TB still lurks in the shadows in spite of global battle(2)

According to Chen, the optimum treatment period for people with MDR-TB is 18 to 24 months, but many patients－especially migrant workers, one of the largest MDR-TB groups－fail to complete the course: "The patients receive standardized treatment at hospitals and are supposed to continue to take medication under the guidance of doctors after being discharged. But in reality they may not take the medication as required, and sometimes the doctors lose contact with patients because they have moved to other cities and regions."

The high cost is one of the reasons that very few MDR-TB patients receive standardized treatment, Chen said. A full course costs about 30,000 yuan ($4,800), according to the WHO, a sum that puts it out of the range of most migrant workers and others in low-paid jobs. To put that figure in context, per capita GDP in China was 47,000 yuan last year.

"Some patients have received treatment intermittently for more than 10 years, but still haven't been cured," Chen said. "Imagine how much they have paid for their treatment over the years."

He said the highly infectious nature of MDR-TB, coupled with the ease of transmission, mean that in some cases entire families have the disease. "We've seen this phenomenon in rural families living in extreme poverty," he said.

Free drugs and tests

To provide a larger number of patients with more financial support, the government classified MDR-TB as a major serious disease in 2012, which means the State will reimburse as much as 70 percent of each patient's medical bills, and basic drugs and tests are provided free of charge.

"We hope that in future the medical costs of all patients with financial difficulties will be covered 100 percent," Chen said. "That would not only benefit the patients, but also society as a whole."

Although TB is preventable and curable, many patients suffer discrimination, which not only has a severe psychological impact, but also makes the task of preventing and controlling the disease far more difficult.

As one of the oldest diseases in the world, and one of the most difficult to treat effectively, TB was once feared, but that fear is diminishing, according to Scano of the WHO.

"Now, there is rapid diagnosis and there is a cure. There is no reason whatsoever for TB to be stigmatized. If a disease is stigmatized, that stigma can kill more people than the disease itself, because some patients hide away and fail to get a diagnosis, or they hide from their families when they take the treatment," he said.

Yan Xiaodong, a former TB patient who was cured after a course of treatment that lasted two years, said: "Society still lacks tolerance of TB patients or those who have suffered from the disease."

Yan spends much of his time on an online forum, where current and former TB patients discuss the illness and exchange information and support. "I've discovered that many patients are less afraid of the disease than the discrimination they are likely to encounter when looking for work," he said, adding that many migrant workers and students are compelled to remain active, but silent, in the face of the disease.

"Some students told me that they won't be allowed to return to school, even if they are cured, and some migrant workers say they have considered getting treatment at unlicensed clinics instead of hospitals because they are worried the hospitals may notify their employers, who are likely to fire them because they have the disease," Yan said.

One of the people on the forum, a migrant worker who used the cyber name Yan Xia, or "Hot Summer", said he is still concerned about how colleagues and friends would if they discovered he once had TB, even though he was cured several years ago.

For the WHO's Scano, education and public awareness are crucial factors in China's battle against TB, because greater public acceptance would result in a more-open atmosphere and reduce the social pressures on patients. "The eradication of TB is not just a task for the government, but for the whole of society, so it's vitally important to educate the entire community," he said.