Under the bridge

By Joe Lowry

“It's hard to believe
That there's nobody out there
It's hard to believe
That I'm all alone”

Those lyrics come in the middle of “Under the Bridge” by the Red Hot Chili Peppers. They could apply to Doy Sen, who lives, literally, under a bridge in the village of Pang Mu, a few kilometres from Mae Hong Son in Northern Thailand.

Doy Sen is 24 and has a permanent look of confusion etched upon his face. He left his native town of Tuanggoo, Myanmar ten years ago because of the conflict there. “I am not from a poor family”, he says, but now he is, indisputably, badly off.

Three years ago he “settled” under his bridge on highway 1095, where he lives in a mosquito net, his clothes hanging on a line, his pots and plates his only real possessions. His nearest neighbours are two oxen.

There’s a stream bubbling close by, which you can see turns into a torrent during the rainy season. But it’s dry under the bridge; there are worse places to be.

When times were better he could earn 120 Thai Baht (USD4) per day in the rice paddies, but that work is irregular, all the more since he developed TB last year. He has been getting medicine every day from the local IOM-supported health clinic and will shortly be officially cured of TB.

Although he worries about his elderly mother, Doy Sen is going nowhere for the time being. As the song says: “Under the bridge, here I stay”.

One third of the world’s population is infected with tuberculosis (TB) and new infections occur at a rate of one case per second.

In the majority of cases the TB bacteria remain in the body dormant for many years, surrounded by a wall of specific cells, preventing their multiplication and spread, but about 10% of infected individuals progress to the disease of TB which kills about 2.3 million people every year. Most of these people are from low-income developing countries.

TB is overwhelmingly a disease of the poor, although people from high income countries are also getting TB and dying of the disease, if their immune systems are compromised by the effects of immunosuppressive drugs, substance abuse, chronic diseases such as diabetes or HIV.

The TB organism usually attacks the lungs, but can attack any part of the body. If left untreated, TB kills more than half of its victims.

It is spread through the air when a person coughs, sneezes, speaks, or even sings.  A single sneeze can release up to 40,000 droplets and it only takes a single inhaled bacterium to cause a new infection.

TB causes major financial hardships especially when the patient is the main breadwinner of the family. The family can lose at least three month’s income, as well as the costs of diagnosis and treatment.

About 75 per cent of active TB cases are due to TB in the lungs, marked by a bad cough, chest pain and coughing up bloody phlegm from deep inside the lungs. Other symptoms can include weakness, weight loss, loss of appetite, chills, fever and night sweats.

In the remaining 25% of active cases, the infection moves from the lungs, causing extrapulmonary TB. Symptoms of TB disease in other parts of the body depend on the area affected. Areas of the body that can be affected include the larynx, lymph nodes, pleura, brain, kidneys, bones and joints.

Tuberculosis is diagnosed by identifying the presence of Mycobacterium tuberculosis bacteria in a clinical specimen collected from a patient. While other investigations may strongly suggest tuberculosis as a diagnosis, they cannot confirm it.

Persons suspected of having TB require a medical evaluation: a physical examination, a test for TB infection, chest x-ray and laboratory tests.

When a person with infectious TB is identified  a full course of the correct dosage of anti-TB medicines should be started, with support of health and community workers or trained volunteers. The most common anti-TB medicines are isoniazid, rifampicin, pyrazinamide and ethambutol.

Supervised treatment helps to ensure that an infected person completes the course of medicine to cure TB and prevent its further spread. Treatment must be continued regularly and uninterrupted for six to eight months. The internationally recommended approach to TB control is DOTS, (Directly Observed Treatment Short-course) which is a cost-effective public health strategy to identify and cure TB patients.

The bacteria that cause tuberculosis (TB) can develop resistance to the antimicrobial drugs used to cure the disease. Multidrug-resistant tuberculosis (MDR-TB) is TB that does not respond to at least isoniazid and rifampicin, the two most powerful antituberculosis drugs. Every year, more MDR-TB cases are being reported.

The primary cause of multidrug resistance is mismanagement of TB treatment. Most people with tuberculosis are cured by a strictly followed, six-month drug regimen that is provided to patients with support and supervision. Inappropriate or incorrect use of antimicrobial drugs, or use of ineffective formulations of drugs, can cause drug resistance. Strong and enforced regulations to ensure acceptable, effective tuberculosis treatment can help control MDR-TB.

In some countries, it is becoming increasingly difficult to treat MDR-TB. Treatment options are limited and recommended medicines are not always available. In some cases even more drug-resistant tuberculosis is developing. Extensively drug-resistant TB, XDR-TB, is a form of multi-drug resistant tuberculosis that responds to even fewer available medicines.

There were about 630, 000 cases of MDR-TB in the world in 2011: nine per cent of these cases were XDR-TB.

In treating Doy Sen, the man under the bridge, along with tens of thousands of others worldwide, IOM helps ensure that the scourge of TB is contained and that migrants can travel in the knowledge that they are disease free.

Joe Lowry is the Senior Media and Communication for IOM