~ by: David L K See ~
I refer to the article "Rise in cases of drug-resistant Tuberculosis" (TODAY, Mar 24). Once thought eradicated, Tuberculosis (TB) has made a comeback worldwide, including Singapore. Our densely-populated, tiny island with its hot humid climate is particularly vulnerable to the spread of infectious air-borne respiratory diseases like TB, SARS, H1N1 and Bird Flu.
Why should Singaporeans take such respiratory diseases seriously? A normal person can survive without water or food for days, even weeks. But if he cannot breathe in oxygen needed by his brain due to infected lungs, he will just die. Such air-borne diseases can be easily contracted in crowded places such as schools, universities, army camps, offices, buses and trains.
Although TB affects mostly the lungs, it can spread to other organs, such as the brain (TB meningitis), heart, kidney, bones and even the womb of a female victim, leading to the inability to bear her own children.
There are now three forms of TB to deal with — normal TB; Multi-Drug Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB). Treatment of the two drug-resistant forms is difficult and costly, with severe side effects.
In 2009, our local news headlines were "Tuberculosis rate in S'pore up for first time in 10 years", "Worrying trend: More younger TB patients and infected foreigners", "More TB patients fail to complete treatment". The 2011 headlines were "New tuberculosis cases on the rise in Singapore", "Cases of infections among non-residents on the rise".
The writing is on the wall and this is just the tip of the iceberg. The following are some of our reported TB cases:
- Foreign Domestic Workers (risk to young children under their care)
- 21-year old National Serviceman (risk to fellow soldiers)
- 30-year old teacher (risk to students and fellow teachers)
- 40-year old Managing Director (risk to office colleagues)
Last November, at a Press Conference, our Health Ministry's Communicable Diseases Director, Dr Jeffery Cutter, tried to downplay public concerns by insisting that most TB patients were elderly people. He also criticised a newspaper report for painting "a very misleading picture that a lot of our TB problems are from foreigners, which is not correct."
Ironically, Dr Cutter had previously contributed a March 2011 paper "Tuberculosis among Foreign-born Persons, Singapore, 2000-2009" to the US Center for Disease Control with these excerpts:
"…Singapore liberalized its immigration policy and underwent rapid economic growth during 2005 – 2010. This policy resulted in a marked increase in its population from 4.17 million in 2004 to 5.08 million in 2010.The proportion of foreign-born persons with tuberculosis in Singapore increased from 25.5% in 2004 to 37.6% in 2009. Of these persons with TB, more than 75% came from five of the seven countries (India, China, Indonesia, Bangladesh, Philippines) with highest incidences of TB.Transmission from foreign-born to native-born persons may have occurred, especially in increasingly crowded urban settings of Singapore. Our study highlights the need for measures to address TB among foreign-born persons in Singapore…"
Just this January, in Parliament, when queried by NCMP Mrs Lina Chiam, MOH Minister of State Dr Amy Khor disclosed, for the first time, that during the last five years, about 100 students each year were diagnosed with TB – giving a total of some 500 students.
Just last week, in a CNA interview, Tuberculosis Control Unit Director Dr Wang Yee Tang raised the concern that our younger population may be at risk of getting MDR-TB. In 2011, Singapore had 6 new cases of MDR-TB, comprising three foreign-born and three Singapore-born residents (19-year-old boy; 27-year-old girl; 30-year-old man).
It is shocking to learn that only 50% of active TB patients in Singapore are currently on Directly Observed Treatment (DOT) to ensure they complete the full course of treatment and limit their risk to the wider community. Unsurprisingly, there were 158 cases of relapse last year.
Many worrying questions remain unanswered. What are our Health Ministry's pro-active and preventive measures to tackle the growing TB public health threat? Will our Infectious Diseases Act be updated to give MOH legal clout to require all active TB patients here to undergo DOT? Is the Tuberculosis Control Unit given sufficient resources (i.e. funds, manpower, equipment) in our fight against TB?
Singapore can never win the fight against new diseases like Bird Flu and re-emerging diseases like Tuberculosis with a laid-back hush-up approach using the convenient excuse of "not wanting to cause public alarm".
Our concerned public now expect MOH Director of Medical Services, Dr Satku Kandiah, to furnish an authoritative reply backed by full facts and figures.
The writer is a 64-year old tertiary-educated Singapore Citizen who has completed full-time National Service.
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