By Bae Ji-sook
Staff Reporter
Many associate tuberculosis with days long gone by when many were poor and disease was rife. Buying Christmas stamps in aid of charity was the only time people thought about the disease.
However, according to the Korean Center for Disease Control and Prevention (KCDC), the number of those with tuberculosis stands at 8.8 million worldwide, with more than 1.5 million dying every year. Most of them are from ``high burden countries'' such as in developing countries in Africa and Asia.
Some say African and Asian ethnicities are more vulnerable to the disease than Caucasians and that individual countries' willingness to combat the disease could be a critical factor, too.
Korea is not a safe zone either. It is true that the number has fallen dramatically on the government's aggressive prevention and treatment policy, but the patient number is still stuck at a certain point. The KDCD assumes about half the population to be exposed to the disease while about 3,000 die every year.
Dr. Kwon O-jung of Samsung Medical Center is one of the most passionate preachers of tuberculosis prevention and treatment. He sees dozens of patients everyday, giving them hope to live a normal life ― something they wouldn't have dreamed of when first entering hospital.
``I say tuberculosis is 95 percent curable with appropriate medication, chemotherapy and surgery. However, I see many people get scared of its name and give upon their chances too easily,'' he says.
When diagnosed with the disease, one can have two forms of it: being infected with mycobacterium tuberculosis causing a person to cough, sneeze or spit spreading it through the air; or a latent infection that eventually progresses to an active disease.
What makes the disease powerful and ``scary'' is the fact that anyone can be infected, without knowing it. Moreover, anyone can spread it.
Tuberculosis is carried through the air when people who have the disease cough, sneeze or spit. Some experts say there is at least one tuberculosis carrier in every single carriage of a metro train or bus.
Becoming infected with tuberculosis does not necessarily lead to full blown symptoms of the disease. Kwon states that about 10 percent of those infected actually develop the disease.
In the early days, the rapid spread and high prevalence was the result of malnutrition leading to weak immune systems. However, these days, Kwon says the primary reason is the tuberculosis sufferers spread it unintentionally. Since many do not know whether they are infected or not, their daily going about life could easily make anywhere a source of infection.
For instance, prevalence among youngsters is rapidly increasing ― in 1995, 15.9 percent of those between 0 and 29 years old were found to be infected. Kwon blames individuals gathering in places where air circulation is not good.
``They visit cinemas or PC game rooms where it is dark ― so one cannot see the hygienic conditions ― and the air conditioning is not good enough,'' he says.
When tuberculosis is prevalent, one coughs a lot and suffers from high fever and in the worst case shows symptoms of hemoptysis (coughing up blood). Then, it is too late because the disease has developed quite far, Kwon says.
For the treatment, rifampicin, isoniazid, pyrazinamide are the main medications while ethambutol and streptomycin are the antibiotics most commonly used. This gets rid of 60 percent of the disease.
However, what worries doctors is the ``multi-drug resistance'' strain, which has a resistance to the five drugs. These days, the number of such patients are on the rise. ``In this case, it means the patients should prepare for a long battle ― it is likely that the disease will develop into a chronic case,'' Kwon says.
When this condition presents itself doctors prescribe multiple drugs ― cycloserine, terisidon, P-aminosalicyclic acid, thioacetazone, clofazimine, amoxicillin, clarithromycin and linezolid and several others. Though not a cure, they are believed to stabilize symptoms.
``Surgery is for acute cases and it does not work under ordinary conditions,'' Kwon says.
Since Korea has a high rate of infection, the country maintains research and treatment in the area. But Kwon feels that this is not enough.
Being the nation's top scholar and medical doctor in the field, he has lots to say about the government's role in disease management. Individual doctors cannot curb the spread of tuberculosis, he says. Therefore, the government should set out measures to prevent the disease infecting more people.
In fact, the Ministry of Health, Welfare and Family Affairs has announced the ``Tuberculosis 2030'' project that is expected to slow the rate of infection to a mere 10 per one million. However, the ambitious project, which calls for ``100 percent finding, 100 percent management and 100 percent treatment,'' is drawing criticism from experts.
``In the United States and others, which have managed to see great declines in the number of sufferers and maintain steady numbers to this very day, they are very strict on those diagnosed. Many of them are requested to be isolated or at least constantly watched over so that they do not put others at risk by spreading the disease through the air,'' he says.
He says the government needs to adopt similar measures ― increase the number of tuberculosis clinics in the nation so the infected could stay there. He also laments that all the multi-drug resistance tuberculosis medicines should be covered by the National Health Insurance ― the KCDC recently proposed this to the health minister.
Most of all, he stresses the importance of raising public awareness about the disease. ``Tuberculosis is an ongoing disease that can be treated and prevented by individual's observation and regular check ups,'' he says.
Kwon graduated from Seoul National University. He was a postdoctoral research Fellow at the Department of Thoracic Medicine, National Heart and Lung Institute in London. After serving in many of the highest positions in the medical field, he now serves as the medical center's senior executive director of the department of medicine.