER: Only twice. Since then it has completely stopped it. But we would like this one to continue. 32:20
Sigabaduru GEOFF THOMPSON: The new TB strategy in Western Province relies on health workers living in these local villages. 32:26
Village meeting They depend on Daru.GOIGA ANU: There is no patient that has been taken to Daru. 32:36
Goiga All the patients are here, even those who are on treatment.GEOFF THOMPSON: Goiga Anu has been Sigabaduru's health worker for 15 years. 32:43
When was the last visit you got from the sea ambulance from Daru bringing drugs to the village?GOIGA ANU: In June... June 27 - that was the last visit and they said that they were going to come on August 3 but they never did. We are still waiting.GEOFF THOMPSON: Have people here with TB run out of drugs?GOIGA ANU: Yes they have run out of drugs and they are still here in the village. 32:50
Thompson talking with Sabdu GEOFF THOMPSON: TB sufferer Sabdu Samai got her drugs from the Australian clinic on Saibai island. She's since run out. 33:16
GOIGA ANU: Yes, the last drugs were supplied at Saibai. And the last clinic, the speedboat came to visit the patients and they advised her that on August 3 they will come again and check the patient. But then they never did and patient's medicine's finished but she's still waiting for doctor's review. GEOFF THOMPSON: So you need to see a doctor?SABDU SAMAI: Yes.GEOFF THOMPSON: And when did you last take drugs for TB?SABDU SAMAI: September 1.GEOFF THOMPSON: About a month?SABDU SAMAI: Yeah.DR RENDI MOKE: This is a concern. We really want these patients to continue their treatment. 33:26
Dr Moke interviewSuper:Dr Rendi MokeDaru Hospital GEOFF THOMPSON: Is that how you develop MDR and XDR? DR RENDI MOKE: Certainly. MDR and XDR do... do develop through the non-compliance. 33:59
Ext. Saibai hospital GEOFF THOMPSON: Australian doctors who worked at the Saibai clinic say Sabdu Samai's case was referred to Dr. Moke for further treatment.DR RENDI MOKE: I'm not sure which patient you're talking about but we are well aware of our drug resistant TB patients on the ground at the moment. So those are the ones we have on the list and we are following up on that. 34:09
Dr Moke GEOFF THOMPSON: I guess this is what to point out, it's difficult to do, but is there a danger of not maintaining?DR RENDI MOKE: No, the system is doing what it's supposed to be doing and this is the... we just started a year ago. These are the initial phases, okay? As I've said, we are very much aware of our challenges. We are very much aware of our shortfalls, but we are working on it. We are not neglecting that. We are not ignoring it. 34:28
Couple with dogs walking along seafront Music 34:53
GEOFF THOMPSON: Without faith in their own TB treatments, more Papua New Guineans like Cathrina may seek care in Australian hospitals. 34:58
Cairns hospital ext. She was diagnosed with Multi-Drug Resistant TB in Saibai in 2010. With relatives in Cairns, she chose to travel here for her check-up rather than remain in Daru.CATHRINA: From Daru, I flew to Port Moresby with my medication 35:06
Cathrina in hospital and I stayed there for three months until, while waiting for my visa, I ran out of medication and by the time I flew here, I got sick. 35:27
Cathrina doing word puzzle GEOFF THOMPSON: Her Australian doctors now believe that three month break from treatment may have led to her developing Extensively Drug Resistant TB. 35.42
Dr Vincent showing a range of pharmaceuticals DR STEPHEN VINCENT: Here we have one that's called Pyrazinamide, one that's called Isoniazid…GEOFF THOMPSON: Treating XDR TB requires a toxic drug cocktail. 35:53
DR STEPHEN VINCENT: ...his one here can cause severe psychosis in 20 per cent of patients... 36:02
GEOFF THOMPSON: If she survives, the cost of Cathrina's treatment could reach $1 million. 36:05
DR STEPHEN VINCENT: And this one here can cause a lot of arthritis. 36:10
Cathrina being administered drug intravenously The majority of the medications are in tablet form and there's one of them that's through a drip, which she'll probably need to be on for at least 12 months. So that's 12 months in hospital, away from her family and friends, and at the moment she's still considered infectious, so she's in isolation. 36:13
Dr Vincent. Super:Dr Stephen VincentThoracic specialist GEOFF THOMPSON: So her treatment might cost a million bucks? DR STEPHEN VINCENT: Yep.GEOFF THOMPSON: And she could still die?DR STEPHEN VINCENT: Yeah. 36:28
Cathrina in hospital GEOFF THOMPSON: The Australian TB services on Saibai and Boigu islands cost about $600,000 a year. 36:33
PROFESSOR LINDSAY GRAYSON: The cost of those clinics up there was nothing, so economically it makes no sense. If Papua New Guinea's got big problems with TB, which it does, and increasingly 36:41
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital now with not only MDR, multi-drug resistant, but XDR-TB, why wouldn't you nip it in the bud by running clinics on those islands to stop it getting into the Queensland population? 36:50
Magnified bacteria Music 37:05
New York skyline/ NY city streets GEOFF THOMPSON: New York City struggled with XDR-TB. You know, they had a bunch of docs and nurses die from XDR-TB. Even throwing the best resources they could at it, people still got infected and couldn't be cured even just by having parts of their lung cut out. 37:08
Prof Grayson So it's a-- it's a worry. 37:21
Crowded Asian street Music 37:24
DR STEPHEN VINCENT: We're going to get to an era when there's the phenomenon called Totally Drug-Resistant TB and this is where it comes to telling these people that we have nothing to offer you, we can't treat you. And the 37:26
Dr Vincent unfortunate thing is that while they're dying from that disease, they're probably going to infect others. So on a public health point of view, it's better off not treatment them and they go off and die alone. It sounds harsh, but unfortunately we're going to be dealt with this phenomenon probably in the next decade or so. 37:35
Pharmaceutical manufacture Music 37:53
GEOFF THOMPSON: Pharmaceutical companies aren't about to save the world from total drug resistance. They have little financial incentive to produce new antibiotics. 37:56
PROFESSOR MATT COOPER: Not so long ago, there were 18 pharmaceutical companies developing new antibiotics; there are now four. And the reason is that antibiotics are fantastic drugs, you take them for two weeks and you can cure the infection. 38:05
Prof Cooper. Super:Professor Matt CooperUQ Institute of Molecular Bioscience And they basically don't make much money for pharmaceutical companies. If you take Lipitor, a cholesterol hypertension agent, you take it for the rest of your life. It's a very profitable drug. So the economics are wrong. 38:17
Woman conducting test in lab That's why here, we are stepping up. If industry isn't going to look at new antibiotics it's really up to institutes like universities and research institutes to start to take that fight to the superbugs. 38:30
Music 38:41
GEOFF THOMPSON: The few new drugs in the pipeline are refinements of antibiotics we've already discovered. 38:43
Antibiotic tablets PROFESSOR DAVID PATERSON: These new antibiotics, which I expect will become available in the next two or three years, are completely inactive against the NDM producers, the very bacteria that we're likely to see in Australia 38:50
Prof Paterson. Super: Professor David PatersonUQ Centre for Clinical Research because of our geographic proximity with Asia and the Indian subcontinent.GEOFF THOMPSON: What are the implications of that? PROFESSOR DAVID PATERSON: So the implications are basically we will have no antibiotics left at all to treat some patients. Therefore, it really rests on us to do surveillance for those infections and for us to put into place very strict infection control measures to prevent person-to-person spread within our hospitals. 39:03
CU Disinfectant bottle/ Woman cleaning hospital bathroom PROFESSOR LINDSAY GRAYSON: In some form or another, we need a central reporting system for these superbugs. You need to go back to basics: improved hand hygiene, proper cleaning, bleach cleaning of hospitals. You know bleach is a wonderful product. It kills HIV, it kills all viruses, it kills everything. 39:31
Prof Grayson In fact, when we introduced bleach cleaning to the hospital here one of my professors said 'Lindsay, you know, do you mean the hospital's going to smell like it used to in 1980?' And I said, 'Yeah, like before we ever had superbugs, you know?' 39:48
Nurse administering intravenous So proper cleaning. We need proper hospital design - one bum per toilet - and we need a set of national guidelines for invasive procedures to stop those superbugs getting into our bloodstream. 39:59
General views. People/hands Music 40:10
GEOFF THOMPSON: Defence may be our only offence in a world where antibiotics no longer work. 41:14
Antibiotics/Petri dish Music 40:21
Operating theatre PROFESSOR DAVID PATERSON: If we've got no antibiotics left, we've only got one option if we're going to save the person's life - and that is to eradicate the source of infection, to eradicate that area of infection. And that means radical surgery, 40:24
Prof Paterson and clearly that's going to impact many people's lives. They're going to be amputees, they're going to have had significant scars from major surgery, in situations where previously we would've used an antibiotic and those measures wouldn't have been necessary. 40:38
David Ricci at home strapping on prosthesis GEOFF THOMPSON: Since he was hit by a train in India, David Ricci has had five operations, each of them has cut away a bit more tissue. It's now been almost a year since his last infection.CHERYL RICCI: They've always said that it could come back and it could even be lying dormant right now, 40:56
Cheryl Ricci so you know, it could come back at any time. 41:17
David Ricci walking DAVID RICCI: I wouldn't say it's all the way out of the woods but I definitely have experienced that feeling of recovery. You know, I'm walking on my prosthetic. I'm going back to school finally, which is something I've been wanting to do since India. 41:23
David Ricci interview I'm just kind a living my life and if the infection comes back it comes back. 41:34
Antibiotics PROFESSOR MATT COOPER: There isn't an infinite number of antibiotics, just like there's not an infinite amount of rainforest or coral reef. It is a very precious natural resource. 41:39
Prof Cooper It's getting tougher. There are fewer companies in the race to discover them and in the meantime the superbugs are going up and up. 41:47
Aerial. City. Night So this is what we call the perfect storm, and if we don't start to take action very soon, the problem's just going to get worse until we go back to the pre-antibiotic age. 41:54
Credits commence 42:07
Outpoint after credits: 42:32
For more information go to http://www.abc.net.au/4corners/stories/2012/10/25/3618608.htm
Credits:
reporter: Geoff Thompson
producer: Mary Ann Jolley
researchers: Mary Fallon
Shaun Hoyt
camera/sound: David Martin
additional camera/sound
Wayne McAllister
Neale Maude
Ron Foley
Richard McDermott
Shawn Anderson
Curtis Enslow
additional interviews
Michael Edwards
Michael Maher
archive producer: Michelle Baddiley
additional research: Simi Chakrabarti
additional footage: King 5 Television
special thanks to
Peter McCutcheon
Samson Jubi
Mark Tudehope and North Shore Private Hospital Pharmacy
producer’s assistant: Wendy Purchase
production manager: Susan Cardwell
supervising producer: Mark Bannerman
executive producer: Sue Spencer
abc.net.au/4corners
Australian Broadcasting Corporation
© 2012 ABC
PRODUCTION
SCRIPT
4 Corners
INTERNATIONAL EDITION
2012
Rise of the Superbugs
42 mins 10 secs
©2012
ABC Ultimo Centre
700 Harris Street Ultimo
NSW 2007 Australia
GPO Box 9994
Sydney
NSW 2001 Australia
Phone: 61 2 8333 4383
Fax: 61 2 8333 4859
Précis/Publicity: Antibiotics are the wonder drugs of modern medicine. They've allowed doctors to save and extend life by killing infection and enabling ground breaking surgery. But imagine a world where antibiotics don't work - that would be a place dominated by superbugs, bacteria that don't respond to antibiotics. Scientists say this would end many modern medical procedures and they claim the threat is greater than we realise.
Four Corners reporter Geoff Thompson looks at the rise of superbugs, visiting the hot spots around the world where the misuse of antibiotics is creating a breeding ground for these bacteria and he tells the horrific stories of those who've contracted infections that can't be controlled. He also reveals that Australian health officials are making decisions that could open the way for a deadly superbug to infect Australians living in the far north of the country.
"...Every time we take an antibiotic we're giving the bug a chance to become a superbug ... the more of us that take antibiotics inappropriately, the greater the chance in the community a superbug will come."
And that's exactly what's happening in India, where antibiotics are not restricted in their use. As a result a new superbug, New Delhi metallo-beta-lactamase or NDM-1, has evolved. Not only is it deadly in its own right, it's also capable of genetically modifying other bacteria to make them superbugs.
Superbugs like this have infected people who've been injured in accidents while travelling overseas. In other cases, apparently healthy people return from abroad only to discover that a simple medical procedure effectively unleashes the bug. In one instance, a healthy middle-aged man went for a prostate biopsy. The procedure was done successfully but one day later he became desperately ill. A superbug, possibly contracted while travelling overseas, had moved from his bowel into his bloodstream making him critically ill.
And Australia is in a region that is particularly vulnerable. The country is also one of the highest users of antibiotics in the developed world, with 22 million scripts a year.
It now faces the grim prospect of a return to the pre-antibiotic era when often the only way to defeat infection was to remove it surgically.
Crowded Asian street GEOFF THOMPSON, REPORTER: The human race has always been at war with bacteria. But the development of antibiotics in the 1930s and ‘40s gave us the upper hand over the bugs that were killing us. 00:13
Suddenly we were superhuman. 00:36
PROFESSOR LINDSAY GRAYSON, AUSTIN HOSPITAL: Prior to that they were used to bacterial meningitis 100 per cent mortality; bad pneumonia, 30 per cent mortality; appendicitis or ruptured bowel, 100 per cent mortality, 00:40
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital unless you had surgery. The only cure really was surgical intervention to cut the infection out. 00:52
Hospital rooms Music 00:57
PROFESSOR DAVID PATERSON, UQ CENTRE FOR CLINICAL RESEARCH: Antibiotics allowed us to do things that no-one could've dreamed of doing historically. They've allowed us to transplant organs, they've allowed us to undergo chemotherapy, they've 01:01
Prof Paterson. Super:Professor David PatersonUQ Centre for Clinical Research allowed us to receive therapy in intensive care units when we're critically ill. 01:11
CU Antibiotics Without antibiotics none of those advances in human medicine would be possible. 01:17
Aerial. City/Traffic Music 01:22
PROFESSOR MATT COOPER, UQ INSTITUTE OF MOLECULAR BIOSCIENCE: We've still got the upper edge. Clearly antibiotics still work, but it's the 01:27
Prof Cooper. Super:Professor Matt CooperUQ Institute of Molecular Biology speed of change that concerns me. Twenty years ago this wasn't an issue. Today it's a real issue. Infectious disease kills more people than cancer. TB kills 5,000 people a day. 01:32
Crowded Indian street So if we don't start to act soon and start to put our pedal on the gas pretty soon, within another 20 years we could be in serious trouble. 01:44
Fast motion. Crowded street GEOFF THOMPSON: We've deployed our antibiotic defences far and wide while the bacteria have kept up their counter-attack. 01:52
Petri dishes with illuminated bacteria They adapted and evolved. 01:59
Antibiotics Now even our last precious antibiotics are surrendering to the rise of the superbugs. 02:03
Beclu interview JOEL BECLU: I was feeling good, no problem, no symptoms, no nothing. I was feeling really great! 02:15
Photos. Joe GEOFF THOMPSON: As his 60th birthday approached Joel Beclu was feeling fit and enjoying semi-retirement. 02:19
His career in Australia as a stage technician was winding down in favour of travel through Europe and spending a year in Bali with his partner Roseann Schoch. 02:28
During a brief return to Australia he thought he'd better get a check-up. 02:39
JOEL BECLU: Getting 60, you think better to have a good check-up, so I did, went to a doctor and 02:45
Beclu interview among the check-up was the prostate check-up, and felt a hard lump there and said 'You better to go to urology'. And I went to urology and they say, 'Oh you better to have a biopsy done'. 02:51
Hospital room GEOFF THOMPSON: It's procedure undertaken by tens of thousands of Australian men every year. 03:01
Animation of the taking of a prostate sample A special device passes a thin needle through the wall of the rectum to take a prostate sample. To prevent infection antibiotics are taken. It's usually over within an hour. 03:08
Dissolve to Photo. Beclu lying on hospital bed JOEL BECLU: The procedure was on Friday morning. By Saturday to Sunday night, two o'clock, that's when I started to shiver. 03:22
Beclu interview And so I thought 'Okay, well I've got the infection, better to go to hospital'. 03:31
Ambulance/Hospital sequence We took the ambulance to the hospital and discovered that the preventative antibiotic didn't work and infection was spreading in my body. 03:34
Photo. Beclu lying on hospital bed GEOFF THOMPSON: The infection spread from Joel's prostate to his shoulder, spine and hip.JOEL BECLU: The first pain was in the collarbone. That was the very first one I noticed. Then the 03:45
Beclu interview lower back pain started to come and the hip - right in the hip joint, ah very, very strong pain. The pain was really horrible. 03:57
Photo. Beclu lying on hospital bed GEOFF THOMPSON: Standard antibiotics had no effect. Joel had a superbug. 04:04
Hospital corridor JOEL BECLU: I think within ten days the pain in my collarbone was so bad that they decided to operate, to do a scraping of the abscess in the collarbone. 04:10
Beclu interview And then I basically lost touch with reality for about a month, because of the painkillers. 04:19
Beclu on weights machine GEOFF THOMPSON: Joel spent three months in a hospital bed on rare antibiotics imported from overseas. His body wasted away. Now he's trying to regain his strength while fighting off the last of the infection.JOEL BECLU: Obviously it has been a progress because 04:24
Beclu interview I'm standing up and I can talk to you and whatever, which I wouldn't have been able to do a mere month ago. A month ago I was in pain and screaming in my bed, so it has been a big progress. 04:42
Beclu undergoing physiotherapy GEOFF THOMPSON: Somewhere in his travels, Joel had consumed a virulent strain of E. coli bacteria. It survived harmlessly inside his gut until it was unleashed by the prostate procedure. 04:51
Joel Beclu and Roseanne Schoch looking at photos of when he was in hospital ROSEANNE SCHOCH: I knew that it was a strain of E. coli they hadn't dealt with before and that they were trying their very best to try and find something that it would respond to and that would have an effect. But 05:06
Beclu and Schoch. Super:Roseann Schoch I wasn't sure at times whether it was going to work, or that his organs would cope with the bacteria and the antibiotics and everything else, and that he would come through it, actually. GEOFF THOMPSON: Did you fear for his life?ROSEANNE SCHOCH: Yes. At times I didn't know that he was going to, to make it or not. 05:22
Asian railway station/Crowded train PROFESSOR LINDSAY GRAYSON: Now we know that people who've returned from overseas in some of these hotspots where resistance is very common and it's in the food supply and it's in the water supply - because of misuse of antibiotics, mostly, in those countries - 05:43
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital that we've had a whole string of men after their prostate biopsy now getting superbugs into their bloodstream cause it's- we've introduced it into their prostate not knowingly and it's then spread into their blood and then they've got incredibly sick. 06:00
Lab/ Plane taking off from a busy airport Music 06:14
GEOFF THOMPSON: With one billion people now travelling the world each year, bacteria are more mobile than ever before. 06:27
Aerial. Busy street crossing And so are superbugs. 06:35
Thompson to camera on street. Super: Geoff Thompson They are born when we abuse antibiotics - and we're doing that across the globe. 06:36
Aerial. Sydney city PROFESSOR MATT COOPER: Every time we take an antibiotic we're giving the bug a chance to become a superbug. So if you think about you in the community, you know, 06:42
Prof Cooper. Super:Professor Matt CooperUQ Institute of Molecular Biology the more of us that take antibiotics inappropriately, the greater the chances in the community a superbug will come. 06:54
Aerial. Sydney city PROFESSOR LINDSAY GRAYSON: Australia I think out in the community is pretty bad. It rates seventh in the world for overuse of antibiotics per capita. 06:58
Australian city railway station Australia's like many of the other developed countries. We saw development and wealth 07:08
Prof Grayson equalling ability to use antibiotics, and we lost the plot in terms of realising well, most sore throats are due to viruses. They're not going to respond to antibiotics but 'I want my antibiotics'. 07:13
City aerial/Bug in Petri dish Music 07:24
Indian city general views GEOFF THOMPSON: It's the Indian subcontinent which is proving to be a superbug's perfect Petri dish. 07:28
Antibiotic abuse is rampant here. 07:37
DR ABDUL GHAFUR: In India, antibiotic overuse is a serious problem. There's no antibiotic policy in the country... 07:43
Dr Ghafur. Super:Dr Abdul Ghafur And but of course there are many countries where there is no antibiotic policy, but I'm concerned about my country and there is no antibiotic policy. 07:50
Indian pharmacy Music 07:56
CU Antibiotics GEOFF THOMPSON: India mass produces antibiotics and sells them cheaply. The drugs are available over the counter without prescription. 08:00
Rubbish dumps near polluted river Waterways and even the soil are contaminated by waste from antibiotic manufacture. On top of poor sanitation and chronic overcrowding, it's fertile ground for antibiotic resistance. 08:08
PROFESSOR DAVID PATERSON: There is a general principle in treatment of infections - the more we use any antibiotic, the quicker the bacteria are going to become resistant to it. So if we have a situation where 08:25
Prof Paterson. Super:Professor David PatersonUQ Centre for Clinical Research antibiotics are used in agriculture, where they're available over the counter, where in hospitals there's very little control over their use, clearly in that environment there's going to be a more rapid spread of resistance. 08:36
Indian hospital operating theatre Music 08:51
GEOFF THOMPSON: When more and more patients in Indian hospitals began dying from untreatable infections, local microbiologists began to ask why. 08:55
Laboratory/Bug in Petri dish Working with international researchers they identified one of the most dangerous superbugs the world has ever seen. They called it New Delhi metallo-beta-lactamase or NDM-1. It's a gene that can turn bacteria once easily destroyed into untreatable killers. 09:05
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital PROFESSOR LINDSAY GRAYSON: The NDM bug is really scary because when you only have to drink one or two of those bugs. And they don't have to multiply in themselves, they just have to spit out the little bits of genetic material that make them superbugs and then they convert all your healthy bacteria into superbugs. So it's a bit like putting a red t-shirt into the washing machine of white shirts. And the t-shirt itself doesn't have to multiply, it just has to leach out this stain and it changes all your white shirts into red shirts and converts them into, you know, a superbug. 09:29
Dr Ghafur into lift GEOFF THOMPSON: India's researchers were shunned at home for bringing the country into disrepute and threatening a multi-billion dollar medical tourism industry. Chennai-based Dr Abdul Ghafur is one of the few Indian doctors prepared to speak out.DR ABDUL GHAFUR: We need wartime measures. 10:03
Dr Ghafur We can't wait and watch. What we need is, we need urgent wartime measures to rationalise the antibiotic in all countries. Governments should take initiative and ask the medical community to use the antibiotics very sensibly. The Government should bring in strict laws to rationalise the antibiotics in countries, there must be strict antibiotic policies on one end. On the other end, governments should talk to pharma industries to stimulate the research on antibiotics. 10:23
India. Train crosses bridge DAVID RICCI: The drugs that they were treating me with seemed worse than the infection because the infection I didn't even know it was there unless they told me. 10:52
Ricci interview But apparently it was so dangerous that they had to go to that extreme levels of treatment. 11:01
India. Trains. Men cross tracks/People walk along tracks GEOFF THOMPSON: David Ricci travelled to India last year to volunteer in the slums of Calcutta. A walk to an orphanage one morning changed his life forever.DAVID RICCI: Me and my group kind of stayed like a single file line and I was in back of it and so we didn't hear the train coming. And it like hooked my right sleeve and kind of thew me in front of the train 11:07
Ricci interview and hit me, ran me over and my leg got caught under the wheel. So I'm directly underneath the train kind of head first. 11:33
Train It pulled me probably about thirty metres or so before it stopped. 11:40
Ricci They had to back the train back over my leg 'cause it was kind of stuck up in the wheels kinda. And they pulled me out and something punctured my lower abdominal region and it was probably about, you know, yea long. And there was a lot, a lot of internal bleeding. And my femoral artery in my thigh started spraying and gushing blood all over me and stuff and I was in shock, obviously, instantly. 11:47
Train platform GEOFF THOMPSON: Miraculously, a passer-by managed to stop the bleeding. David Ricci was bundled into a cycle rickshaw and taken to a local clinic.DAVID RICCI: They started just 12:11
Ricci putting water all over my leg and just kind of washing off all the dirt and the filth. Because when they pulled me out of the train, they set me in the trash because that was kind of the only place not on the tracks that they could put me. And so, you know, I was just covered in filth and this black gunk all over me. And so they were washing all that off and then he took out like a big leather bundle of knives and untied it and pulled out like a big medical knife and just started cutting my leg off. 12:27
Excerpt of report from King 5 Television, showing David in recovery. Super:King 5 Television GEOFF THOMPSON: David was in so much pain those first few days that he didn't want to live. Within a few weeks he was in a hospital back in the United States. Blood tests confirmed he still faced a danger even greater than being hit by a train and losing his leg.DAVID RICCI: A couple of days later they came in, you know, all suited up and they're like 'Uh sorry, 12:55
Ricci we kind of need to quarantine you 'cause you have a lot of dangerous infections that we haven't seen before and we need to figure out how to treat this before we can do anything else'. 13:18
Bacteria in Petri dish GEOFF THOMPSON: David was infected with several types of NDM-1 bacteria.PROFESSOR MATT COOPER: So what's happened with NDM-1 is this particular gene has been able to jump around very, very quickly. 13:26
Prof Cooper. Super:Professor Matt CooperUQ Institute of Molecular Biology It likes to get out and about, if you like. S o it's jumped from one bacteria to another, it's jumped from one country to another very, very quickly. And that's why it's quite a dangerous bug, the NDM-1 gene that's in all these different bacteria. The other key thing, of course, is there's only really one antibiotic left now that can kill this NDM-1. 13:38
Prof Cooper and Thompson don lab coats and protective goggles and enter lab GEOFF THOMPSON: To date, Australia has dealt with fewer than 10 cases of infection by NDM-1 type bacteria. The superbug is kept inside tightly secured laboratories like this one at the University of Queensland. 13:56
Indicating five bacteria cultures in a square Petri dish PROFESSOR MATT COOPER: When you look at one of the superbugs, it's the same type of bacteria but this one has acquired those genes, the NDM-1 gene. What you can see now is these powerful antibiotics that were being used before just aren't working at all. The bacteria is just ignoring them and growing quite happily in the presence of antibiotics. The one in the middle here is the only one we've got left, Colistin, which can kill this particular superbug. 14:13
GEOFF THOMPSON: So will this superbug eventually defeat that antibiotic too? PROFESSOR MATT COOPER: Yes it will. We haven't seen that in Australia yet, but overseas there are some cases where this particular bacterium is resistant to all antibiotics, including this one in the middle.GEOFF THOMPSON: So you're only really buying some time?PROFESSOR MATT COOPER: Yes, we are. 14:35
Colistin bottles Music 14:50
GEOFF THOMPSON: Colistin was the only drug that worked for David Ricci. It was abandoned decades ago because it was too toxic. 14:54
Ricci walking with stick DAVID RICCI: I was only able to be on it for so long before my kidneys and my white blood cell count and everything started dropping and they had to they had to pull me off right before you know most of my organs were unretainable. And so 15:03
Ricci interview at that point they figured that it had worked because they didn't see any signs of infection - there was no fever, no irritation around the site and so they figured that, 'Well I guess the infection's gone'. But they left a track open in my leg which we cleaned out every day and it was just causing extreme pain like, like it was worse than India. It was a ten out a ten pain and I would just scream every single morning. 15:16
Pumpkins/Ricci with mother Music 15:41
CHERYL RICCI, DAVID'S MOTHER: You would just see every day, he would just go down you know downhill and very pale and lethargic. And at times 15:43
Cheryl Ricci. Super:Cheryl RicciDavid’s mother I felt like I was losing him but it was from the antibiotics. And they didn't even know if they were going to work. So it was it was a hard time, really hard time. 15:50
Still photo of David and one of his doctors DAVID RICCI: And you know my doctors were like all right 'He shouldn't still be in this much pain, what's going what's going on in there?' 16:00
Ricci interview So they surgically went in and looked and it was all black and infected. So they're like 'Oh, well it's back'. 16:05
Bacteria in Petri dish Music 16:11
Austin Hospital exterior GEOFF THOMPSON: The tenacity of infections like NDM-1 threaten not only individuals but the very future of modern medicine. 16:15
Examining bacteria under microscope PROFESSOR DAVID PATERSON: I think the worst nightmare for a hospital would be that not only is there an outbreak of these particular infections, but they become entrenched; they're an ongoing problem for decades to come. 16:23
Prof Paterson. Super:Professor David PatersonUQ Centre for Clinical Research That really changes the whole game in terms of ability to deliver high quality medical services, to deliver transplantation or chemotherapy or intensive care medicine. 16:38
Austin Hospital exterior Music 16:49
GEOFF THOMPSON: Melbourne's Austin Hospital faced this challenge last year when it agreed to accept a patient infected with a superbug. 16:54
Photos. Komilionis holidaying in Greece Nick Komilionis picked it up while holidaying in his native Greece. 17:04
NICK KOMILIONIS: I've been in the last five years, three times to Greece. I have beautiful time, beautiful country for holiday, 17:10
Komilionis interview, with Noula nice weather. I enjoy myself 80 days, the last ten days I come sick. 17:18
Photo. Komilionis in hospital GEOFF THOMPSON: Nick ruptured his bowel and required urgent surgery. He was soon overcome by infection.NICK KOMILIONIS: I feel tired. 17:27
Komilionis interview Outside 38, 40 degrees -- hot. I like to be, to put me five, ten blankets. 17:39
Photos. Komilionis in hospital PROFESSOR LINDSAY GRAYSON: In the end he was in hospital in Greece for six months, three different hospitals, multiple operations to save his life and ended up with lots of abscesses inside his abdomen, 17:51
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital but was finally stable enough. I mean, Nick is -- he's a tough nut, you know, and he was well enough to get airlifted back to Australia. We knew that he had these superbugs in his bowel but also in all these abscesses. Essentially, they were untreatable. 18:02
Isolation ward, Austin Hospital GEOFF THOMPSON: At the Austin, Nick was kept in strict isolation.NOULA SETTINELLI, NICK'S DAUGHTER: There was precaution taken and 18:18
Nick and Noula. Super:Noula SettinelliNick’s daughter it was a harsh time for the family. Dad was quite, you know, isolated and was in quarantine for the length of time he did stay at Austin which the family felt --we felt for him. 18:25
Doctor with Petri dishes of bacteria Music 18:37
GEOFF THOMPSON: Doctors struggled to find a combination of antibiotics which could kill Nick's superbug without killing Nick. Just like NDM-1, this superbug was sharing its antibiotic resistant gene with other bacteria.PROFESSOR LINDSAY GRAYSON: Now what's interesting is, this is a strain also from the patient. 18:41
Prof Grayson shows Thompson bacteria in Petri dish And this is a different bug, it's called an E. coli, and previously this was sensitive, and you can see in this case that it's also growing quite well -- just carefully look. You can see it's pink though.GEOFF THOMPSON: And that agar is full of antibiotics as well?PROFESSOR LINDSAY GRAYSON: Full of antibiotics. 19:01
GEOFF THOMPSON: It's become a superbug?PROFESSOR LINDSAY GRAYSON: So what's happened is that this klebsiella strain has transferred its resistance gene to normally sensitive E. coli and turned this into a superbug and this is from the same patient. 19:18
Komilionis into operating theatre GEOFF THOMPSON: In the end the infection could not be stopped. The only cure available was from a time when antibiotics did not exist. Nick's bowel was removed.PROFESSOR LINDSAY GRAYSON: We were still not able to get on top of all his abscesses and so in the end, there was a long discussion with the surgeons to say 'Look, maybe we should go back to the pre-antibiotic way of doing things and just cut it all out'.In the end, we said to him 'Look, 19:32
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital there's a 50 per cent chance you're going to die on the table, on the operating table. If you don't have the surgery you probably- you're dying in pieces'. And, mean my view was he had maybe a three per cent chance of living for another six months. 19:58
Komilionis at home with Prof Grayson And this was this was just for him, let alone all the risk to the greater community, you know. So essentially we had to take a pre-1940s approach to cure him. 20:17
Prof Grayson But that's an example of where we're headed. Unless we do something about this, there'll be more of him for sure. 20:30
Komilionis at home with family around table NICK KOMILIONIS: Now I feel like before, exactly. 20:36
Komilionis interview I can tell you - more better. Now I not for nothing, I do everything. I see the doctor sometime in hospital. I can say 'Thanks, you saved my life'. 20:44
Komilionis family NOULA SETTINELLI: It can happen to anyone. It happened to my dad, it certainly can happen to anyone that travels or that's away from home, and, yeah, it is a scary thing. And if surgery wasn't an option, then we'd have nothing 21:04
Nick and Noula and we wouldn't have my father today. So it's a worry and it's scary, yep. 21:16
Photo. Australian city street at the turn of the 20th century and hospital wards GEOFF THOMPSON: At the beginning of the 20th century, tuberculosis was Australia's biggest killer. Antibiotics helped bring it under control. 21:26
Thompson by sea in PNG to camera Today Australia's rate of this bacterial infection is one of the lowest in the world. Indeed, it's easy for us to believe that TB is a disease of the past. 21:36
But here in Papua New Guinea - right on Australia's doorstep - not only is TB thriving, but superbug TB has already crossed the border. 21:46
Exterior of Cairns Base Hospital Music 21:56
GEOFF THOMPSON: Most Australians wouldn't know it, but superbug TB bacteria are living here at Cairns Base Hospital. 22:01
Cathrina in hospital They're surviving inside the lungs of this young woman from Papua New Guinea.CATHRINA: How I got this TB, 22:10
Cathrina interview like it's an airborne disease and like people you talk with... like, you stand with somebody and talk, like you don't know that the person got sick. 22:21
GEOFF THOMPSON: Cathrina is currently Australia's only known case of Extensively Drug Resistant Tuberculosis or XDR-TB. 22:32
CATHRINA: There's many people for TB and some are dying for TB. 22:41
Cathrina in isolation ward GEOFF THOMPSON: It's her fifth month inside this isolation room which she's very rarely allowed to leave. Negative air pressure keeps the disease contained. 22:46
Nurse enters isolation ward Anyone entering must wear a mask.NURSE (speaking to Cathrina): So these here are the tablets...DR STEPHEN VINCENT, THORACIC SPECIALIST: She's on medication at the moment, pretty stable but unsure as to what the outcome's going to be in the next months and years, as 22:58
Dr Vincent the cure rate is fairly low and there's about a 40 per cent chance of death from this disease despite treatment. 23:12
Cathrina takes tablets GEOFF THOMPSON: Dr Stephen Vincent is a TB specialist based in Cairns.DR STEPHEN VINCENT: We've got a lot of cases of drug-resistant TB in Papua New Guinea and now we've got Extensive Drug-Resistant TB -- 23:19
Dr Vincent which wasn't even around 10 years ago and now it's worldwide. And Australia has a case currently up here in Cairns and also there was a case I think two years ago. And I believe it's about three or four cases of Extensive Drug-Resistant TB in Papua New Guinea at the moment, so if you don't get onto these early and it gets into the population, that's, that's the disaster. 23:29
Aerial. PNG. Plane landing Music 23:51
GEOFF THOMPSON: To understand why Cathrina came to be receiving treatment in an Australian hospital, we went to Papua New Guinea. The rate of TB infection here is about 50 times greater than Australia's. 23:59
Travelling to Daru About 3,000 people die from TB in PNG every year - around one every three hours. 24:14
Scenes of busy streets in Daru We travelled to the island of Daru - the dirt poor capital of PNG's Western Province. 24:23
Thompson walks with guide to visit Cathrina’s father GEOFF THOMPSON: This is the father of the woman in Cairns? GUIDE: Yes.GEOFF THOMPSON: It's here we found Cathrina's father Abraham.ABRAHAM: So I was really upset. So I was really worried about her. She was losing weight fast. 24:30
Abraham interview At my own expense I had to take her to Saibai. It cost me a lot of money and... just because I love my daughter and I want her to get better. So I had to take her to Saibai. 24:43
Map showing the islands of Saibai and Boigu GEOFF THOMPSON: At their closest points, the Australian islands of Saibai and Boigu are only 5 kilometres away from mainland PNG - a ten minute ride in a speedboat. 25:02
Speedboat with passengers Unfettered two-way travel is permitted for locals under the terms of the Torres Strait Treaty.DR STEPHEN VINCENT: People don't realise but there's about 50,000 movements back and forward between Torres Strait Islanders and the PNG nationals due to traditional purposes. 25:13
Dr Vincent. Super:Dr Stephen VincentThoracic specialist So there's no gate there. It's a porous border. 25:29
Boigu Island health centre GEOFF THOMPSON: For the past seven years Australian doctors have staffed TB clinics on the islands. 25:34
Doctor treating PNG patient at island clinic They treated infected people from Papua New Guinea. 25:39
But in June this year the clinics were controversially closed. With help from AusAID, PNG is now trying to manage its TB patients on its own. 25:45
Dr Moke interview DR RENDI MOKE: I would say that we are doing much better now than it was before. 25:55
Daru Hospital GEOFF THOMPSON: Daru Hospital is the main centre for TB treatment in PNG's Western Province. Dr Rendi Moke is the chief physician.DR RENDI MOKE: We are more than confident that we can take on board all the patients that have been handed over to us, and the current patients on the ground. 25:59
Dr Moke interview We have the capacity with very good support from people, our stakeholders, very good support from AusAID, very good support from World Vision. 26:16
Dr Rendi Moke greets patients as he walks down the hospital corridor GEOFF THOMPSON: Built in 1963, Daru Hospital is badly rundown and always busy. Dr Moke leads us through to the outpatients clinic, where suspected TB sufferers are first diagnosed.DR RENDI MOKE: Any patient we suspect may have 26:24
Daru Hospital isolation ward TB and is coughing, we isolate them and give them a mask to prevent transmission to our staff as well as other patients. 26:44
Thompson with Dr Moke in hospital GEOFF THOMPSON: So this is the first line - when people first come to the hospital they come here? DR RENDI MOKE: Yes, this is the point of entry, if you like, to the hospital.GEOFF THOMPSON: So far AusAID has spent about one and half million dollars improving this hospital. 26:52
Inside hospital It's part of an 11 million-dollar aid package over four years aimed at boosting TB services in the Western Province. 27:04
Dr Moke indicates the chest area of an illuminated X-Ray DR RENDI MOKE: So this is typical of a TB chest X-Ray... GEOFF THOMPSON: The money has helped pay for a new X-Ray machine and training to use it. 27:13
Dr Moke shows Thompson diagnostic machine DR RENDI MOKE: This is our GeneXpert machine. It has four slots...GEOFF THOMPSON: Within two hours this new machine can determine resistance to one of the six types of TB antibiotics.But it still takes months before multi or extensive drug resistance can be confirmed by a laboratory in Brisbane.DR RENDI MOKE: Yeah, well it may take more than two months 27:23
before we can know that. But it's a control because these patients that we diagnose here, we take them and we isolate them while we initiate treatment. They are given a face mask and we isolate them in our TB wards so it reduces the chances of transmission and right then they are commenced on drugs. 27:46
TB wards/ Patients wearing masks GEOFF THOMPSON: Dr Moke showed us around Daru Hospital's TB wards.DR RENDI MOKE (to patients): Wear your masks, please. Wear your masks.GEOFF THOMPSON: Here the concept of isolation is a loose one. 28:04
DR RENDI MOKE: We encourage them to wear masks and they are expected to wear masks when they are in the ward to prevent cross-transmission. 28:14
And we also encourage our staff to wear the masks as well. 28:23
Dr Moke wearing mask We discourage guardians from coming here. If they are to come, they are to come with masks.GEOFF THOMPSON: So everyone here's meant to wear- wears a mask? DR RENDI MOKE: Yes, we expect them to wear masks, okay? TB patients. 28:26
Patients By wearing masks it prevents transmission by 50 per cent.GEOFF THOMPSON: Makes a big difference?DR RENDI MOKE: Makes a big difference. 28:40
Bulldozer on new TB ward site GEOFF THOMPSON: Outside, Dr Moke explained the very beginnings of the hospital's brand new TB ward. It's also being paid for by AusAID and is expected to be finished next year.DR RENDI MOKE: It will be 22 bed space ward and it will be 28:46
Dr Moke and Thompson on verandah six isolation for drug resistant TB, including MDR TB and XDR TB, and 16 bed will be general TB, those sensitive TB. 29:08
Unmasked patients in TB ward GEOFF THOMPSON: When Dr Moke left we returned to the TB ward. Most patients were now unmasked and the special isolation room for extensively drug resistant patients was suddenly empty. 29:18
Sister Konga in TB ward SISTER KONGA, NURSE: From the 15th month of her treatment...GEOFF THOMPSON: From the Sister in charge we learned that one woman in this multi-drug resistant ward was actually suspected of having Extensively Drug Resistant TB. 29:34
So which one of these girls is XDR? SISTER KONGA: Antonia.GEOFF THOMPSON: Antonia is XDR?SISTER KONGA: Yes, suspected.GEOFF THOMPSON: And why is she in the MDR ward? 29:46
Super: Sister Konga SISTER KONGA: Because in the isolation room we've got only four beds available in the isolation room... 29:56
Antonia GEOFF THOMPSON: Is that a bad idea for infection?SISTER KONGA: Of course it is because if she's confirmed XDR then she can spread it to the other patients. 30:03
Anton Narua in TB ward GEOFF THOMPSON: Anton Narua is the deputy president of the region's local government. He's just learnt that two of his nieces are here with TB. One of them is Antonia - the girl with suspected XDR-TB.ANTON NARUA: That's why I'm saying they're all going to die. They should separate them but they're all mixed up together. 30:15
Narua interview I know my two girls are going to die. They're definitely going to die. There is something wrong which I can't- I can't- I can't explain. It happened to a lot of people. My two girls are going to die. 30:38
Travelling by boat to Sigabaduru GEOFF THOMPSON: Anton Narua is also concerned about the fate of villagers living far away from Daru, along PNG's southern coast. 30:56
Narua and others in boat He took us to meet the people of Sigabaduru. It takes two hours and the fuel costs $350. 31:06
Arriving at Sigabaduru That's way beyond the means of people used to making quick trips to islands like Saibai, where Australia's TB clinic has shut its doors. 31:15
Thompson with Councillor Salee COUNCILLOR KEBEI SALEE: Over there is Saibai, just only about four nautical miles from here - sea nautical miles.GEOFF THOMPSON: It's very close. And how long does it 31:24
Super: Councillor Kebei Salee take you to get there each day?COUNCILLOR KEBEI SALEE: It takes me only 10 minutes across by 60 horsepower outboard motor. 31:32
Sea ambulance GEOFF THOMPSON: AusAID has provided a sea ambulance to help bridge the distance between outlying villages and TB services in Daru. It cost about half a million dollars. 31:38
It's meant to travel up and down the coast dispensing TB drugs and checking on the sick. Since it was delivered in May, Sigabaduru's villagers say it's only visited them twice. 31:49
Village meeting VILLAGER: I'm Mr Beri (phonetic) from Sigabaduru community and I would like to raise a concern on a shutdown of the TB clinic on Saibai island. 32:03
GEOFF THOMPSON: The community of Sigabaduru is not happy about the closure of Saibai's TB clinic or the service it's getting from the new sea ambulance. 32:11
VILLAGER: Only twice. Since then it has completely stopped it. But we would like this one to continue. 32:20
Sigabaduru GEOFF THOMPSON: The new TB strategy in Western Province relies on health workers living in these local villages. 32:26
Village meeting They depend on Daru.GOIGA ANU: There is no patient that has been taken to Daru. 32:36
Goiga All the patients are here, even those who are on treatment.GEOFF THOMPSON: Goiga Anu has been Sigabaduru's health worker for 15 years. 32:43
When was the last visit you got from the sea ambulance from Daru bringing drugs to the village?GOIGA ANU: In June... June 27 - that was the last visit and they said that they were going to come on August 3 but they never did. We are still waiting.GEOFF THOMPSON: Have people here with TB run out of drugs?GOIGA ANU: Yes they have run out of drugs and they are still here in the village. 32:50
Thompson talking with Sabdu GEOFF THOMPSON: TB sufferer Sabdu Samai got her drugs from the Australian clinic on Saibai island. She's since run out. 33:16
GOIGA ANU: Yes, the last drugs were supplied at Saibai. And the last clinic, the speedboat came to visit the patients and they advised her that on August 3 they will come again and check the patient. But then they never did and patient's medicine's finished but she's still waiting for doctor's review. GEOFF THOMPSON: So you need to see a doctor?SABDU SAMAI: Yes.GEOFF THOMPSON: And when did you last take drugs for TB?SABDU SAMAI: September 1.GEOFF THOMPSON: About a month?SABDU SAMAI: Yeah.DR RENDI MOKE: This is a concern. We really want these patients to continue their treatment. 33:26
Dr Moke interviewSuper:Dr Rendi MokeDaru Hospital GEOFF THOMPSON: Is that how you develop MDR and XDR? DR RENDI MOKE: Certainly. MDR and XDR do... do develop through the non-compliance. 33:59
Ext. Saibai hospital GEOFF THOMPSON: Australian doctors who worked at the Saibai clinic say Sabdu Samai's case was referred to Dr. Moke for further treatment.DR RENDI MOKE: I'm not sure which patient you're talking about but we are well aware of our drug resistant TB patients on the ground at the moment. So those are the ones we have on the list and we are following up on that. 34:09
Dr Moke GEOFF THOMPSON: I guess this is what to point out, it's difficult to do, but is there a danger of not maintaining?DR RENDI MOKE: No, the system is doing what it's supposed to be doing and this is the... we just started a year ago. These are the initial phases, okay? As I've said, we are very much aware of our challenges. We are very much aware of our shortfalls, but we are working on it. We are not neglecting that. We are not ignoring it. 34:28
Couple with dogs walking along seafront Music 34:53
GEOFF THOMPSON: Without faith in their own TB treatments, more Papua New Guineans like Cathrina may seek care in Australian hospitals. 34:58
Cairns hospital ext. She was diagnosed with Multi-Drug Resistant TB in Saibai in 2010. With relatives in Cairns, she chose to travel here for her check-up rather than remain in Daru.CATHRINA: From Daru, I flew to Port Moresby with my medication 35:06
Cathrina in hospital and I stayed there for three months until, while waiting for my visa, I ran out of medication and by the time I flew here, I got sick. 35:27
Cathrina doing word puzzle GEOFF THOMPSON: Her Australian doctors now believe that three month break from treatment may have led to her developing Extensively Drug Resistant TB. 35.42
Dr Vincent showing a range of pharmaceuticals DR STEPHEN VINCENT: Here we have one that's called Pyrazinamide, one that's called Isoniazid…GEOFF THOMPSON: Treating XDR TB requires a toxic drug cocktail. 35:53
DR STEPHEN VINCENT: ...his one here can cause severe psychosis in 20 per cent of patients... 36:02
GEOFF THOMPSON: If she survives, the cost of Cathrina's treatment could reach $1 million. 36:05
DR STEPHEN VINCENT: And this one here can cause a lot of arthritis. 36:10
Cathrina being administered drug intravenously The majority of the medications are in tablet form and there's one of them that's through a drip, which she'll probably need to be on for at least 12 months. So that's 12 months in hospital, away from her family and friends, and at the moment she's still considered infectious, so she's in isolation. 36:13
Dr Vincent. Super:Dr Stephen VincentThoracic specialist GEOFF THOMPSON: So her treatment might cost a million bucks? DR STEPHEN VINCENT: Yep.GEOFF THOMPSON: And she could still die?DR STEPHEN VINCENT: Yeah. 36:28
Cathrina in hospital GEOFF THOMPSON: The Australian TB services on Saibai and Boigu islands cost about $600,000 a year. 36:33
PROFESSOR LINDSAY GRAYSON: The cost of those clinics up there was nothing, so economically it makes no sense. If Papua New Guinea's got big problems with TB, which it does, and increasingly 36:41
Prof Grayson. Super:Professor Lindsay GraysonAustin Hospital now with not only MDR, multi-drug resistant, but XDR-TB, why wouldn't you nip it in the bud by running clinics on those islands to stop it getting into the Queensland population? 36:50
Magnified bacteria Music 37:05
New York skyline/ NY city streets GEOFF THOMPSON: New York City struggled with XDR-TB. You know, they had a bunch of docs and nurses die from XDR-TB. Even throwing the best resources they could at it, people still got infected and couldn't be cured even just by having parts of their lung cut out. 37:08
Prof Grayson So it's a-- it's a worry. 37:21
Crowded Asian street Music 37:24
DR STEPHEN VINCENT: We're going to get to an era when there's the phenomenon called Totally Drug-Resistant TB and this is where it comes to telling these people that we have nothing to offer you, we can't treat you. And the 37:26
Dr Vincent unfortunate thing is that while they're dying from that disease, they're probably going to infect others. So on a public health point of view, it's better off not treatment them and they go off and die alone. It sounds harsh, but unfortunately we're going to be dealt with this phenomenon probably in the next decade or so. 37:35
Pharmaceutical manufacture Music 37:53
GEOFF THOMPSON: Pharmaceutical companies aren't about to save the world from total drug resistance. They have little financial incentive to produce new antibiotics. 37:56
PROFESSOR MATT COOPER: Not so long ago, there were 18 pharmaceutical companies developing new antibiotics; there are now four. And the reason is that antibiotics are fantastic drugs, you take them for two weeks and you can cure the infection. 38:05
Prof Cooper. Super:Professor Matt CooperUQ Institute of Molecular Bioscience And they basically don't make much money for pharmaceutical companies. If you take Lipitor, a cholesterol hypertension agent, you take it for the rest of your life. It's a very profitable drug. So the economics are wrong. 38:17
Woman conducting test in lab That's why here, we are stepping up. If industry isn't going to look at new antibiotics it's really up to institutes like universities and research institutes to start to take that fight to the superbugs. 38:30
Music 38:41
GEOFF THOMPSON: The few new drugs in the pipeline are refinements of antibiotics we've already discovered. 38:43
Antibiotic tablets PROFESSOR DAVID PATERSON: These new antibiotics, which I expect will become available in the next two or three years, are completely inactive against the NDM producers, the very bacteria that we're likely to see in Australia 38:50
Prof Paterson. Super: Professor David PatersonUQ Centre for Clinical Research because of our geographic proximity with Asia and the Indian subcontinent.GEOFF THOMPSON: What are the implications of that? PROFESSOR DAVID PATERSON: So the implications are basically we will have no antibiotics left at all to treat some patients. Therefore, it really rests on us to do surveillance for those infections and for us to put into place very strict infection control measures to prevent person-to-person spread within our hospitals. 39:03
CU Disinfectant bottle/ Woman cleaning hospital bathroom PROFESSOR LINDSAY GRAYSON: In some form or another, we need a central reporting system for these superbugs. You need to go back to basics: improved hand hygiene, proper cleaning, bleach cleaning of hospitals. You know bleach is a wonderful product. It kills HIV, it kills all viruses, it kills everything. 39:31
Prof Grayson In fact, when we introduced bleach cleaning to the hospital here one of my professors said 'Lindsay, you know, do you mean the hospital's going to smell like it used to in 1980?' And I said, 'Yeah, like before we ever had superbugs, you know?' 39:48
Nurse administering intravenous So proper cleaning. We need proper hospital design - one bum per toilet - and we need a set of national guidelines for invasive procedures to stop those superbugs getting into our bloodstream. 39:59
General views. People/hands Music 40:10
GEOFF THOMPSON: Defence may be our only offence in a world where antibiotics no longer work. 41:14
Antibiotics/Petri dish Music 40:21
Operating theatre PROFESSOR DAVID PATERSON: If we've got no antibiotics left, we've only got one option if we're going to save the person's life - and that is to eradicate the source of infection, to eradicate that area of infection. And that means radical surgery, 40:24
Prof Paterson and clearly that's going to impact many people's lives. They're going to be amputees, they're going to have had significant scars from major surgery, in situations where previously we would've used an antibiotic and those measures wouldn't have been necessary. 40:38
David Ricci at home strapping on prosthesis GEOFF THOMPSON: Since he was hit by a train in India, David Ricci has had five operations, each of them has cut away a bit more tissue. It's now been almost a year since his last infection.CHERYL RICCI: They've always said that it could come back and it could even be lying dormant right now, 40:56
Cheryl Ricci so you know, it could come back at any time. 41:17
David Ricci walking DAVID RICCI: I wouldn't say it's all the way out of the woods but I definitely have experienced that feeling of recovery. You know, I'm walking on my prosthetic. I'm going back to school finally, which is something I've been wanting to do since India. 41:23
David Ricci interview I'm just kind a living my life and if the infection comes back it comes back. 41:34
Antibiotics PROFESSOR MATT COOPER: There isn't an infinite number of antibiotics, just like there's not an infinite amount of rainforest or coral reef. It is a very precious natural resource. 41:39
Prof Cooper It's getting tougher. There are fewer companies in the race to discover them and in the meantime the superbugs are going up and up. 41:47
Aerial. City. Night So this is what we call the perfect storm, and if we don't start to take action very soon, the problem's just going to get worse until we go back to the pre-antibiotic age. 41:54
Credits commence 42:07
Outpoint after credits: 42:32
For more information go to http://www.abc.net.au/4corners/stories/2012/10/25/3618608.htm
Credits:
reporter: Geoff Thompson
producer: Mary Ann Jolley
researchers: Mary Fallon
Shaun Hoyt
camera/sound: David Martin
additional camera/sound
Wayne McAllister
Neale Maude
Ron Foley
Richard McDermott
Shawn Anderson
Curtis Enslow
additional interviews
Michael Edwards
Michael Maher
archive producer: Michelle Baddiley
additional research: Simi Chakrabarti
additional footage: King 5 Television
special thanks to
Peter McCutcheon
Samson Jubi
Mark Tudehope and North Shore Private Hospital Pharmacy
producer’s assistant: Wendy Purchase
production manager: Susan Cardwell
supervising producer: Mark Bannerman
executive producer: Sue Spencer
abc.net.au/4corners
Australian Broadcasting Corporation
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