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Hope and despair for new entrants with TB

The ambiance is serene. Except for the sound of television, there is hardly any other noise at the semi detached Block 9 at Muhaisnah Medical Fitness Centre.

Perhaps the masks, that leave only their eyes uncovered, prevent them from sharing their feelings, aloud.

The masked figures tread cautiously around the facility, inwardly afraid of possibly contracting the worst of the disease they already have. Block 9 or the infectious diseases ward of the Dubai Health Authority is temporary home to those suffering from pulmonary tuberculosis.

Caught just before they could infect others in the community, the centre provides free-of-cost treatment and medicines to all those admitted before sending them back home.

Maintaining the Medical Fitness Department currently costs the Dubai government up to Dh1.5 million annually - the highest cost incurred on any health department in the emirate.

“This excludes medication,” says Dr Hassan Shurie, Consultant Head of Technical Services at the department.

All new expatriates seeking a work permit or residency in the UAE are required to undergo a chest X-ray that will expose any infection in their lungs. Tests are also done for HIV, leprosy and syphilis, and Hepatitis for some categories of workers.

While those suffering from syphilis are treated and allowed to take up jobs in the UAE, those with HIV and tuberculosis are deported and can come back to the country only after six months and if completely cured. “This is the federal law,” says Dr Shurie. While it would be a mild cough with fever for some, others would already be spitting blood before the nature of their illness was confirmed. Chronic weight loss and cough, breathing problems and fever all point to pulmonary TB. But no one admitted at the centre knows how they could have contracted the disease.

The UAE, being a signatory to the World Health Organisation, follows International Health Regulations which require treatment of all open TB cases rendering them non-infectious before allowing them to board an aircraft.

“The person has to be treated until a test done weekly declares him/her disease free and fit to travel.” As a precaution, tests are also done for those who come in contact with the patient. “This is a treatable and curable disease, and we want all people to come forward and seek treatment,” he adds.

The 46-bed ward does not house patients more than two months at a stretch. “The patients usually recover between four to eight weeks following intense treatment and are sent home with instructions to continue medication and join clinics in their home countries,” says the doctor. However, relapse often occurs since patients stop their medication once they recover partially.

“It is absolutely important that the patient does not interrupt treatment since this could eventually lead to multi-drug resistance problems which are now a major issue in sub-Saharan Africa,” says Dr Shurie.

Multi-drug resistant cases that take more than two months to cure or require secondary line therapy are shifted from the centre to Rashid Hospital’s infectious diseases ward or Ward 14 that can accommodate up to 20 patients. The stay here could sometimes last even for over a year if the patient is compliant.

The screening process is done cautiously and each of the suspicious cases is double-checked to avoid error. A radiologist screens the X-ray films, and if abnormality is suspected, the ‘client’ is subjected to sputum tests for three consecutive days. If the three tests are negative, then the case is referred to the TB committee consisting of four doctors to decide if it is an old TB case.

Treatment is done in two phases with the patient required to take four drugs during the intensive phase which lasts for two months, and two drugs for the maintenance phase. Sputum tests done weekly either mean that the patient is either ready to be sent back home or shifted to Rashid Hospital for further care. Reflecting Dubai’s demographic nature, the bulk of patients are from India, Pakistan, the Philippines and Bangladesh. Some are from other Arab countries and Africa.

Each day, the centre screens up to 3,000 people and shares the results with the immigration authorities. However, since the new federal ruling came into effect, the numbers have fallen. Until July this year, 2,211 people suffering from HIV, TB and Hepatitis B were declared medically unfit.

asmaalizain@khaleejtimes.com