Although TB rates in Nepal have plummeted in the past decade it is still one of the biggest killers of Nepalis.
In November 2012 in the US- Mexico border at Texas, the Border Patrol detained a Nepali man who was trying to get into the country illegally. This would have been just another case of illegal entry if the detainee had not been coughing constantly.
The police made him undergo a health examination which showed he had tuberculosis (TB), not the regular, drug-sensitive TB, but the resistant kind. In fact the organism was super resistant, known as XDR: extensive drug resistance. There is a multi-drug resistance (MDR) TB, but XDR is deadlier as it is resistant to many more drugs.
During his three month ordeal to reach the US, the man travelled by air, car, boat, and foot across 13 countries. TB can be transmitted from person to person through breathing so every time he coughed he could have possibly spread life-threatening bacteria across the world. This particular strain of XDR TB had been identified once before in the US and the patient was again a Nepali.
XDR is uncommon in the US. In 2011 only six cases were identified. So these two cases of the same strain from Nepal caused a great deal of alarm in the country. The World Health Organisation was immediately notified and officials in the 13 countries have been trying tirelessly to track down thousands of people the detainee may have come in contact with to see if they were infected with TB. Just reconstructing his exact path must be a daunting task.
Although TB rates in Nepal have fallen in the past decade in large part due to the DOTS (directly observed treatment) program introduced by the government in the early 1990s, it is still one of the biggest killers of Nepalis. What is more worrisome, however, is the rise in MDR and XDR cases because patients are either misusing or not completing their treatment.
While countries like the US spend millions trying to prevent the spread of TB, we in South Asia have focused largely on treatment. There have been no efforts made to detect the disease within households of TB patients or hospitals. Luckily new detection technology like the WHO-endorsed GeneXpert machine (pic, above), now available in Nepal, will help detect resistant cases so that therapy can be started early to strengthen the DOTS program.