On World Health Day (7 April 2015), the Global Fund reports on the continuing battle against tuberculosis, in Honduras, Myanmar, the Philippines and the Ivory Coast.

In Honduras:

Elder Cualez has spent 11 years serving a drug sentence in a prison in Honduras. In its narrow and overcrowded corridors, he found his calling. Elder is a volunteer TB counsellor for fellow inmates, participating in an innovative partnership that brings together law enforcement authorities, local hospitals, churches and inmates to provide treatment to a vulnerable population that has long been neglected. “I saw the need. My fellow inmates were suffering,” Elder explained.

TB rates in Trujillo Prison are high compared with civilian population in nearby towns. Full capacity is supposed to be 150 inmates, but currently there are more than 300. There are no cells, just open bunks and a common area. Beds stack three high, and some inmates sleep on mattresses in the narrow corridors.

Elder’s days are busy. He is constantly touring the prison, greeting inmates, checking in and making sure they adhere to their treatment. “Life is not easy for any prisoner here,” said Elder. “Especially in the beginning, when you don’t know anybody. The support we get from the TB program is really important.”

The program, supported by the Global Fund partnership, began in 2012. Volunteers are trained, accompany inmates to the prison health center, and often meet in an area that serves as a church to discuss cases, where a rendering of the Virgin of Guadalupe looks on. Inmates who test positive for TB also get an HIV test.

The program reaches beyond the prison walls. A supermarket provides meat, distributed to the prison by the local church and the fire department, because in the past deficient food has resulted in lower treatment success rates. A local judge may reduce a sentence if an inmate adheres to treatment or becomes a peer educator. Law enforcement authorities say community partnership is vital. “It’s my duty to keep the prisoners alive,” said Ramón Bonilla, director of the prison.

As a volunteer in the fight against TB, Elder has found some personal redemption for his mistakes. “I failed to take care of my family, but at least I can mean something for the community.” He is due to be released in September and is looking forward to spending more time with his children, who now only see him during brief prison visits. Once he is free, he wants to study, and find a meaningful job. “I want to work in health, perhaps as a lab technician.”

In Myanmar: 

When community health volunteer Cherry Moe finds people suffering from a persistent cough or other symptoms of TB, she has good advice: Go to Dr. Yu Yu May’s clinic on the outskirts of Mandalay. The visit and medicines are free, and the doctor’s clinic doors are open from morning till evening.

Dr. Yu Yu May’s clinic is one of more than 1,500 general practitioners throughout Myanmar that are part of the Sun Quality Health Clinic franchise, begun by PSI, the international non-governmental organisation in 2001. It aims to equip general practitioners throughout Myanmar with training to treat TB in line with national disease strategy and international treatment guidelines. TB treatment is provided by Myanmar’s Ministry of Health, and general practitioners receive approximately US$2 for each patient they treat. In 2012, Sun Quality Health Clinics throughout the country reached approximately 20,000 people.

In addition, the initiative provides training to the Community Health Volunteers, and technical support to doctors to use data entry tools so that the patients they treat are documented in national health data—an essential part of efforts to effectively combat TB.

In the Philippines:

Multi-drug resistant tuberculosis left Louie Zepeda blind and at risk of infertility. An architect from Manila, Philippines, Louie suffered terrible physical symptoms, from the disease and also from the intense treatment it required. “The side effects of the treatment to my body were nausea all day, vomiting 30 minutes right after drinking, darkening of my skin,” Louie said. “My left foot folded on its own, my hands wiggled in the first months, and I couldn’t feel some parts of my body sometimes. I lost a lot of weight.”

It was eight years ago this month that Louie collapsed and was diagnosed with tuberculosis meningitis. She had been considering a move overseas. Her diagnosis, and treatment, was compounded by the way other people looked at her. A stranger told her she’d been punished by God, and didn’t deserve a partner. She fell into a deep depression.

Yet Louie considers herself lucky. She is getting treatment, as only one in three people with tuberculosis do. Today she has children, a loving husband and a growing role as a tuberculosis advocate. As Louie prepared to travel to Australia to address a parliamentary function marking World Tuberculosis Day, she spoke of the life events that have punctuated her challenges. “Every time that I go so low, I get opportunities like the scholarship, the international speaking engagements, marrying my boyfriend,” she said. “He didn’t leave me after the disease and losing my vision, and now I have a beautiful daughter. It just amazes me sometimes that I can only see these unbelievable factors after fighting for my second life.” She displays an optimism that is infectious. “Good thing that I went blind in this decade, when bionic eyes are starting to be discovered. I’ll just wait for my eye opener.”

In Ivory Coast:

The area outside the Tuberculosis Treatment Center in Koumassi, one of the poorest and most densely populated neighborhoods in Abidjan, has been transformed into a waiting room. Every morning at 6:30 A.M. or so, well before the other patients, those with multi-drug resistant tuberculosis, or MDR-TB, start showing up. Many feel tired, weak and wear a white mask, as they come to get medication.

Venance, one of 30 patients being treated at the center, is 32 years old. He had been coughing for a number of months before TB was detected. He was given a six-month treatment plan, but he often forgot to take his pills. When he was re-examined, he had MDR-TB. “I have been coming here every day for two months now, and they always give me 14 pills and an injection. When I swallow the pills, it feels like my whole body is resisting and it often makes me vomit,” he said. “I have to follow the treatment plan for another seven months. The worst part for me is being snubbed by other people, the way they look at me when I wear the mask.”

TB is a public health problem in Côte d’Ivoire. In 2013, 25,300 people were treated for uncomplicated TB. In addition, health authorities are highly concerned about the increasing number of cases of MDR-TB, with 320 people currently being treated. Cases have been diagnosed at military bases, prisons and schools, and all patients are now being treated at five places in Abidjan.

Maxime Djangone Bi is a social worker, trained and working as part of the Ministry of Health’s National Anti-Tuberculosis Plan. He comes to Koumassi once a week. “Our youngest patient is eight years old, and he is fighting for his life,” he said. “My role is to get everyone to understand that this disease is serious and that treatment is vital – for them and for their family and friends – and that they must follow strict hygiene practices.” On this particular morning, in front of the entire group, he insists that patients follow their treatment plan and take each prescribed drug, even if the treatment plan seems long and difficult. Venance can’t wait for the treatment to end. “This disease is making me miss out on so many things,” he said. “I can’t wait to swallow the last pill; then, I will really celebrate. It will be like being born again.”

The Global Fund is a 21st-century organization designed to accelerate the end of AIDS, tuberculosis and malaria as epidemics. This piece has been adapted from the Global Fund News Flash released on 24 March 2015.