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Mark viewing stained slides of Mycobacterium tuberculosis bacilli

Tuberculosis is caused by the bacterium Mycobacterium turberculosis.  While other organs of the body can be affected, by far the most common infected organ is the lungs.  Untreated, the infection can result in death.

In the United States, tuberculosis has been controlled and is no longer considered to be a major health problem except in AIDS patients.  In Ecuador, AIDS patients also have a greater risk for tuberculosis, as we observed in the public hospital in Quito.  However, the tuberculosis problem in Ecuador extends beyond the immunocompromised.

According to the laboratory director of the Pedro Vicente Maldonado Hospital, tuberculosis is a re-emerging disease in Ecuador.  It had been contained in the past, but recently an increase of cases in the general population has occurred.  There were two main reasons for this.  The first reason is non-compliance with treatment.      Treatment periods are long and must be followed precisely, and the patient will feel better before treatment is complete and discontinue it if unsupervised.  Although the patient experiences relief, they are not cured until the treatment period is complete and they not only have a resurgence of disease, but also may have contributed to the second reason for tuberculosis prevalence:  drug resistance.

Even when medicine is available, patients will sometimes not comply with their treatment schedules

Entrance to the Catholic Missionary Hospital Stadler Richter in Archidona

Every health facility we visited expressed concern about tuberculosis drug resistance.  Some patients are infected with multiply-drug-resistant bacteria, and treatment is difficult.  To counter this problem, a program exists in Ecuador to insure mandatory compliance with treatment to hopefully halt or slow the emergence of drug-resistant bacteria.  Patients are required to either visit a healthcare facility daily to receive medication or be visited daily by a nurse who physically places the pill into the patient’s mouth.  This is a good program, but it only works when there are funds for treatment.  One woman we heard about has had tuberculosis for over a year and was in a treatment program that was stopped due to lack of money.  Now, funds are available again, but her condition has worsened so that she may need injectable treatment.

The hospital staff in Ecuador are knowledgeable about tuberculosis, but facilities are limited.  In the Catholic Missionary Hospital in Archidona, patients have private rooms, but they are not isolated.  Although that hospital could diagnose tuberculosis, the only hospital that can identify different strains of the bacterium in the entire Amazon region is the Evangelical Hospital in Puyo.  That hospital had modern equipment and a separate lab for dealing with tuberculosis, which was operated using good techniques.  It contained a hood and all necessary reagents were prepared in the lab as to not contaminate the rest of the facility.  Hopefully with time other hospitals can get similar facilities, but the hope for controlling tuberculosis in Ecuador lies not with the doctors, who are very competent, but with the government funding, which must remain consistent so that people can get well and drug resistance is curbed.