The lessons of Carabayllo: making tough choices in the fight against TB

Poverty and multi-drug-resistant tuberculosis condemned Melquiades Huaya Oré to a certain death.

He was 17 in 1993, and so thin that doctors needed only a few fingers to encircle his arms; his skin was stretched so taut that you could see his ribs and other bones. All the odds were against Melquiades, and he should been another number in the statistics of TB, a major public health threat that costs 4,000 lives daily.

Globally, 9.6 million people fell ill with tuberculosis in 2014, one million of them children. According to the latest world health statistics, in 2014, 1.5 million people died of the disease.

Melquiades had the worst kind of TB, the one that is resistant to even the most powerful and effective medicines. He was so sick that even pills were painful to swallow.

At the time he was living in Carabayllo, a very poor community 20 miles north of Lima, Peru. A small  band of committed doctors, nurses, and community health workers that included Dr. Jim Yong Kim, the current president of the World Bank Group, helped establish an NGO called Socios en Salud, or Partners in Health.

In Carabayllo, they discovered an alarming number of patients like Melquiades, suffering from multi-drug-resistant TB, who were not only in danger of death, but also were infecting their families and neighbors.

To stop this lethal disease and save the lives of people like Melquiades, Dr. Kim with his colleagues Dr. Paul Farmer and Dr. Jaime Bayona reported their alarming findings to the Ministry of Health of Peru and the World Health Organization.Their advice was to not to take this fight – that the drugs were too expensive and treating drug-resistant TB would be a distraction from their single-minded approach to treating ordinary TB.
The government actually threatened Dr. Kim and his colleagues that if they treated a single patient, they would be kicked out of the country.

Fast-forward to 2015, when the presence of Melquiades Huauya Oré is drawing discreet tears from the eyes of the women and men who represent the governments and economies of all the world.

He is standing between them, dressed in a new suit, receiving a standing ovation. He is all smiles, thanking them and waving. Giant photos of his formerly emaciated torso are projected on the big screens that hang over the walls of this football-wideballroom in the heart of one of the fanciest convention centers of South America.

Melquiades was saved. Rescued from becoming a statistic of TB and poverty, he graduated as an accountant, occasionally plays soccer, and still lives in a more prosperous Carabayllo.

He realized his dreams, a right that every person should have.

He and other patients are alive because of the determination to do the right thing, explains doctor Kim.

Kim added that despite their fears or being evicted form Peru, they put courageous health workers to monitor and support their patients, under the supervision of Dr. Bayona. That led to the cure of 50 patients at a rate of more than 80% which was higher than many of the best hospitals in the United States.

The results changed the policies of the World Health Organization and the Peruvian government, which now recommend that persons with multi-drug-resistant tuberculosis should be treated no matter the cost, no matter where they live and no matter whether they are rich or poor.

Today TB is still the deadliest preventable infectious disease in the world, and the global community has made a pledge to eradicate it by 2030.

But the headwinds of a slowing global economy could make us forget the lessons learned with Melquiades and others in Carabayllo.

In a speech in 2015 at the Annual Meetings in Lima, Kim summarized what he had learned about fighting TB, poverty, and underdevelopment.

First, listen to the aspirations of the poor, and lift your own to meet them. Second, don’t be afraid to make tough decisions even if you have to stand alone.

Passionate about fighting poverty, Kim added:

“We are in a difficult time in the world. Governments must make tough choices in order to grow their economies in a way that helps the poorest. But with every reform we make, with every road we build, with every health clinic we support, are millions, even billions of people, like Melquiades, who only want a chance to live and pursue their dreams. We must do all we can, together, to ensure that every person on this earth can live a more dignified, healthier, and more prosperous life.”