Bringing faith into the TB fight

By Katherine Marshall

FAITH IN ACTION

The body of Simon Bolivar, father of the Latin American revolutions, was exhumed last week in Venezuela. Hugo Chavez, Venezuela's president, is pursuing a hunch that Bolivar died of some nefarious violent act, and not, as the official story holds, of tuberculosis.

The story is a reminder of how deeply tuberculosis, or TB, has been wound up in human history. Through the ages, it was ubiquitous and feared, a slow cruel killer. A passage from the Old Testament illustrates graphically the dread around TB: "The Lord shall smite thee with a consumption, and with a fever, and with an inflammation, and with an extreme burning, and with the sword, and with blasting, and with mildew; and they shall pursue thee until thou perish" (Deuteronomy 28:22).

In wealthier countries, TB is largely a distant memory. Yet tuberculosis is not dead. The modern epidemic is, in many parts of the world, a leading killer. A new TB infection occurs somewhere in the world every second, and two billion people carry the TB infection (though most of these cases are latent, and not threatening to individuals). It is therefore a leading challenge, one of the "big three" infectious diseases that global health professionals have at the top of their priority list. Yet, though TB is widespread and highly contagious, the complexity of different strains confounds medicine to this day.

TB is more difficult to treat, both individually and from a public health perspective, than other major infectious diseases, including HIV/AIDS and malaria. It is difficult to diagnose, and treatment regimens are lengthy and exacting. As antibiotics helped defeat TB in the wealthier world, interest in research and development for new treatment options and a vaccine faltered. The recent resurgence of TB - there were 9.4 million new cases and 1.8 million deaths in 2008 besides issues arising from TB and HIV/AIDS co-infection and emerging new, drug-resistant TB strains -- has spurred increased TB-related awareness and activity.

The difficulties in moving aggressively to deal with TB are linked above all to the fact that it is a disease of poverty, with most TB-related deaths in the world's poorer countries. The difficult diagnostic and treatment regimes are especially hard to follow in poor communities and impose extraordinary burdens on the young adults who are most affected. Action is complicated by the damaging stigma associated with TB. As TB has become closely linked to HIV/AIDS, the stigma is magnified. Changes in physical condition that are common with TB can make infection noticeable and open the door for prejudice, so people postpone treatment or deny their disease. Diagnosis rates are lowest, and treatment abandonment rates highest, where TB stigma is at its most severe.

There is a major and remarkably well organized global campaign to fight TB, yet the battle is barely engaged. The journal Lancet in May published a series of articles hailing progress but underscoring how far there is still to go.

That is why and where religious communities need to be more actively and creatively engaged.

Faith-inspired organizations are keenly aware of the TB challenges, especially the religious organizations that act as primary healthcare providers, but also all who live and work in poor communities where TB is common. Large faith-inspired development organizations that focus on TB include international NGOs like World Vision, Catholic Relief Services (CRS), and the Adventist Development and Relief Agency (ADRA) and there are many others. Local congregational structures, representing the gamut of world faith traditions, play varying roles in meeting TB, encouraging people to seek treatment and helping in the long process of healing.

But despite their extensive reach, the work of faith-inspired organizations addressing TB is poorly understood. To fill the gap the World Faiths Development Dialogue has explored the topic (I lead the organization) and uncovered a wealth of action and ideas. The question now is: what next? How to make the connection between the insights of the communities that see tuberculosis day in and day out and those who lead the global campaign and direct energy and resources?

There is no magic bullet but many important, practical steps. Keeping the spotlight on the underlying challenge of fighting poverty is essential. A second is drawing far more actively on the extraordinary resources of faith institutions in communities, to encourage diagnosis, monitor and cajole people into treatment, and fight stigma. An obvious step is to break down the silos that separate those working on HIV/AIDS and tuberculosis so that the two diseases are dealt with together. Bringing the experience and voices of the faith actors into the picture seems not only obvious but imperative, and that will mean building their capacity as well as quelling inhibitions separating the groups. The challenge that tuberculosis presents today demands it.

Katherine Marshall is a senior fellow at Georgetown's Berkley Center for Religion, Peace and World Affairs, a Visiting Professor, and Executive Director of the World Faiths Development Dialogue.

By Katherine Marshall |  July 26, 2010; 12:53 AM ET

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