VietNamNet Bridge – Sitting alone in a house bereft of possessions, skinny and frail Tran Thi Nhung looks a great deal older than her 53 years.

Both her son and husband are stricken with Tuberculosis (TB), leaving Nhung unable to maintain the family's major income came from their 2,100 sq.m rice-field.

Worried and desperate, Nhung had no other choice than to sell the valuables in her house to pay the treatment fees of her loved ones.

"All of my property has gone since my husband and son were infected with TB five years ago. My life is very miserable," said the An Lu Commune resident in Hai Phong's Thuy Nguyen District.

"I had to borrow up to VND30 million (US$1,430) to ensure TB treatment for the pair of them," added Nhung.
Her husband, Pham Van Duc, said he could no longer manage agricultural work after contracting the disease and all family work fell to his wife.

Experts have told Duc that TB is not a "death penalty" like HIV/AIDS but the treatment is a long and costly process, especially for poor people like his family.

"I know many people who have died of TB in this commune," added Duc.

Although the health sector has covered the main treatment expenses for all TB patients, many families like Nhung's cannot afford the remaining treatment course which often lasts six to eight months.

Some refuse treatment and choose to stay at home, not realising they could be a TB danger to others in their community.

Chairwoman of Thuy Nguyen District's HIV Prevention Club Nguyen Thi Thanh said many patients do not go to hospital for early TB examinations and treatment due to the financial barrier.

Last year, the Hai Phong TB and Lung Diseases Hospital treated more than 2,300 TB patients, of which more than 200 were HIV and TB co-infection cases.

The hospital deputy director Nguyen Minh Thau said though the province regularly holds awareness campaigns to highlight TB's harmful effects and possible prevention measures, but people's understanding of the disease is still limited due to poverty and poor knowledge.

Health experts say the TB virus is easily transmitted from person to person through respiration and a TB patient can potentially transmit the disease to 10-15 others each year. The number of undetected TB cases is likely to multiply in communities and cause unpredictable challenges to the health sector.

"The World Health Organisation estimated that Viet Nam has around 200,000 new Tuberculosis (TB) cases yearly," said the National TB Prevention Programme Director Dinh Ngoc Sy.

"However the biggest problem is that we have detected only 60 per cent of the country's total TB cases," Sy said.
This means there are 80,000 undetected TB patients still living alongside healthy people in communities, according to Sy.

"This really is the tip of the iceberg," stressed Sy.

Partly to blame, Sy believes, is the fact that at least a third of TB patients don't go to hospital for an examination and only a fifth of TB patients go to hospital for both examination and treatment, while the majority buy medicines for self-treatment at home or visit private medical units.

"Though the National TB Prevention Programme targets all provinces and cities nation-wide, treatment services for people does not yet cover all localities," said Sy.

Sy suggests controlling the situation by expanding the TB prevention strategy in current state hospitals to wider facilities, adding that private hospitals should be encouraged to join the TB prevention system by sending suspected cases to TB specialist treatment units.

"Local people should go to hospital for examination when they have any TB symptoms. This would enable us to see beneath the tip of the iceberg and bring the situation under control." said Sy.

VietNamNet/VNS