Montenegro

Controlling TB in Montenegro

We have come a long way since the days when it was commonly believed that people suffering from tuberculosis were the victims of either witches or malevolent fairies. In 1882, a German physician named Robert Koch isolated tuberculosis bacillus (TB), for which he was awarded the Nobel Prize for Medicine in 1905, thus laying to rest the supernatural silliness once and for all. Still, 127 years after Koch’s success, the contagious respiratory disease remains a huge problem on the global scale, taking a life every 20 seconds. 

On World TB Day (March 24) the Secretary General of the United Nations, Ban Ki-moon, put the epidemic into perspective, “The steps being taken around the world to stop tuberculosis (TB) are having an impact. Today, the epidemic is continuing its decline. But the rate of decline is far too slow…. Millions of people are benefiting from treatment through coordinated national efforts, but millions more are still missing out.  Unless we accelerate action, the numbers of those falling ill will continue to grow.”

During the conflict in the western Balkans following the dissolution of Yugoslavia in the 1990s, there was precious little money available to keep the disease under control. No one can accurately say how great was the increase in TB cases when hundreds of thousands of people were displaced from their homes as wars raged and economies and social structures collapsed but there definitely was a spike in the numbers. Across the region today, the medical community is grappling with the problem and having success in doing so.

In Montenegro, the United Nations Development Programme has, since 2007, been helping the country’s medical practitioners build a health care system that will prevent, diagnose and treat TB. The five year, 1.3 million euro Program for Establishing and Pursuing a High Quality of Tuberculosis Control - which is financed by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) - has been responsible for the training of 50% of the country’s doctor in early detection and diagnosis practices prescribed by the World Health Organization.

Up until the in-progress, extensive reformation of Montenegro’s medical system, anyone displaying symptoms of a respiratory disease went directly to a specialist. Now, the populace must first consult with their “chosen doctor” (commonly known as a family doctor, or General Practitioner, in the West). But chosen doctors lacked the specialized knowledge to correctly differentiate TB from other respiratory diseases, either minor of major, until they received training recently. Doctors involved in the training were so impressed by and thankful for the training regimen that they have asked the program’s administrators to prepare similar trainings regarding other respiratory diseases.  

Because TB is highly contagious, it is essential that anyone diagnosed with the affliction be isolated and treated as quickly as possible. Treatment at Montenegro’s Special Hospital for Lung Diseases in Brezovik can often take several months or more. Because there is no realistic way to hold patients against their will, the facility is very comfortable and incentives are provided to keep the poorest patients away from the general populace of the country until they have been completely treated.

Everything from diagnosis to treatment is free to citizens of Montenegro but doctors will not turn away anyone who is displaying symptoms of TB. Montenegro’s TB specialist doctors insist that politics do not enter into consideration when confronted by an individual who may be afflicted. A diagnosis is done first and other questions are asked later. In 2008 a Romanian national who was in the country illegally was in police custody. The Romanian had a persistent cough and police brought him to the hospital. The patient was diagnosed with TB and treatment began. A week later the police returned with orders to have the man deported but thought better of doing so after hospital staff carefully explained that it would be in nobody’s best interest, least of the officers who would have to execute the deportation order, to remove the man from the premises. After successful treatment the man was handed back to the police.

Treatment for primary TB is not always successful. Some patients develop immunities to the drugs and in such cases they must be sent for treatment of multidrug-resistant (MDR-TB) and extensively drug-resistant (XDR-TB) outside the country, all of which is also free of charge.

The professionals who are in charge of the tuberculosis control program are quick to say that information and communication are vitally important in the fight against TB. Around the world doctors and scientists are toiling to gain a better understanding about TB, how to prevent it and how to treat it. Thanks to the advent and proliferation of information technology, data regarding progress being made in the fight can be quickly disseminated and the program’s administrators are very diligent about getting the information to the frontline medical professionals including nurses and lab technicians.

The program has established ‘directly observed treatment’ with two field teams that are covering 50 % of the population (the mobile team has been provided with two fully equipped vehicles). Lab equipment and supplies have been purchased for the National Reference Laboratory and staff have been provided protective equipment. IT equipment has been given to those engaged in the fight against TB and software that enables a coordinated effort has been developed and distributed.

In addition to suffering the physical effects of disease, TB patients also find themselves ostracized in Montenegro. The country’s tuberculosis control program is working to remove the social stigma from the disease by conducting an outreach campaign. To date, more than 2000 individuals – patients and their family members, young people, social workers and medical professionals – have been educated about TB and TB related issues. Brochures have been distributed across the country and the program has received a significant amount of media coverage. 

All around the world health care costs have ballooned in recent years. The budgets of hospitals and laboratories are extremely strained. By keeping TB under control in Montenegro, the country’s health care professionals are freeing up desperately needed resources that are needed in the fight against numerous other diseases.