Washington Post (03.02.10) - Wednesday, March 03, 2010
Residents of one poor neighborhood north of Lima have been hit
hard by TB, which is fueled by poverty, poor nutrition, and
limited access to health care. The residents live close
together in ramshackle housing, so it is common for one family
member to transmit TB to the rest of the household.
"Incidence of disease absolutely follows the poverty map,"
said Carole Mitnick, a Harvard-based epidemiologist who works
with the Peruvian nonprofit Socios en Salud. "You take central
Lima, and rich and poor districts have inversely proportional
Drug-resistant TB was sparked by Peru's reliance on one
treatment regimen during the 1980s. The country's sluggish
response to the problem in the 1990s made it worse, said
Oswaldo Jave, head of Peru's national TB program.
Many area TB patients are taken to the Hospital Sergio
Bernales in the north part of Lima, where the cure rate is 85
percent. Its patient load is stretching available resources,
though the hospital receives support from the government and
Of 20 TB patients seen at the hospital each day by
pulmonologist Epifanio Sanchez, one-third have multidrug-
resistant TB (MDR TB). "We see often that colleagues use
treatment patterns that are too weak and therefore strengthen
the resistance," said Sanchez.
Poor areas lag in terms of access to MDR TB drugs, Mitnick
said. "There is a perception it's not a disease where the
victims can pay, unlike HIV, which has victims in North
America and Europe who pay very, very high prices - their
insurance companies can - that makes up for the inability of
populations in poor countries to pay," Mitnick said. "But that
option doesn't exist for TB." "This disease requires health-
system strengthening, not just getting drugs in the patients'
mouths," she added.