by Katherine Marshall, Senior Fellow, Berkley Center for Religion, Peace, and World Affairs at Georgetown University
Tuberculosis (TB) is often remembered through long-dead artists and poets who left moving testimonies of the suffering it caused. Scriptures of various religions cite TB because it was a constant reality in societies everywhere. But today TB is so rare in wealthier societies today, the result of better sanitation and better drugs, that it is almost forgotten: Even medical schools long treated TB as a disease of the past. But the stark reality is that TB is very much with us. It is one of the "big three" infectious diseases that are the leading causes of death in poor communities across the world. A new TB infection occurs somewhere in the world every second. The saddest figure is that 3 million people with TB do not get the care they need.
TB is getting far more attention these days, as the magnitude of the disease sinks in and new risks, like drug-resistant varieties, have emerged. The Global Stop TB Partnership brings together more than a thousand organizations to fight the disease. It is one of the most effective global partnerships today, a successful example of bringing public and private, national and international, together. Halting the spread of TB is one of the year 2000 Millennium Development Goals, and the Global Fund to fight AIDS, Tuberculosis, and Malaria supports large national TB programs in the most affected countries. March 24 is noted each year as World TB day
But there is a potential partner in this global effort whose work is rarely acknowledged and whose potential is barely recognized: the vast network of faith communities. TB is a prime case of where these communities can and should be key partners. There are glimmers of hope that this is happening, but to nowhere near to the extent it should.
So why faith and TB? The reason for advocating for a stepped up, purposeful partnership is that the factors that have kept TB in the shadows and that make it difficult to fight are precisely those that suggest untapped potential for creative action by faith-inspired communities and organizations.
TB is a disease of poverty, focused in poor and often excluded communities. It is rampant among prison populations, for example, and common among migrants and transitory populations. Health facilities are often weakest in the poorest communities where TB is most common. But faith communities are very often there, present in the communities, working with vulnerable populations.
TB is difficult to treat, both individually and from a public health perspective. It is hard to diagnose, and today's treatment regimens are lengthy and exacting. HIV and AIDS dramatically increase TB infections. New, drug-resistant strains of TB are emerging that are harder still to treat. A community is what is needed to pinpoint where help is needed, to address the bottlenecks, and to support those who need treatment, practically and morally. With so many faith communities working with AIDS affected populations, the case for building on experience and synergies is strong.
Stigma is another important factor that makes it especially difficult to deal with TB. Changes in physical condition that are common with TB can make infection noticeable and open the door for prejudice. Stigma discourages people from seeking help and it is a reason people abandon treatment. This is an area where the moral voice of faith leaders should lead to compassion and to care, encouraging acceptance and supporting those who fear exclusion.
There are inspiring examples of work on TB by faith communities and by faith-inspired development organizations like World Vision, Catholic Relief Services (CRS), Caritas, and the Adventist Development and Relief Agency (ADRA). There's lots going on as religious communities from the full gamut of the world's great religions find ways to help. We have identified examples of innovative and caring work in Swaziland, Tanzania, Philippines, Cambodia, and many other counties.
Even so, despite their evident and extensive reach, the work that faith-inspired organizations do and could do to address TB has not yet been explored in any significant depth. And they are not seen in any purposeful way as central partners in the global effort.
What would it take to translate potential into reality? Knowledge, good case studies, and a purposeful exploration of actual and potential work, starting at the national level, is always the essential starting place. Faith work can be as much in the shadows as TB itself and light can help. Capacity issues are a common challenge, as new capacities are often needed to manage care programs with appropriate accountability and monitoring. Poor coordination is a common challenge. An area that deserves deliberate effort is engaging faith-linked women's groups in programs like DOTS (Directly Observed Treatment, Short Course), the treatment programs that require regular follow up and care. All of these action areas are difficult, as the institutions and efforts are dispersed, but they are also doable and are likely to be effective both in producing results and in terms of cost.
It is reassuring to see a new determination to bring the very modern scourge of TB out of the shadows. But neglecting the real potential for faith engagement in the effort is a mistake. It is an engagement with an ancient history and a modern face, one that can bring out the best that faith communities have to offer.