Copyright ©2013 NPR. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

DAVID GREENE, HOST:

Tuberculosis remains one of the most deadly infectious diseases in the developing world, even though it's relatively easy to prevent. Ventilation, sunlight and simple infection control measures can significantly cut the transmission of the airborne bacteria. But unfortunately, TB often spreads among the poorest of the poor, which makes it hard to suppress the disease.

As part of our ongoing series looking at TB around the world, NPR's Jason Beaubien recently traveled to the Central Asian nation of Tajikistan. There, he found an epidemic being stoked by a lack of adequate medical care, poverty and myth.

JASON BEAUBIEN, BYLINE: Earlier this year, four-year-old Orion Qurbonaliev was withering away in a tuberculosis ward in southern Tajikistan. TB meningitis had paralyzed the right side of his body. He weighed just 18 pounds.

Tina Martin, a nurse with Doctors Without Borders, says when she first saw the four-year-old in the hospital, he was dehydrated and severely malnourished.

TINA MARTIN: Before we arrived, limited resources being as they are and limited education, they kind of just left this kid to die.

BEAUBIEN: But Martin wouldn't accept that the boy's case was hopeless.

MARTIN: And we said he doesn't have to die. We can do things, and we'll fight and see what happens.

BEAUBIEN: She pushed for an intense treatment at the hospital with the correct antibiotics to fight the TB infection and steroids to reduce the inflammation around his spine. A few months later, Orion had returned home.

(SOUNDBITE OF A DOG BARKING)

BEAUBIEN: Orion's family lives in a cluster of mud-walled houses outside the southern Tajik city of Vose. Cows are tethered in the dusty dirt yard. Turkeys, chickens and dogs wander amongst a whirlwind of children. Orion is lying on a small mat on the porch of the main house. A white bird in a cage clucks and coos beside him.

(SOUNDBITE OF A BIRD)

BEAUBIEN: Orion still can't speak or walk, but he's slowly regaining movement in the right side of his body.

MARTIN: See, this is new. This tremor, he didn't have that before.

BEAUBIEN: Orion smiles broadly at Martin as she checks his chest with a stethoscope.

MARTIN: He's not malnourished anymore. He's still not speaking. He has some deficits. He needs a lot of rehabilitation, but he's actually doing much better.

BEAUBIEN: He's gained almost 10 pounds since she first met him earlier this year. But Martin is now worried about the rest of the family, and who else may have TB. Orion's older brother Higeron was recently hospitalized with TB. The grandmother has been off and on TB treatment for years. And Martin has just confirmed that the matriarch still has active, infectious TB.

Talking to a group of family members who've gathered around Orion on the porch, Martin tries to stress that the whole family should get screened for the disease.

MARTIN: So we're concerned because what illness they have can be transmitted. So you can share the infection.

UNIDENTIFIED MAN: (Foreign language spoken)

BEAUBIEN: And she says that anyone who has TB should sleep in a separate bedroom. But Orion's grandmother, Kholbibi Abdulloeva, doesn't want to talk about this. She insists that TB comes from the river, and she's told all the kids repeatedly, including Orion, to stay away from the cold water.

KHOLBIBI ABDULLOEVA: (Foreign language spoken)

UNIDENTIFIED MAN: He likes fish. So he was saying, fish, fish, and he would go into the river. That's why he got the TB.

MARTIN: So TB is not spread through cold water.

ABDULLOEVA: (Foreign language spoken)

UNIDENTIFIED MAN: She says no, it's from cold.

ABDULLOEVA: (Foreign language spoken)

UNIDENTIFIED MAN: She says even me myself, I got it from cold.

MARTIN: So we worry because there are other people in the family coughing. And we ask about coughing all the time.

BEAUBIEN: As Martin tries to explain again, that TB is transmitted through the air, one of Orion's aunts shows up and joins the grandmother in arguing against this scientific fact.

UNIDENTIFIED WOMAN: (Foreign language spoken)

UNIDENTIFIED MAN: So still, they still don't believe that it's through cough because she says she has the TB for six, seven years and Orion just got it recently. So it's been seven years, only Orion got it.

MARTIN: And Higeron got it.

ABDULLOEVA: (Foreign language spoken)

UNIDENTIFIED WOMAN: (Foreign language spoken)

UNIDENTIFIED MAN: Higeron got it because in the evening he went to the river and he was swimming.

ABDULLOEVA: (Foreign language spoken)

UNIDENTIFIED MAN: The water is the reason.

BEAUBIEN: Martin says she's very concerned about this family.

MARTIN: This is a very close family. They live together. They eat together. They sleep together. And as TB is airborne transmission, the family is re-infecting each other over and over again.

BEAUBIEN: Another difficulty in tackling TB here in Tajikistan is that people who have it are shunned. One of Orion's cousins, 22-year-old Dilshod Ghazoev, says it's shameful even to have a family member with tuberculosis.

DILSHOD GHAZOEV: (Foreign language spoken)

UNIDENTIFIED MAN: So he says Even if they kill me, if I have TB, I'm not going to tell anyone that I have TB, because I'm going to be ashamed of that.

BEAUBIEN: Ghazoev says people are scared of the disease and don't want to be around anyone who has it.

GHAZOEV: (Foreign language spoken)

UNIDENTIFIED MAN: So, he says if I have TB, then I'll have less friends and people won't talk to me. And, for example, their parents are going to talk to their kids that don't hang out with that guy or don't eat food with him.

BEAUBIEN: Left untreated, tuberculosis can consume a person's lungs, spread through out the body and eventually be fatal. The difficulty with treating TB is that it takes months of antibiotics - sometimes even years - to drive the bacteria out of a person's body.

Tajikistan is the poorest country in Central Asia and it has the highest rate of tuberculosis in the region. This is not a coincidence.

The country's clinics and hospitals are overcrowded and under-funded. The winters are bitterly cold and families tend to crowd together in one room. There's a lack of education about the disease. Some people even think the coughing and wasting away is a genetic condition.

MARTIN: Because it impacts families. So father has TB, daughter has TB, granddaughter has TB. So you can understand in a way that they believe it is genetic. And so that actually has huge impacts on the ability of a child to get married later in life. So they try to hide TB. So we find that is a big problem.

BEAUBIEN: And containing a potentially, deadly airborne disease, when no one wants to admit they have it, is nearly impossible.

Jason Beaubien, NPR News.

(SOUNDBITE OF MUSIC)

GREENE: And Jason's reporting on Tajikistan will continue. Later today on ALL THINGS CONSIDERED, he'll examine the special problems presented by children with TB in that country.

Copyright © 2013 NPR. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to NPR. This transcript is provided for personal, noncommercial use only, pursuant to our Terms of Use. Any other use requires NPR's prior permission. Visit our permissions page for further information.

NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR's programming is the audio.

Comments

 

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.