Chapter Mother is the dearest

Speaker:

The air is high and clear here, below the peaks of the Himalayas.

It´s bracing and rich in oxygen.

Life seems healthy and bearable,

for all the hard work it entails.

The people exude a kind of

joyful innocence and simplicity.

And yet ­ death is among them,

death by suffocation.

01:59

DrIan Smith, WHO Nepal:

Tuberculosis is caused by a germ Mycobacterium tuberculosis.  We have known that for over a hundred years.  Why though do some people develop the diseaseand some people not when they have been infected.  Why do some people get infectedand others not get infected.  We have to look not only at the scientific technical causes of the disease.  We have to look at the social causes of the disease.  The factors that make some people a greater risk of getting infected, a greater risk of getting the disease.  And very often those social factors are related to poverty.  Related to a lack of resources, denial of human rights for example.  So you find that tb is concentrated in the poor groups of society.  It can effect anybody but it is clearly the poor who are affected most by it not only getting the disease more than the rich.  But also when they get the disease it has a much greater impact on them.  We know that tb primarily affects people in the ages 15 to 45.  People who are active economically, people who are supporting a family.  Those who have a prime responsibility for maintaing the family in the community

03:27

Ram Kadkha, teacher:

There are too many patients of tuberculosis in our country.  I think many of them are because of their poverty.  They are unable to make the balance of their food.  This is the main cause of tuberculosis in our country!  We have to eat meat, horsecram pee. We  have to use fruits,  green vegetables etc.  Milk, eggs, meat, which give us various kinds of vitamins.  So people are unable to gather all these elements in their food.  They are unable to make so well, so healthy.

Speaker:

04:39

Ram Kadkha knows what he's talking about.

He's a  school  teacher of 25 fromChargaru village in Katmandu valley.  I met him for the first time 2 years ago, at the Kalimati Chest Hospital.  He himself was still well, he was a visitor to the hospital, like us.  But life had already tried him.  On his young back he bore a heavy burden of experience.

05:24

(Ram Kadkha):

She is my mother, mrs Ruko Kadkha, a widow. She suffers from TB since 4 years.  Continually she was treated by TB hospital in Timi. But she could not be well.  She became so serious and I have taken her to hospital.  She had almost finished first line drugs and seconds line drugs.  Now one way is possible to be well.  That is: if we can use third line drugs.  Certainly she can be well, there is more possibility to be well.  But we are poor people, I am a student.  I am not able to buy third line drugs.  Doctor has councelled me to buy third line drugs. But it´s so expensive.so I am unable to buy that drugs.  So now second line drugs are used for her. But she is not feeling well.

06:37

What do you think of her perspectives?

Possibilites?

There are so many INGO:s and NGO:s and they have their funds.  If they provide their help, then certainly I can buy medicine.  Buy her third line drugs, and she can be well and she will get new life.

07:15

Why do you think she got this tb?

My father was also suffering by TB and he died because of it!  My father´s disease affected her.  Now she has become the patient of TB.

08:00

(Ram Kadkha mourning at the burial-site

I tried my best to make her well cause mother is the dearest one on this earth.

Speaker:

Five months have now gone.  We go to meet Ram Kadkha.

He lives with his grandfather and a cousin, who does the housekeeping.  They scrape a living from a milk buffalo, a few hens, a couple... ...of tiny patches of land and Ram's scanty teacher's salary. Although only two years have one, Ram looks ten years older.  He himself fell victim to TB, and has just completed his treatment.  The sorrow caused by his mother's death still lies heavy on his heart.

09:08

(Ram Kadkha):

I took her on Friday, and she was OKtil five o´clock. She could speak and eat.  But correct at six thirty suddenly she vomited something like black, dirty things.  In this way she became unconscious,  And the treatment was in process.  The doctors tried to do many things.  They brought many equipments there.  She was in the emergency ward.  And it was Friday six thirty pm.  And then Saturday came and on Sunday at eleven a m she had lost her life.  She forgot to breath and she took leave from this world for ever. 

This was the reality of my mother.  I tried my best to make her well cause mother is the dearest one on this earth.  I know that. Isn´t it?  So I did my best, but unfortunately, God took revenge upon me.  But not God. The main causes were our poverty and carelessness of my mother.  I felt that now I am alone in this world.  Nobody is here and I am alone.  I don´t have father and mother and we are only two, my younger brother and me.  Nobody is here. I´m unmarried. I thought that now I am the only one person in this world.  And my life will be so difficult, so uneasy.  So unconfortable.  But we have to bear anything. We know that   we can´t always have what we want in life.  So I think that I am here to do my duty, to carry out my responsibility.  So I have to live in this world.  And my mother wanted to make me a prestigious person, a great person.  So I think I have to fullfil her dream!  Day to day the the patients of TB are increasing in this world.  If there won´t be any effective step immediately, certainly the whole world......will be full of the patients of TB.  And it will be like the hell!  It will be like the hell.

Castle of cough

13:11

Speaker:

More and more people are coughing themselves to death.   That is what this woman in Tallinn is doing.   Nearer to three million other people will suffocate, or waste away a year.  One third of the Earth's population carry the TB bacteria Worst-affected regions: South-East Asia and Southern Africa.  The figures are also high in the former Soviet Union, and even in slum areas... ...of major cities in the West such as London, Paris and New York. But also and the immigrant ghettoes in Scandinavian cities. We came into the 20th century with falling levels of TB......and as we leave it the curves are pointing upwards.   We're coughing our way into the new millenium.  To our shame we're sliding backwards into the future.  That's not how it was supposed to be. In 1978 WHO adopted the slogan "Health for all by the year 2000". That's where we are now and whereveryou look, disease is gaining ground.

14:04

Prof Don Enarson, The Union Against TB and Lung Disease :

The strategy was, the slogan was"Health for all year 2000".  I don´t think that there is anybody in the world today who would say that we will reach "health for all" by the year 2000.We are certainly as far away from "Health for all" now as we´ve been for a long time.

14:23

Speaker:

One example among the many is this slum district of New Delhi. This boy on his father's arm has TB.His medicine costs 500 rupees a month.That is more than his father earns. Here nobody can afford health or medicine. 100 metres away is WHO's South East Asia headquarters. Its back is turned to the slums. When we ask people who live here they have no idea what the WHO is.  Look, what's that written above the door? They've turned the slogan into a meaningless catchphrase: "Health for All ­ All for Health".

14:49

You can read above your gate here that "Health for all - all for health is your slogan.  But wasn´t WHO:s slogan lately "Health for all the year 2000"? What have you to say about that?

15:15

No comments. Next question!

The Iron Man

15:34

Roger Loganstein, welder:

I don´t want to tell a word of a lie.  But this country is affected by TB.  I weigh now about say fortyfive. I´m used to weigh about sixtyfive.  But I was well built, I was about your body.  And I used to go with my boss every Wednesday evening to the gym. 

They used to call me the iron man!  I was well built.  This sick, once it got you.,it drops you just like that.  Most of my friends they tell me: Roger, what´s wrong with you , man?  You can see in my face. These parts. These are all bones.  I was never like this before. True.  This sick is extremely dangerous.  Like I said: If you not take your

medication properly, then you die! 

You can se how it´s swelling up. This part here.  Both sides is like that. I can´t even trip properly on my feet.  It´s just like a pain. From my toes, straight up here.  See my legs, skinny, you know. Bone.  I wasn´t like this before. It´s very painful.  I couldn´t sleep at night. During daytimes it´s alright.That´s why I keep it close. Just to keep it warm so the pain can´t get worse.I don´t know where it is from, this sickness.   These parts. You can put your finger in here. It´s like your finger soak into it.  It´s very sore, man.  I got here something that I wrap on to my feet.  But it makes it so freezy. Ice,ice cold. So I have to cover it. It´s very very sore my man.  I´m telling you!

18:52

Dr Jennifer Talenti:

Patients who have TB but are sort of up and about.  They can be very adequately treated at work or at the clinic.  But there are some that do not present until half their lungs are destroyed.  And some of those  bad ones are the ones that get admitted here.

I find that nearly 80 percent of the patients in my ward are illiterate. They have had little, if any education.   Most of them are unemplyed and therefore most have had very little food to eat at home.  The whole socioeconomic side of it is very obvious to me when I sit with a patient and take a history. 

I´m an optimist but in the long term.But I think we´ve got a long way to go yet.  If we can make sure that patients adhere regulary to their treatment for the prescribed time.  And if we can improve the socioeconomic conditions.In the long term I´m hopeful that we will get on top of it.  In the short term, I think it´s going to get worse as more and more people are developing AIDS . And TB is very much a feature of the AIDS epedemic in this area, where so many people have the infection.

20:39

Cynthias story

Cynthia Voyi, unemployed:

By the time I was going to deliver a baby the sister saw that I got tb.After that I came back to stay here.I was very sick at that time.  But I didnt want to go to the doctor cause I was taking care of my baby.  This thing became so serious that I had to go to serious doctors.  I had to sleep at the hospital for two months.  I came out and felt terrible.  Now I eat my treatment  an I feel better than I did first.

And I asked them: Is my baby safe as I have this thing?  They say: The baby´s got nothing because we saw this.  After that we checked everything.  The baby´s got nothing. She is safe!  But something else makes me scared.  I can´t talk about it in front of people.  Then we ask them to go, don´t we?

(This is a private interview.

Can you please back up)

By the time I was at the hospital, I asked my doctor:"Doctors, what is it to me?  But the doctors didn´t want to tell me.  And I begged the doctor to tell me.  "Doctor, I won´t do nothing, I just want to know what´s in my body.  And the doctor told me I am HIV-positive.  And I just take it easy.  I told the doctor: "If you give me a tablet I can carry on with my life".  But I got this boyfriend here.  This baby is from him. I told him: "You must go to the clinic and check yourself!"  "Maybe this thing is coming from you or it is  coming from me.  But he didn´t want to.  He´s just leaving it like that.But we use condoms now.  Sometimes he forces me:  "I don´t want this!"  But I told him I need it. It´s me who´s ill so I need to use it.  He is just OK now.  He likes it.  That´s all...

But if I can just have some money......I can just make my own house to stay away from this guy.  Because he does not stop doing things like sleeping out... ...and coming to me, forcing me to make love.  So I want to stay away from him.So if I can work and have a job,I can live with my children.  These tablets are going to make me better.  But on the other side: he is coming with another disease.  I am just trying to be well.

To get my life back.  Something like that...

24:50

D G of Health

What is in your opinion the main causes of TB?

and this resurgence, you could call it.

Gro Harlem Brundtland, head of WHO:

There is a combination of situations.HIV/AIDS is one important aspect.HIV/AIDS carries with it reduced immunity to also other infectious diseases.  So the risk of an HIV positive person to acquire TB is 30 times someone without the HIV infection.  That has led to a real increase ib the numbers.  Also it is combined with malaria.  If malaria is on the increase, you will even then have an increase in more Tuberculoses cases.  People get weakened by other types of disease.  Also the fact that drugs that were effective have...lost their effectiveness and that there is antibiotic resistance developed has contributed to the situation.

25:57

And how about poverty? When I am out in the field meeting doctors, nurses, WHO workers and so on...that's the first thing they mention when

we are discussing this.

This is obvious, it´s clear. Every infectious disease is linked with lack of nutrition.  With poverty, with lack of means for both nutrition,housing. So that is clear.  But I don't think that the reasons for the increase globally of the tuberculoses can be attributed solely to an increase in poverty.  We have had big numbers of poor people.Even if we go ten, twenty yaers back.  But it is clearly linked to poverty, lack of access to treatement.  Lack of a livingstandard that gives you the strenght to be able to fight and have immunity enough to fight diseases.This clearly the case.  But that is a point which is as relevant with  diarrhoea, with other diseases than exactly tuberculoses.  But it is true. It is, as so many other diseases, linked clearly to poverty.

27:20

But when I read your material I think  you overlookit sometimes. In your printed material.

27:30

Well, you see. If WHO would try to give tecnical advice to contries about how to deal with TB and we would say"Look, you have to fight poverty". They would say:" Yes we know that, but we also want to know from you......in what way we should program specifically towards dealingwith the problem of TB even if we still have poverty."This is a continuous discussion. Poverty leads to ill health and ill health leads to poverty. We have to break this circle both ways!

28:18

The Death Sentence

Speaker:

This is hell ­ a black hell. As under the apartheid regime, almost all the prisoners have black faces.  We're in the high security wing.No-one before us has ever been allowed in with a film camera. These prisoners have been convicted for murder and other violent crimes.  Conditions are extremely cramped, overcrowded.There are twice as many prisoners asthe prison was built to accommodate.

This is an ideal environment for the tuberculosis contagion. This is where Nelson Mandela contracted TB.  Here sits Isaac Jackson.He has been here for the last two years.  He's seriously ill - is it possible to believe that he's actually only 30 years old?  His TB has eroded him from 84 kilos down to no more than 50  kilos today. Isaac has a long sentence to serve. Soon he will be given another verdict. But he doesn't know that yet.

29:12

Isaac:

Good morning. How do you feel?Been sleeping well?

Yes, I have.

And how do you feel today?

Very bad. I´ve been coughing blood!

Last week I went to sister van Staden to get treatment downstairs.

But everybody working there told me theygot no responsibility for my medical care.  They asked me to fuck off!  They refused to help me.  I am supposed to be a human being.  Not an animal!

I understand. Just follow me. I want to discuss your medication.

(thet both pass the corridor)

30:09

Evan Edas, HIV coordinator:

Did you keep any sample from the blood your were coughing?

No.no, I didn´t

Did you get your pills for the weekend?

I was at sister van Stadens office.  But they chased me off like a dog.  One of the members in my gang Sexy Boys will take care of her. That´s a promise!  It will be rather violent, I bet.  What sister van Staden is doing...

I understand. There are problems here. Sorry they don´t seem to bother.  Is there anything else?

I´m not sleeping well. After half an hour I have to change sheet.  It´s soggy. I´m sweating on my pillow.  Everything is just soaking wet.

31:15

That´s a side-effect of your TB.  No pill on earth could change that.  You are resistent to all medicines!

(music and memories)

32:03

You are resistent to all medication!  Do you understand?  We try different medicins and see if they at least give you some relief.  The pills don´t work. We have to try,

but they don´t work.  Do you understand what I say.  We´ll do some more tests.

Then we will see. OK?

32:55

Oppression

Ibrahim Rasool, ANC ex Minister of Health:

I think that apartheid is going to haunt us for a long time.Many people think that apartheid was only that you couldn´t ride in that bus or you couldn´t swim at that beach and you couldn´t get that job. It was more than that.  It was how the system looked after you. If you were black you didn´t get clinics. You didn´t get tablets to fight tb. It´s not an accident that fewer white have tb. Because they generally are more wealthy. It´s not an accident that it´s happening to the poorest  coloured people and the poorest African people who get tb. Even president Mandela had tb. But that was when he was pushed into a damp cell with poor food and everything like that. Thats where he got tb. So there is a connection between tb and apartheid and diseases such as tuberculosis.

33:42

Dr Ian Smith, WHO:

If you take people like prisoners, refugees, migrant workers those groups who often have limitations on their human rights:They are greater risk of developing disease

than other people.They are also often greater risk of developing drugresistant disease.

George Soros, financier sponsor of tb programs, Russia:

The prison population i Russia is very high. Russia and the United states are the two countries where prison population is the highest. In the United States it is due to the very restrictive drug laws. That´s an issue that also the foundation is involved in. In Russia it is mainly due to preventive detention.People when they commit a crime are taken into custody. And they are kept in custody . With the spread of tuberculosis, effectively to be taken into preventive is to be infected with tuberculosis. If you are released you then carry those germs with you.

35:04

Speaker:

Russian prison tuberculosis is notorious. It has attracted the attention of media

and of donors such as George Soros. What is less well-known, perhaps even to Soros, is that prisons ......in the USA have been scourged by TB outbreaks since the early 1980s.

Few kilometres from here there are prisoners suffering from MDR TB. Overcrowded prisons and a reversion to 19th-century methods, have led... ...to Amnesty International accusing the USA of violating human rights.

Here we see other prisoners and refugees, from the war in Bosnia. The picture of Fikret Alic caused quite a furore. His emaciated body.....was reminiscent of what the prisoners from the Nazi kz camps looked like. The Serbs defended themselves, saying the man had not been starved at all:He just had TB! But "just" having TB was more or less equivalent to being a prisoner of the SS. TB and nazism will forever be associated with each other. And not only in the ways you think. The truth is much worse than that!

36: 16

Inger Gulbrandsen Norwegian kz camp prisoner:

In Auschwitz they experimented on Jewishchildren taken from the whole of Europe.They used them as guinea pigs in thedevelopment of tuberculosis vaccines.At first, of course, they had to get TB. So they were operated on, under their arm. TB was introduced into a gland.We also know that others were given TB by having a tube put down into the lungs. And IG Farben wanted to find out if they could make use of this.The children were given normal amounts of food ­it was important to keep them alive for the duration of the experiment.  Loads of children died. At last there were twenty children left.They were aged between 3 and 12. We've got pictures of them,and we know their names,so we know exactly who they are.When the Russians liberated Auschwitz the Germans flew the children to Hamburg.  First they were taken to Neuengamme,and then they were moved to Bullenhoserdamm School in Hamburg. In the cellar there the experiments continued.  But then the English came from the west to liberate Hamburg. The SS man responsible for the children had orders from above,not to let the children fall into English hands. Nobody was to know what had happened to these children! He actually came as far as standing trial after the War, this man. He told his story himself: "I was under orders to execute the children.I gave them an injection to put them to sleep. One by one their eyes closed..."

38:30

Speaker:

We let the veil of mercy fall back over the story told by Inger from Norway. She herself was made the object of experiments in the Ravensbruck camp......where scientists in the employ of IG Farben infected her with Typhus. She was lucky to survive. IG Farben has also survived. Following judgement in the Nuremberg trials the company... was resurrected a few years later under the new-yet-old name of Hoechst. Today Hoechst is a world-leading company in the drug industry.Not least in the area of TB medicine.

39:10

Cure worse than Disease

Speaker:

Bombay's skyline. Bombay is one of the world's biggest cities.It is the financial centre and commercial heart of South East Asia. Businessmen from the West are drawn by the favourable investment climate... ...created by the IMF, the World Bank and India's government.  This is the investment climate: a never-ending stream of ever cheaper labour......where competition for jobs keeps wage costs down. This is the final destination of their long journey from the countryside.They end up here, in Darawi, the biggest slum district in Asia. Darawi is also a part of Bombay.

39:53

Anabel Mehta, socialworkersince 20 years in Bombay slum:

When I first came to Bombay I had a very good friend who was in K E M Hospital in Bombay.He showed me around the hospital and I asked him what he thought was the the biggest health problem in India. And without a moments hesitation he said: "Tb!". Probably one could call it the biggest health issue facing the city of Bombay or India as a whole.Bombay is a city of I believe 12 million people and 60 to 65 percent of these live either in slums or on the pavements. For these people, particularly the ones who are not so well off, there is no health insurance. Not for the poor, certainly, and very little even for better off people. So for an illness like tb, for which the treatment is expencive... I mean, if I´m earning even 2000 Rupees a month and I have to spend 500 Rupees a month on medicines......for just one member of the family, it´s probably impossible for me to do it.So the municipality does provide tb sort of nodule centres. But even in these centres themselves they very seldom have an adequate supply of drugs. So if you refer somebody to them or you refer to the municipal hospitals......to the chest department where they treat tb,they may be given medicines for the first month. When they go back for the second month they will be given a prescription......and told to go and buy them themselves. If they go over a four months period: two months they will get the medicines... ...two months they will not get the medicines. And a poor person will obviously stop to take medicines if they can´t afford to buy them.  So our point is: it´s better not to start somebody on tb treatment......than to get them drug resistent straight away by dropping out.  I would have thought that it´s the duty of the municipality to see... ...that drugs are available for people who need treatment.

The main problem is the medicines. I think there is no two ways about that. Why there are no medicines, don´t ask me! The medicines are manufactured in India. You can go to a chemistry you told me yesterday, you can go to a chemistry and buy all medicines!

42:24

Speaker:

Yes,  I went to one of Bombay's countless private chemists and asked... ...what they had in the way of medicine for TB.  They had everything! All the standard medicines, both from India and all the world leading drug companies. There was no need for a prescription. I got what I asked for as long as I could pay.In other words, my prescription was my rupee notes. That's a good thing? It is, if your aim is to create multidrug-resistent TB. Nothing encourages such a development like uncontrolled, incorrect medication. Too much, too little or wrongly dosed. The wrong combinations of medicines. Courses of treatment which are too short or which aren't completed. All these give rise to resistant bacteria, bacteria which are tough enough......to survive - since in effect, they've been vaccinated against medicine! The usual scenario in our day

as far as antibiotics are concerned. The cure is worse than the disease! And never have I seen cures for sale on such a huge scale, without any order......without any inspection or control. Talk about a deregulated market.

It is without a doubt very profitable. And without a doubt, it is very lethal!

44:00

 Professor´s Warning

Prof Alfred Crosby historian:

Multible Drug Resistant Tuberculosis scares me more than anything else in the world in this day. God knows there are many scary things going on  out there. But most of them I know how to avoid.I don´t know how to avoid tuberculosis which is simply transmitted by air, by breath, by coughing. And if I get MDR TB, then I don´t know what anybody does about it!There are always people running around the sky is falling, and they are usually wrong. In this instance the sky is in the act of falling. It might happen. It is falling and we neeed to do something about it fast. Because if you try to do something about it just as an individual, what are you gonna do? You´re going to stop breathing in crowds? Stop breathing on elevators? Stop breathing on the subway?As long as you inhale you´re gonna run a chance of getting tuberculosis.

45:11

Speaker:

Alfred Crosby is scarcely afraid on his own account. Professor Crosby knows that he is

not at any risk where he lives:The exclusive island of Nantucket, next door to the Kennedys' holiday paradise. Here nobody have tuberculosis.However he is in the habit of adopting a broad perspective. He's a historian - an unusual historian. His specialist area is ecology and biology. He follows the developments of diseases and epidemics over the millennia. He issues a warning from the point of view of the survival of humanity: To be or not to be - so to speak .

45:45

(Crosby continues):

In democracies you have to change opinions of a great many people and it takes a while lot of time. Usually you only get massive changes if you scare the hell out of people. And people aren´t scared of tuberculosis.

OK. Then I want you to scare the hell out of people by using the same metaphor you used the other day. Namely the petrol station. Would you please repeat that!

Biology or epidemiology can not be predicted arithmetically. It´s not like two and two equals four.  You can´t simply say that the odds are increased in favour of X or Y.  Are we gonna have a worlrd wide pandemic of tuberculosis? All I can say: it is increasingly likely that we will. And the longer we wait to do something about it......the more and more likley it is that this will happen.  What we are doing is like a person who is flicking a cigarette lighter by ab open gas tank. If you do it just once or twice or three or four times the chances are that nothing will happen. But if you keep it up and keep it up and keep it up it will blow your head off, eventually. It´s gonna happen the seventh time or

the twentieth time, I don´t know. But keep it up and it will blow your head off!

CONSEQUENTLY BLACK AS NIGHT OR IS THERE  A HOPE?  THAT QUESTION IS DISCUSSED IN PART TWO

47:21

(Tomas Frieden):

Today we have the means to control TB. We have a system, now known as DOTS......which ensures that at least eight out of ten patients are cured!

47:29

(N H Antia):

The answer that they tell us is: "Use drugs!". But don´t talk about poverty. After all, that is inevitable.

(George Soros):

It´s too utopian to expect that all of the countries of the world would eradicate poverty!

ENDS 47:47