Disease & moral duty demand Australia helps TB fight

BY BRUCE FLEGG MP *
Courier Mail (Brisbane)

THERE IS A TUBERCULOSIS EPIDEMIC in Papua New Guinea that has been fuelled by its high number of HIV cases but has now spread predominantly to non-HIV patients.

Two TB clinics on the border islands that have protected north Queenslanders are to be closed and $1.1 million given to PNG to deal with its epidemic.

PNG has seven million people and produces only 35 medical graduates a year with no assurance that even they will stay to work in the country. Health outcomes are of Third World standard.

The PNG health system must deal with maternal mortality rates of 733 mothers per 100,000. Infant mortality is 5.7 per cent of all babies.

There is an epidemic of heterosexually transmitted HIV-AIDS, with up to 3 per cent of the sexually active population infected.

Up to half of Third-World TB patients are diabetic, a disease prevalent in Australian indigenous populations. A standard course of treatment for tuberculosis costs about $1,000.

However, increasingly we are no longer dealing with a straightforward disease.

Cases of Multi-drug Resistant Tuberculosis (MDR TB), which describes strains resistant to at least the two main first-line TB drugs, are increasing. MDR TB costs $45,000 a patient to treat.

Disturbingly, there is now the emergence of Extensive Drug-Resistant TB (XDR TB) strains - resistant to three or more of the six classes of second-line drugs and thus virtually impossible to treat. The cost of treatment in this category is about $100,000 a patient, and this often results in containment only, not a cure.

A quarter of all the multi-resistant TB cases in Australia now emanate from Torres Strait and medical authorities are warning that without significant action to stop the penetration of infected cases in Torres Strait and Cape York, TB is likely to become endemic in local populations.

In a paper entitled Protecting Australia's Health Security, Professor Ian Wronski, of the James Cook University Medical School, warns that some previously rare tropical diseases are re-establishing themselves in Australia, of which multi-resistant TB is one.

Media attention and political concern about this issue resulted in a partial backdown, whereby the Torres Strait TB clinics slated for closure on Boigu Island and Saibai Island will be allowed to complete the treatment of existing patients.

This is a small win for the protection of Queenslanders living in the far north and the Torres Strait. However, in the medium term this will not protect local residents.

Torres Strait Islanders have close links, in many cases family links, to far northern communities such as Bamaga. Travel between PNG, Torres Strait islands and far northern communities is frequent and legal.

The nearest major centre within PNG at which it would be feasible to provide tuberculosis treatment is Daru. Daru's hospital has been described as being on the verge of collapse, without drugs, doctors or even security.

If we are to protect north Queenslanders from the incursion of TB, there appears little option but to offer treatment to those cases that visit legally on our shores.

Australia, not PNG, has the First World research and infrastructure capacity required to combat this deadly disease in the region with any degree of efficacy. And much of our research is already aligned with addressing the higher burden of infectious disease in the tropics.

In all fairness, the Queensland Government has a valid point that the cost of this sort of human biosecurity at Australia's northern border should not fall overwhelmingly to state taxpayers.

There are two other considerations that I believe are important.

Firstly, Australian self-interest dictates that if TB continues to extend further south, the cost burden of this disease becoming endemic in northern communities will far exceed the cost of maintaining the clinics.

Secondly, and importantly, Australia should be seeking to be a compassionate country that does not refuse medical care to our neighbours (particularly when they are legal visitors to our shores) when their families or their children have life-threatening disease.

The Australian Government can't flick sole responsibility for the management of TB to the PNG Government. To do so is irresponsible and dangerous.

Resistant TB management is way beyond the capacity of the PNG health system.

* Bruce Flegg is Liberal National Party MP for Moggill in Queensland and a medical practitioner of 30 years

Comments

[Peter Kranz]

Well said Dr Flegg. There was considerable debate about this issue on PNG Attitude last year and some responses from both Commonwealth and Queensland members.

It is far too important an issue to be compromised by Federal/State rivalries or party political point-scoring. And as you say, it is in Australia's interest to see adequate and effective treatment offered to PNG TB patients.

I believe that the Thursday Island hospital will continue to treat TB patients from PNG, even though the Sabai and Boigu clinics are still slated to be closed after current patients have been treated.

Transferring these patients to Daru would be a death sentence given the current state of Daru hospital.

Perhaps a with a bit more effort Queensland could be persuaded to keep these clinics operating, provided Canberra and the State authorities cooperate.

The cost is miniscule compared with the potential risks of resistant TB spreading to mainland Australia, let alone considering our humanitarian obligations to our nearest neighbour.

[Mrs Barbara Short]

An excellent article by Bruce Flegg.

Let us hope that the Australian government will reassess this problem and reopen the two TB clinics in the border islands.