Cambodian Journalists Alliance Association

Former TB patients describe their experiences as fight to end the disease continues

Health services organization officials meet at a pagoda with current and former tuberculosis patients, as well as others with contact with the disease, to form a community group to combat the disease. Photo taken on September 14, 2021. Photo Supplied
Health services organization officials meet at a pagoda with current and former tuberculosis patients, as well as others with contact with the disease, to form a community group to combat the disease. Photo taken on September 14, 2021. Photo Supplied

Lida knew she was sick before she tested positive for tuberculosis.

Now 34 years old, the resident of Kandal province’s Sa’ang district said she’d been coughing for about two weeks, was fatigued, had trouble breathing and was losing weight. That was more than two years ago now, and Lida has long since recovered, but she still remembers the hardships of her battle with tuberculosis.

“Villagers and neighbors also discriminated against my family because they were afraid to be infected with tuberculosis from me,” Lida said.

Lida said that while she was treating her tuberculosis, she always used separate plates, spoons, pots and other items and slept in a different place in order to protect her family.

“The first time I took tuberculosis medicine, it bothered me, and I went to the doctor and asked him why it was so bad. The doctor said it was okay and changed the medicine, and he provided some extra tonics,” Lida said.

Though treatment wasn’t always easy, it was a success. With the help of the medication, Lida was cured of tuberculosis in six months.

Her story isn’t unusual in Cambodia, nor in other countries around the world.

Falling case numbers last year reportedly pushed Cambodia out of a list of 30-most-infectious countries for tuberculosis, but the disease still lingers in the kingdom.

Rates of tuberculosis infection continue to fall gradually, but the disease still kills an estimated 13,000 Cambodians every year, according to USAID. And as the pandemic drags on with the new omicron variant, some experts say efforts to fight tuberculosis may fall by the wayside.

“The COVID-19 pandemic has reversed years of progress in providing essential tuberculosis services and reducing tuberculosis disease burden,” said Choub Sok Chamreun, executive director of health services organization Khana. “Global tuberculosis targets are mostly off-track, although there are some country and regional stories.”

Before COVID-19 took the world’s attention, tuberculosis was the main respiratory illness on the public health priority list. Though it is also a respiratory illness that can destroy the lungs when left untreated, tuberculosis is caused by a bacteria, not a virus. The Centers for Disease Control (CDC) says tuberculosis is the largest infectious disease killer in the world and estimates 1.7 billion people worldwide were infected by the tuberculosis bacteria as of 2018.

The CDC says roughly 1.5 million people globally die of tuberculosis-related illness each year.

A peddler in front of the National Center for Tuberculosis and Leprosy Control in Phnom Penh, November 11, 2021. CamboJA/ Pring Samrang

For Cambodia, a key source of tuberculosis-related data in Cambodia is the National Tuberculosis Program, an office of the National Center for Tuberculosis and Leprosy Control (CENAT). The program estimates an infection rate in Cambodia of 274 cases per every 100,000 people, meaning about 46,000 people may be infected each year.

However, Sok Chamreun says Cambodia has found only about 30,000 people in need of treatment, meaning that roughly 16,000 people could be going undiagnosed and untreated in their communities.

“If they do not find the services for treatment, they face death in the future,” he said.

Tuberculosis is not hereditary, and Sok Chamreun explained the disease is both treatable and curable with medical assistance.

The first major symptoms of an active tuberculosis infection include: Coughing for three or more weeks, sometimes with blood or mucus; chest pain, or pain with breathing; weight loss; night sweats; high temperature; fatigue; loss of appetite; and swellings in the neck. Infections can also be inactive, which are less obvious but still require treatment.

The rate of tuberculosis infection in Cambodia has decreased 20 percent since 2015, he continued, which in 2020 caused the kingdom to finally fall outside the list of the 30-most-infectious countries in the world for this respiratory illness.

“To end tuberculosis disease in Cambodia requires all parties, including patients and authorities as well as other relevant parties, to pay attention to protect and treat together,” said Sok Chamreun.

Though the pandemic did get in the way of some trainings and workshops to beat tuberculosis, CENAT director Huot Chan Yuda said treatment services and research had carried on. Cambodia hopes to end new infections of the disease by 2030 in accordance with global health targets, Chan Yuda said.

He cited statistics from WHO, which stated Cambodia had much fewer tuberculosis deaths than estimated by USAID: Roughly 2,900 cases of tuberculosis related death in 2018, 2,700 in 2019 and 3,300 last year.

Though statistics are still ongoing for this year, Chan Yuda said the country has witnessed a significant decrease in new cases.

In the first quarter of 2021, Chan Yuda said, Cambodia recorded 6,138 cases, marking a 20 percent decrease from the same period in 2020. The second quarter saw an even steeper decrease of 33 percent compared to the year prior, and, so far in the third quarter, case counts have decreased by 48 percent.

However, Chan Yuda said, that decrease may be more circumstantial than anything else.

“The reason that the number of people infected with tuberculosis has decreased is because of the COVID-19 pandemic,” he said.

Despite the challenges of the pandemic, local health advocates urge their peers to be conscious of tuberculosis.

Health services organization officials meet in the Leuk Dek district of Kandal province with current and former tuberculosis patients, as well as other local stakeholders to form a community group to combat the disease. Photo taken on January 1, 2021. Photo Supplied

Ban Sokhorn, 73, a villager who also lives in the Sa’ang district and runs a local Khana network in Kraing Yov commune, told CamboJA that 214 people there were targets for tuberculosis treatment in 2021 including 44 people who had the disease and 79 people who are using medicine to prevent it.

Sokhorn herself had tuberculosis in 1999 and recovered after following treatment for six months. Though treatment was difficult for her, she said anyone who thinks they might have the disease should go get tested.

“I appeal to the people who are suspected to have a tuberculosis infection, please go to test at the health center and treat tuberculosis disease in a timely manner,” she said.

Lida, her fellow resident of Sa’ang district, said she’d like to see more public funding go to the support of patients with tuberculosis. She says that when she was fighting the disease, she was advised against doing any heavy work.

“I request the government to supply some food and budget for tuberculosis patients while they are in treatment because they can’t do any work but they need money for their daily expenses,” Lida said.