Nolen: The first tuberculosis patient I sat in Nairobi was a man who had drug-resistant tuberculosis, or widespread XDR-TB. Essentially, the chances that the only drug we know will actually cure him are very slim. We have no choice. And he picked up his Delamanid that day, as he had been very optimistically for a week each day. And it was out of stock.
Green: What a disaster.
Noren: And I just said, “This is terrible for you, Barak. This is terrible for your wife and your five children.” They were all screened, so everyone was TB free so far. But like so many people, he was bankrupt due to his infection. He couldn’t afford to keep his wife and his children in the city, so he had to send his wife and his children to the village.
XDR-TB is scary for him, his family and all those who care about him. But it’s scary for the rest of us to go back to this apartment after this guy goes to this clinic every day. He lives with 500 other people crammed into his cheeks. That’s very bad for him. But that’s very bad for everyone else too.
Green: Yes. I think it’s important to understand that this is an individual level tragedy at hundreds of thousands of individual levels, and so is it. I don’t know how you feel about the phrase “global health.” The truth is, this is a crisis for human health, everywhere for humans. People were exposed to antibiotics that hopefully worked. And because of the stockout caused by the US government, their infections have the opportunity to develop resistance to the drug, in addition to developing resistance to many other drugs.
It can easily end up in a situation where there is no tool to combat tuberculosis. And it brings us back to the early 20th century. I’ll bring us back when my gratuncle died of tuberculosis when he was 29. He worked as a lineman at Power and Right in Alabama. His dad was a doctor and there was absolutely nothing his father or anyone else could do to save his life.
Noren: Will someone in the US get it now?
Green: Yeah, there have been around 10,000 active tuberculosis cases in the US this year. In fact, the rate of tuberculosis in the United States is rising.
Noren: Why?
Green: We are shortening our public health systems. He also does a terrible job of providing treatment where there is a need for treatment.
Nolen: I mentioned earlier that I know exactly how to live in a tuberculosis-free world, but I choose not to. Why do you think we are so happy living in that world?
