I don’t see myself going into public health. I know that there are other ways to be involved in the fight against MDR-TB, I also know that that is the most direct route. I do know that my commitment to fighting AIDS has been renewed by this project. As a gay man I know the damage that a disease of the disenfranchised can bring. Probably the way I will fight MDR-TB is by proxy and within my own community. I will continue to fight for responsible sex practices and access to education and protection. I also will continue in my commitment to responsible use of antibiotics. It is steps like these that will change the world.
MDR-TB is an issue that is very difficult. Indeed, my last guide to action is rather strained. It is—for now—a disease entrenched in the poor parts of the world. It is complicated by its affinity for AIDS. It afflicts people who are already disenfranchised. Yet, I take hope from the fact that we can stop the spread of AIDS. In many parts of the world birth control and education have stopped at the very least the growth of the AIDS epidemic and in some parts it has reversed it. This is the first step in breaking the stranglehold of the disease that travels in its wake. The future is could be far bleaker.
I am rarely surprised by the cruelty of humanity—one might even say I’m desensitized. But because I feel that health is fundamental to life, I can hardly imagine a human being callous enough to deny someone medical care simply because they are a citizen of a foreign country. Nonetheless, it is common practice in South Africa to dump migrant workers with TB over the border—a death sentence for both the patient and the people they might infect. It is wrong, plain and simple. Moreover, it only augments the epidemic, putting as all at risk.
This project has made me more aware of what drugs I put in my own body. I was never one to take a good deal of medicine; I’d rather not deal with side effects. Unfortunately, last week I somehow got a corneal abrasion; basically I had a hole in my eye. Part of the treatment was a prophylactic anti-biotic. Normally I’m opposed to this kind of medicine—and MDR-TB should say something about why—but the risk of infection was too high. I was told repeatedly to not miss doses and finish it. I was never told why, but the reason is obvious. They did not want to create drug resistant strains. I finished out the drug exactly prescribed, and was careful about it in part because of this blog. Hopefully one of the lessons we can all take away from MDR-TB is to remember that drugs are only somewhat effective and only that much when used correctly.
I am surprised to learn just how prevalent the link between MDR-TB and HIV/AIDS is. This shouldn’t come as such a surprise. It’s clear that an immunocomprimised individual would foster illnesses and not be able to supplement the antibiotics that were used to fight said illness. Nonetheless, the pattern of the disease looks like reports on HIV/AIDS a decade ago. Sub-Saharan Africa, Russia, New York, Los Angeles, Haiti—these are all places that AIDS festers in. The underlying problem is that the same things that make treating HIV so difficult are repeated again in TB. It not only follows in HIV’s footsteps, it has the same footprint.
There is a striking amount of literature available on the subject of MDR-TB, however, the issue is mostly unknown in Western nations. This is in part due to our faith in medicine. It would seem an anathema that any disease could evade modern medicine, especially once defeated. But indeed, the evidence is there—and not just for MDR-TB. Another reason is apathy. We don’t—and I am as guilty of this as the rest of us—care about events that take place in some of the most remote parts of the world. But if pandemics have taught us anything, even the most selfish of us should care. The result is that nations are unwilling to finance programs to prevent a pandemic that originates beyond their borders.
In the 1950’s, a mathematician debunked the idea of describing the weather in simple equations by proposing his now famous butterfly-effect. The idea is that small things—like the flap of a butterfly’s wing—might have an enormous impact on the entire world. This idea has transmuted into other branches of science and popular thought. Applied to epidemiology and foreign policy, it demands that we look at the world as an interconnected system. Simply put, we cannot afford to develop isolationist policies. In the short run this must mean policies that promote the funding of the responsible distribution of drugs and in the long run promote stability, a key component of establishing good healthcare. Without that focus, we run the risk of pandemic.