There's a story I would like to share with you. It's entirely true and it's certainly no fairy-tale. The story tells a tale about the bacteria called Mycobacterium Tuberculosis, otherwise known as TB. In our 21st Century, you could perhaps imagine that this disease had been eradicated, wiped out for good. TB claimed the lives of the Bronte sisters, poet John Keats and George Orwell. Can you imagine then that this disease still lives on, still affects people today? Known in the Victorian era as 'Consumption', it is still alive and very present now. How do I know this? I've personally been treated for TB and I work with it.
The common conception is that TB was eradicated decades ago after antibiotics were found to kill the disease. The rates did hugely drop with the introduction of the BCG vaccination. Since the 1980's the rates of TB have increased until recently. The Tuberculosis in England Report 2016 from Public Health England (PHE) states that "a total of 5,758 TB cases were notified in England in 2015, a rate of 10.5 per 100,000 population, a further reduction since the peak of 8,280 cases in 2011 (15.6 per 100,000). There has since been a year-on-year decline in the incidence of TB in England over the past four years, down to 10.5 per 100,000 (5,758 cases) in 2015, a reduction of one-third since the peak of 15.6 per 100,000 (8,280 cases) in 2011 (Reference: Tuberculosis in England Report 2016, PHE).
Between 1st July 2015 and 30th June 2016, there were 2247 cases of TB notified in London alone" (Reference: Tuberculosis in London, Quarterly Report, PHE).
The report goes on to say that "despite the reduction in overall TB cases the number of
cases with social risk factors, such as homelessness, drug or alcohol misuse and imprisonment hasn't declined. In fact, the proportion of cases with at least one of these risk factors has increased from 9.8% in 2014 to 11.8% in 2015. Furthermore, the TB cases with these social risk factors are more likely to have pulmonary disease and drug resistance, and the outcomes for them is worse in that they are more than twice as likely to have died or be lost to follow up at 12 months post starting on treatment, compared with patients with no risk factors". (Reference: Tuberculosis in England Report 2016, PHE)
TB is a fully curable disease and can affect any part of the body (excluding hair). It is only ever infectious when it is found in the lungs (Pulmonary TB). When someone is diagnosed with TB they get started on a regime of four antibiotics. These have to be taken every day for six months. In a straightforward case of TB this will be enough to kill the disease. In more complicated strains of TB such as Multi Drug Resistance (MDR) and Extensive Drug Resistance (XDR), it all becomes much more complicated as other drugs have to be used; the treatment regime is longer - up to two years longer. Not an easy feat. The side effects from these drugs they can be quite severe and long lasting. People can die from these types of TB - but this should not be happening. First line antibiotics work really well, when they are taken properly.
The TB Nursing role is vital. We see patients get better from their TB by taking antibiotics regularly. I've witnessed sick patients with what seemed like a death sentence over their lives, walk out of hospital cured. I have seen people from all walks of life - rich, poor, homeless, people with addictions, adults, children, from most ethnic backgrounds suffer from TB and get through treatment. I have also seen the patient with every hope of getting better; fail their treatment as their challenging life issues overpowered them. In the majority, the role of the TB nurse is a positive one, as the majority of patients do get better. The TB nurse will always seek to reduce the stigma of the disease. Unfortunately it is still perceived as a 'dirty' disease linked with poverty and in many cultures seen as curse. Contrary to popular belief it is good to have a diagnosis of TB as we know it can be treated. I am living proof that resistant pulmonary TB can be treated and cured and that anyone can catch this disease (I'd had very little contact with TB when I fell ill). There are barriers to helping people overcome stigma, but conversation is one way of helping this. Let's get the TB conversations going and beat the stigma forever.
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