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FIGHTBACK TIMEBOMB DR. LEE REICHMAN SOUNDS OFF ON POLITICAL WILL, INNOVATION AND EMPOWERING PATIENTS .............................. Tuberculosis Forgotten, But Far From Gone. Are medical schools tod

TABLE OF CONTENTS 3 4 Contributors D r.LeereiChman The Importance of Political Will in TB Control 6 5Questions abouttb ERS President Francesco Blasi 8 32 60 PhiLiPPines Strength in Numbers e

LEADING THE WAY TOGETHER ...we sought to offer portraits of hope that may be able to inspire those who are currently battling TB... We at Otsuka are extremely proud to partner with the European Respi

Early morning rush hour in downtown Manila, Philippines. 2

CONTRIBUTORS Journalist and photographer are no strangers to global health issues and TB. But working together on assignment for the first time, they were impressed to find strong TB programs at work,

THE IMPORTANCE OF POLITICAL WILL IN TB CONTROL By Dr. Lee Reichman was given the opportunity to participate in this project and visit Estonia I immediately jumped at the chance to observe a program I

The first element of the World Health Organizations Stop TB Strategy is political will. This cannot be overemphasized as it is the lynchpin to all other aspects of TB control which include case detect

QUESTIONS ABOUT TB 1. What do you see as the greatest challenge to TB control today The main point now is that even though we have an overall reduction of the TB burden, we have not yet achieved any m

3. What role does ERS have in helping bring about innovations in TB treatment ERS is working a lot on TB right now. I think we need more advocacy at the EU level on TB because there is mounting evide

PHILIPPINES OVERVIEW 8

PHILIPPINES By John Donnelly maniLa,Philippines Mark Gregory de Guzman had big dreams. He was in his third year in a hotel and hospitality college when he came down with tuberculosis. His family took

THERE IS NO RICH OR POOR HERE WHEN IT COMES TO HOW WE TREAT EACH OTHER. ITS ALL ABOUT EMPATHY WITH EACH OTHER. I want to get better for my mom, so I can help take care of my family, said Mark Gregory

PHILIPPINES OVERVIEW STRENGTH IN NUMBERS TB can often tear people apart in the Philippines, its bringing many together. I FEEL BLESSED, BECAUSE OF THE SUPPORT I HAVE FROM MY SOCIAL WORKER, FROM MY M

PHILIPPINES OVERVIEW Louie Zepeda is adjusting to living with her disability as a result of TB. I now live separate from my parents and am trying hard to overcome the detachment anxieties. Dr. Mamel

I TELL PEOPLE THAT THERES NO ALTERNATIVE. YOU CANT GET CURED UNTIL YOU TAKE THE MEDICINES AS DIRECTED. Nurses at the Lung Center of the Philippines see more than 500 patients per day who come for amb

PHILIPPINES OVERVIEW Vianzon and others understand that the push to decentralization will take time. One of the concerns is that the safety net for patients social workers checking on them and other

BROKERING PARTNERSHIPS IN TB CONTROL TOWARDS ZERO TB DEATHS TB elimination can only happen if there is vigilance and commitment from all healthcare providers. Ensuring quality TB diagnosis, treatment

FIGHTBACK OTSUKAPHILIPPINES OVERVIEW OUR STRATEGIC PLAN IS MOVING TOWARD LOCALIZING TB CONTROL. WE WANT EVERYONE WORKING IN CONCERT WITH THE NATIONAL PLAN. A lab analyst at the Lung Center of the P

There is no rich or poor here when it comes to how we treat each other, said Denice de la Cruz, also a teacher. Its all about empathy with each other. They were enjoying a meal in the shade on a warm

IF THE LORD SAYS, YOU CARRY THAT CROSS, YOU CARRY THAT CROSS. Mildred Fernando has overcome many hurdles to beat her TB but she is finally ready to live her life again. 18

PHILIPPINES OVERVIEW FACES OF TB MILDRED FERNANDO What happens if you get extensively drugresistant tuberculosis twice One womans story. 2 ildred Fernando is 29. Many of her friends are married wit

PHILIPPINES OVERVIEW In November 2001, a doctor first diagnosed Fernando with the disease. That led to a series of missteps over the next several years by private doctors who made such simple errors

One bright spot to her ordeal Mildred met John Stuart Pancho, her nurse who later became her boyfriend. Having recently been cured, Mildred is taking advantage of some simple joys in life, like picki

PHILIPPINES OVERVIEW FINDING STRENGTH A patients story industry, was diagnosed with tuberculosis in 2007. He saw a private doctor and started and stopped treatment several times over the next three y

Mark Gregory de Guzman at home with his mother and younger sister. Mark used to enjoy running but his cough prevents him from much physical activity. He looks forward to resuming his runs following t

PHILIPPINES OVERVIEW BREAKING BARRIERS A nurses story Nurse Hernando Caseria, Jr., has been working at the Lung Center of the Philippines for 18 months treating multidrugresistant TB patients. His f

Like so many other healthcare workers, Hernando Caseria, Jr. brings a personal dedication to his job. Every morning from approximately 8 am to 12 noon a rush of patients arrive at the Lung Center of

SNAPSHOT PHILIPPINES Children are particularly vulnerable to TB. The disease occurs in its most severe form among the youngest such as in Glenn Canoy, 13, who suffers from a severe form of extra pulmo

Children play in the Quezon City neighborhood of Manila, Philippines. 27

Top left Two girls gaze at the Pasig River running through metro Manila. Top right The Philippines is a deeply religious country. About 80 of the population is Catholic. Patients receiving DOT at the

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The greater Manila area contains more than 11 million inhabitants, comprising 13 of the national population. 30

PHILIPPINES OVERVIEW TB BY THE NUMBERS PHILIPPINES 2010 With 93 million people in total spread across an archipelago of 7,107 islands, TB treatment must be localized so that patients can receive the

ESTONIA OVERVIEW 32

ESTONIA By John Donnelly tartu,estonia Estonia had to do many things right in its fight against multidrugresistant tuberculosis MDRTB. It needed to treat ordinary TB effectively. It needed to control

WE KNEW THAT CONTROLLING TB IS COSTEFFECTIVE YOU SAVE WHEN YOU STOP THE SPREAD OF CASES. Agne Nikandrove sits in a local restaurant in Vorumaa, near her hometown. She is proud to have beaten her TB

ESTONIA OVERVIEW THREE FRIENDS, FIGHTING MDRTB TOGETHER Their story of supporting each other is one of the countless unsung reasons for Estonias success. IT WAS MOST IMPORTANT THAT THESE THREE PEOPL

ESTONIA OVERVIEW But Estonia bounced back and regained control of MDRTB. Experts say the main reason was that political leaders made the fight a priority. We had political support and commitment at t

Dr. Lea Pehme and nurse Evi Kivi examine a chest xray. WE TRAINED NOT ONLY THOSE DIRECTLY IN THE TB PROGRAM BUT ALSO ALL ADMINISTRATIVE STAFF, PULMONARY SPECIALISTS, FAMILY DOCTORS, AND NURSES IN THE

ESTONIA OVERVIEW The stigma of TB is very strong in Estonia. Pille Kapsi lost her job as a kindergarten teacher after parents complained she would infect their children despite the fact negative cult

For more than seven years the UK Ukrainian AIDS Response has provided expertise, project development and oversight to organizations in Ukraine and Russia, and in the Central Asian Republics, the Balti

FIGHTBACK OTSUKAPHILIPPINES OVERVIEW Every day I think about that day when I wake up in the morning and wont have to take my pills anymore, says Annika Negin. SHE HAD TO TAKE THE DRUGS, NO MATTER H

In 2007, Margot, married and with two young children, had a persistent cough and saw a family doctor, who diagnosed her illness as pneumonia. But antibiotics didnt make her feel any better, and a year

FIGHTBACK OTSUKAPHILIPPINES OVERVIEW RAIDO WAS REALLY NERVOUS ABOUT THE OPERATION. HE WANTED TO RUN AWAY FROM THE HOSPITAL. Raido Remmeglas still has a long road ahead of him. He has been in treatme

Raido is very kind, he has a warm heart, and he is very thankful for everything, she said in the clinic. He needed to talk. The most important thing was to let Raido talk. So we listened to him. When

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space to fill. Share Your Story Here www.TBinnovation.org TB can affect anyone, anywhere. The stories in this magazine represent only a fraction of the millions of lives all around the world who are

WHAT I DIDNT KNOW, OR DIDNT SEE, WAS THAT THEY ALSO GAVE ME TB. Former patient Ave Peetsman has a special bond with her daughter. My other children are all boys. They are wonderful but they are boys,

ESTONIA OVERVIEW TB AND ALCOHOLISM BREAKING THE CYCLE TB doesnt just affect alcoholics in homeless shelters or dingy quarters. It also affects children in their own homes. 2 ve Peetsmans parents dr

ESTONIA OVERVIEW A paper published three years ago in the BMC Public Health journal did a systematic review of studies on whether there was a relationship between alcohol problems and TB and found th

Ave Peetsman and her daughter Karoliis at home with the family cat. Mother and daughter enjoy drawing together. When Ave was sick, Karoliis drew her a picture almost every day like the one seen here.

ESTONIA OVERVIEW TAKING CONTROL A doctors story Dr. Manfred Danilovits, the head of the Department of Tuberculosis at Tartu University Clinics and a coordinator of the National TB Program, has been

What was most important for us was government support. Raido Remmeglas has been a patient of Dr. Danilovits for nearly five years. From left to right Kaja Hurt, Tartu University Hospital, TB Departme

ESTONIA OVERVIEW PROVIDING HOPE A nurses story Several patients singled her out for her kindness. In particular, she has grown close to one patient, Raido Remmelgas, who by the end of 2011 had been i

Evi Kivi, a TB nurse, tries to support the younger patients in the hospital. They need people just to listen to them. The most important thing I can do is be there to listen. OUR WORK IN MEDICINE ALS

SNAPSHOT ESTONIA Nestled along the Gulf of Finland, Tallinn is Estonias largest city and its capital with a population of nearly half a million. The Old Town of Tallinn is a designated UNESCO World He

Agne Nikandrove is finally enjoying a TBfree life. During her treatment she would go sledding on a hill near the clinic or eat in the mall she likes to visit with her friends. Margot Anitskin on a cl

Margot Anitskin at the Tallinn Christmas Market. Dr. Piret Viiklepp of the National Institute for Health Development has been a tireless advocate for TB patients in Estonia. She works long hours and

Agne Nikandrove and her sister walk through their hometown on a cold December morning. Support from family members like her sister helped get her successfully through the treatment. 57

People who have TB need help, says Annika Negin. They dont want to speak about their illness but you have to speak with them. 58

ESTONIA OVERVIEW TB BY THE NUMBERS ESTONIA Following the collapse of the Soviet Union there was a great deal of disruption to health systems such as that in Estonia. Today, Estonia is back on track b

PERU OVERVIEW 60

PERU By John Donnelly Lima,Peru On the chest Xray, the doctor pointed out an area of inflammation on the left lung. Inez Youri Naola leaned forward in her seat. Her stomach was a ball of knots and she

PLEASE, GOD, LET THERE BE NO PROBLEM FOR ARIANA. Dr. Epifanio Snchez examines 5year old Ariana Naola for TB. 62

PERU OVERVIEW IN HOUSES, TB INFECTS ALL INCLUDING THE CHILDREN Adults are giving TB to their children because of the close proximity of their lives. PRESIDENT OLLANTA HUMALA HAS MADE THE FIGHT AGAI

PERU OVERVIEW In his travels around the country, the president saw TB as being the biggest health issue in Peru, said Dr. Antonieta Alarcn, the coordinator of the National TB Program. He has all the

IF LIMA WERE A COUNTRY, IT WOULD OUTRANK ALMOST ALL COUNTRIES IN LATIN AMERICA AND THE CARIBBEAN FOR MDRTB CASES. 65

ESTONIA OVERVIEW Dr. Antonieta Alarcn, the coordinator of the National TB Program, and her team are responsible for coordinating an ambitious government plan to reduce incidences of TB and increase c

3 million people every year fail to get appropriate care for TB FINDs aim is to help drastically reduce this figure, especially for the most vulnerable populations that are often missed. FIND is devel

FIGHTBACK OTSUKAPHILIPPINES OVERVIEW CHILDREN, ESPECIALLY IF THEY ARE MALNOURISHED, ARE AT GREAT RISK. Children of all ages are treated for TB and other diseases at the Instituto Nacional de Salud

This is key, Bayona said. I can have the best drugs to give to patients, but having the best drugs will not guarantee that the patient will stay on treatment for two years. Dr. Oswaldo Hctor Jave, a f

FIGHTBACK OTSUKAPHILIPPINES OVERVIEW Antonia Naola breaks down after hearing her granddaughter has TB. WE ALWAYS WORKED HARD SO THIS COULD NOT HAPPEN. AND NOW IT HAS. 70

Ariana Naoloa, at home with her family in North Lima. She is one of three children living in the house who is infected with TB. Its particularly important now because one of her sons has stopped taki

HOW IS IT POSSIBLE THAT SOMEONE WHO GETS GOOD GRADES, DOESNT SMOKE, WHO IS GOOD AT SPORTS AND EVEN HAS ALL THESE MEDALS, GETS TB 72 Henry Gonzalez wearing his first prize medals from various karate c

PERU OVERVIEW FACES OF TB HENRY GONZALEZ Cured of TB, Peruvian tackles new challenge Running a marathon. 2 TODAY HE SAYS HE IS STRONGER FOR IT AND WANTS TO SHARE HIS STORY TO GIVE HOPE TO OTHERS WI

PERU OVERVIEW There was definitely a moment when our extended family was very worried about us, but the whole experience also made us stronger, he said. What made him stronger One thing, he said, was

I didnt feel sick at first. I was still competing in karate tournaments even though I was infected with TB and didnt realize it. Henry training for an upcoming marathon with two friends. 75

PERU OVERVIEW DOCUMENTING CHANGE A journalistfilmmakers perspective Sonia Goldenberg, a journalist and filmmaker, produced a documentary film called Amor en el Aire Love is in the Air, which documen

Sonia Goldenberg, Stop TB Partnership Ambassador. 77

PERU OVERVIEW TAXI CAB CONFESSION A husbands story we didnt realize how true these words were until we met Carlos Franco, the driver who accompanied us during the Peru portion of this project. Arrivi

Lima Cathedral on the eastern edge of Plaza Mayor. Carlos Franco is a taxi driver in Lima, Peru. He and his wife had four children three are living and one died as a young man in an accident. In 2005

SNAPSHOT PERU With nearly 9 million inhabitants, Lima is the fifth largest city in Latin America. Its sprawling size covers an area of approximately 800 square kilometers that runs from coast to mount

Dr. Oswaldo Hctor Jave examines a patient at the Dos de Mayo Hospital in Lima. Locals gather at lunchtime in the University Park of San Marcos in Lima, Peru. 81

PERU OVERVIEW Frank Bilcas is an XDRTB patient. Bilcas first contracted TB when he was 17 and because of the illness had to drop out of high school. One thing the illness did for me was that it turne

Dr. Hernn Del Castillo Barrientos is a pneumologist at the Instituto Nacional de Salud del Nio in Lima. The TB threat in Lima is serious, says del Castillo, particularly for children in infectious hou

Lima is comprised of thirty densely populated districts and a mix of architectural styles ranging from early Spanish colonial to French neoclassical. 84

PERU OVERVIEW TB BY THE NUMBERS PERU Peru has one of the highest TB burdens in Latin America with the vast majority of cases concentrated in the capital of Lima. On paper, the number of cases appears

CAREGIVER OVERVIEW 86

PERSONALLY By John Donnelly Lima,Peru In this capitals brown hillsides, in villages nestled in the darkgreen forests of Estonia, and inside the crowded riverside communities in Manila, there is one c

VARGAS, A MOTHER OF TWO YOUNG BOYS, PRESENTED AN OMINOUS CHALLENGE SHE WANTED TO DIE. Melissa Vargas with her son. I kept going for my children, she says. I thought of them every day. 88

CAREGIVER OVERVIEW CAREGIVERS THE FRONTLINE OF TB TREATMENT For some healthcare workers, treating patients with TB is more than a job, its a life calling. o help a person with MDRTB get well, there

SHE SAID SHE WAS THERE TO TAKE HER TO A PSYCHIATRIST. THE MOTHER REFUSED. THE NURSE DEMANDED IT. THE MOTHER WENT. Ruth Espinoza of Socios en Salud in the home of Melissa Vargas. She visits her every

The next morning, the nurse appeared at the young mothers house. She said she was there to take her to a psychiatrist. The mother refused. The nurse demanded it. The mother went. Today, several months

ESTONIA OVERVIEW A nurse at a clinic in Estonia keeps track of each patients medication and makes a note of who came in and reports those who did not so that clinic staff may conduct appropriate foll

Asked how many defaulted, she said 12 out of 480 had stopped taking their drugs last year. Told that number seemed low compared to many HIV treatment programs, Atienza said she looked at it differentl

We hear a lot of statistics quantifying the TB crisis, but theres only one number the TB Community is focused on zero. Zero new infections, zero deaths, zero stigma and zero discrimination. Today, par

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