Surviving TB in the shadow of the city dump

Surviving TB in the shadow of the city dump in the Philippines

Published 06 September 2010

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  Sofia Perez is a volunteer health worker in Payatas, one of the poorest and most densely populated neighborhoods of Manila, the Philippines. She visits TB patients in their homes, provides free medicine and educates them about the disease.
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  Sofia: “Because of the many home visits I made lots of friends and the people welcome me. Every day they give me inspiration. I hope that patients work with us and take their medicine. I pray that one day Payatas will be TB free.” Global Fund financing allows the local health center to conduct lab tests and provide free TB medicine and education for people living in Payatas.
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  The nearby garbage mountain provides an income for thousands of people living in Payatas.
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  Because of overcrowding and poor living conditions respiratory diseases like TB are far more common than in other parts of the city.
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  In 2000 the slum settlement made world headlines when a huge mountain of garbage collapsed, killing more than 200 people.
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  Sofia pays a visit to 53-year old Reynaldo, who lives at the foot of the mountain. Reynaldo is being treated for TB. Since he got sick his wife does most of the garbage collecting.
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  Reynaldo, his wife and two of his children live in a windowless cramped space constructed with materials collected from the dump site. Under such conditions TB can spread rapidly. Fortunately Reynaldo received treatment in time and his family is free of the disease.
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  On her next home visit Sofia follows up with Jocelyn, who initially used cough syrup to treat her symptoms. In addition to providing medicine, health workers play a crucial role in educating people about TB. In Payatas this has resulted in a major reduction of stigma. TB has often been associated with unhygienic or “improper” behavior like kissing or having sex.
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  Fatima is next on Sofia’s rounds. Fatima initially believed she got TB because of handling pigs living next door. She was terrified that her children would lose their mother.
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  Relieved to learn that she could be cured, she is currently following treatment for multi-drug-resistant TB. Together with her supportive husband she is able to take care of her three sons aged three, five and eleven.
Sofia is an outreach worker visiting some of the 3,500 families who live at the dump's edges. Locals earn around 100 pesos (US$ 2,20) a day collecting plastic, cardboard, wood, glass, metal and other refuse items that can be sold to scraping agents. Overcrowded housing is constructed from materials from the dump site with no windows for ventilation. TB thrives in such conditions.

Sofia works with Philippine Business for Social Progress a social development foundation financed by the Global Fund which organizes home visits to educate people about TB, testing for those who show symptoms and medicine for TB patients. The 56 outreach workers trained by the scheme play an important role in reducing the stigma of TB and creating demand for the local health center, since people are generally reluctant to seek treatment without some encouragement.

Before the home visits no one believed TB could be cured. Since the educational program started, stigma has reduced significantly and people are more willing to go for treatment. Thanks to outreach workers such as Sofia, the local health center treated 60 cases of TB in the first half of 2010. Patients with difficult to treat strains of TB are referred to the local pulmonary hospital where they are treated for free.

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