Chipambano ndi Tsoka
“Nkhani ya chifuwa cha TB pazaka 30 zapita yakhala ya chipambano ndi tsoka—chipambano pamene asayansi apeza njira zotetezera ndi kuthetseratu nthendayi, ndipo tsoka chifukwa cha kulephereratu kugwiritsira ntchito zomwe apezazo.”—J. R. Bignall, 1982.
CHIFUWA cha TB chakhala chikupha anthu kwa nthaŵi yaitali. Kale chinavutitsa Ainka ku Peru azungu asanapite ndi zombo zawo ku South America. Chinali kugwira Aigupto pamene mafumu otchedwa Farao anali kulamulira mwaulemero. Mabuku akale amasonyeza kuti TB inali kugwira anthu apamwamba ndi apansi omwe ku Babulo, Greece, ndi China.
Kuyambira m’zaka za zana la 18 kufika kumayambiriro kwa zaka za zana la 20, TB ndiyo inali kupha anthu kwambiri m’maiko a Kumadzulo. Kenaka, mu 1882, dokotala wa ku German Robert Koch analengeza kuti anapeza kachilombo kotchedwa bacillus komwe kamayambitsa nthendayi. Zaka khumi ndi zitatu pambuyo pake, Wilhelm Röntgen anatulukira cheza cha X ray, chomwe chinatheketsa kuunika m’mapapo a munthu wamoyo pofuna kuona ngati ali ndi zizindikiro za nthendayi. Kenaka, mu 1921, madokotala a ku France anapanga mankhwala akatemera a TB. Mpaka lero mankhwalaŵa ndiwo katemera yekha wa nthendayi, otchedwa BCG (Bacillus Calmette-Guérin), dzina lotchedwa potengera asayansi omwe anaŵapeza. Ngakhale zili choncho, TB inali kuphabe anthu ambiri zedi.
Mankhwala Apezeka!
Madokotala anali kutumiza odwala TB ku zipatala zapadera. Kaŵirikaŵiri zipatala zimenezi zinali m’mapiri, kumene odwala akanatha kupumula ndi kupuma mphweya wabwino. Kenaka, mu 1944, madokotala ku United States anapeza streptomycin, mankhwala oyamba kuchiritsa TB. Kenaka mankhwala ena ambiri ochiritsira TB anapangidwa. Potsirizira pake, odwala TB anali kuchiritsidwa, ngakhale kunyumba kwawo.
Pamene odwala matendaŵa anayamba kuchepa, tsogolo linaoneka labwino. Zipatala zapadera zinatsekedwa, ndipo kuwonongera ndalama pakufufuza za TB kunalekeka. Maprogramu onena za kuteteza analekeka, ndipo asayansi ndi madokotala anayamba kulingalira za matenda ena.
Zinthu zinayenera kusintha ngakhale kuti TB inali kuphabe anthu m’maiko omatukuka. TB inali mbiri yakale. Izi ndizo zomwe anthu ankaganiza, koma analakwa.
Kubweranso Mwamphamvu
Chapakati pa zaka za ma 1980, TB inabweranso moopsa ndipo mwamphamvu kwambiri. Ndiye mu April 1993, bungwe la World Health Organization (WHO) linalengeza kuti TB ndi “ngozi yadziko lonse,” ndipo linawonjezera kuti “pokhapokha patachitika kanthu mwamsanga kulepheretsa kufalikira kwake, nthendayi idzapha anthu oposa mamiliyoni 30 m’zaka khumi zilinkudza.” Aka nkoyamba kuti WHO ilengeze choncho m’mbiri yake yonse.
Kuyambira nthaŵiyo, palibe “kanthu kachitika mwamsanga” kulepheretsa kufalikira kwa nthendayi. Kunena zoona, vutolo lakulirakulira. Posachedwapa, WHO inachita lipoti kuti anthu ambiri anafa ndi TB m’chaka cha 1995 kuposa chaka china chilichonse m’mbiri. WHO inachenjezanso kuti pafupifupi anthu 500,000,000 adzadwala TB mkati mwa zaka 50 zikudza. Anthu ambirimbiri adzadwala TB yosamva mankhwala amitundumitundu.
Nchifukwa Chiyani Yabweranso Mwamphamvu?
Chifukwa chimodzi nchakuti mkati mwa zaka 20 zapita, njira zotetezera TB zaloŵa pansi kapena kulekekeratu kumbali zambiri za dziko lapansi. Izi zachedwetsa kupima ndi kuchiritsa amene ali ndi nthendayi. M’malo mwake, zimenezo zadzetsa imfa zambiri ndi kufalikira kwa nthendayi.
Chifukwa china chimene chapangitsa kuti TB ibukenso ndicho kuwonjezereka kwa chiŵerengero cha anthu osauka, anthu opanda chakudya chokwanira omwe amakhala m’mizinda yochulukana anthu, makamaka m’mizinda ikuluikulu, ya m’maiko omatukuka kumene. Ngakhale kuti TB sinali pakati pa anthu osauka okha—aliyense ikhoza kumgwira—kusoŵeka kwa ukhondo ndi kukhala mothinana kumatheketsa matenda kufalikira mosavuta kuchokera kwa wina kupita kwa wina. Zimachepetsanso kwambiri mphamvu yoteteza matenda m’thupi.
HIV ndi TB—Mavuto Ochitikira Pamodzi
Vuto lalikulu nlakuti TB yapanga mgwirizano woopsa ndi HIV, kachilombo ka AIDS. Mwa chiŵerengero chongoyerekezera chokwana miliyoni imodzi cha omwe anafa ndi matenda okhudzana ndi AIDS mu 1995, mwinamwake chigawo chimodzi mwa zitatu anafa ndi TB. Ichi nchifukwa chakuti kachilombo ka HIV kamafooketsa thupi kuti lisathe kulimbana ndi TB.
Mwa anthu ambiri tizilombo toyambitsa TB sitifika poti nkudwalitsa munthu. Chifukwa ninji? Chifukwa chakuti tizilombo totchedwa bacilli toyambitsa TB timatsekeredwa mkati mwa maselo otchedwa macrophages. Mmenemo timatsekeredwa ndi chitetezo cha munthu, makamaka ndi ma T lymphocytes, kapena T cells.
Tizilombo ta bacilli toyambitsa TB tili ngati amamba omwe awatsekera m’madengu okhala ndi zivundikiro zolimba. Madenguwo ndi maselo otchedwa macrophages, ndipo zivundikiro ndi ma T cells. Koma, pamene mavairasi a AIDS aloŵa m’thupi, amachotsa zivundikiro pa madenguwo. Zimenezo zikachitika, tizilombo ta bacilli timatuluka ndipo timakhala ndi ufulu wosakaza paliponse m’thupi.
Motero, pali mpata waukulu woti odwala AIDS akhoza kudwala TB poyerekeza ndi anthu omwe chitetezo m’thupi lawo chili bwino. “Anthu omwe ali ndi HIV ngosakayikitsa kuti adzadwala nthendayi,” anatero katswiri wa za TB ku Scotland. “Pachipatala ku London, anthu aŵiri okhala ndi HIV anatenga nthendayi pamene anali m’likole ndipo munthu wodwala TB anamdutsitsa pamenepo ali pamachira.”
Motero, AIDS yathandiza kufalitsa mliri wa TB. Malinga nkuyerekezera kwina, pofika m’chaka cha 2000, mliri wa AIDS udzapangitsa anthu mamiliyoni 1.4 kudwala TB zomwe mwina sizikanachitika. Mfundo yaikulu pa kuchuluka kwa odwala TB si yakuti odwala AIDS sachedwa kugwidwa ndi TB komanso yakuti akhoza kupatsirako ena, kuphatikizapo omwe alibe AIDS.
TB Yosamva Mankhwala Osiyanasiyana
Mfundo yotsiriza imene ikupangitsa TB kukhala yovuta ndiyo kubuka kwa mitundu ina yachifuwachi yosamva mankhwala. Mitundu yovuta imeneyi ioneka ngati ipangitsanso nthendayi kukhala yosachiritsika, monga momwe zinalili pasanapezeke mankhwala.
Chodabwitsa nchakuti mankhwala ochiritsira TB omwedwa mosatsata bwino malamulo ndiwo achititsa kuti TB ikhale yosamva mankhwala. Mankhwala a TB amaperekedwa kwa miyezi yoposa isanu ndi umodzi ndipo kumafunikira kuti wodwalayo azimwa mibulu inayi mosaphonyetsa. Wodwalayo angamafunikire kumwa mapilisi okwana mpaka 12 patsiku. Ngati wodwalayo sakumwa nthaŵi zonse kapena sanatsirize mankhwalawo, mitundu ya TB yovuta kuchiritsa kapena yosachiritsika nkomwe imabuka. Mitundu ina sichiritsika ndi mankhwala amakono ochiritsira TB mitundu isanu ndi iŵiri.
Kuchiritsa odwala TB yosamva mankhwala sikuti nkovuta chabe, komanso nkokwera mtengo. Mtengowo ungafike nthaŵi 100 kukwera kuposa mtengo wochiritsira odwala ena amene TB yawo imamva mankhwala. Mwachitsanzo, ku United States, mtengo wochiritsira munthu mmodzi ukhoza kuposa $250,000!
Bungwe la WHO likuyerekezera kuti pafupifupi anthu mamiliyoni 100 padziko lonse angakhale ndi TB yosamva mankhwala, ina yomwe singachiritsike ndi mankhwala ena alionse a TB omwe tikudziŵa. Mitundu yoopsa imeneyi ndi yopatsirana monga momwe ilili mitundu yodziŵika kaleyi.
Kuteteza ndi Kuchiritsa
Kodi pakuchitika zotani kulimbana ndi ngozi yadziko lonse imeneyi? Njira yabwino kwambiri yotetezera nthendayi ndiyo kuzindikira ndi kuchiritsa mitundu yopatsirana mwamsanga. Izi sikuti zimangothandiza omwe akudwalawo komanso zimateteza kufalikira kwa matendawo kwa ena.
Ngati TB ilekereredwa, imapha oposa theka la odwalawo. Koma, akamamwa mankhwala moyenera, pafupifupi aliyense wodwala TB amachira malinga ngati si mtundu uja wosamva mankhwala osiyanasiyana.
Momwe taonera, kuti wodwala achiredi zimafunikira kuti amwe mankhwala onse. Kaŵirikaŵiri, satsiriza. Chifukwa ninji? Chabwino, kukotsomola, kutentha m’thupi, ndi zizindikiro zina zimatha m’milungu ingapo chabe atayamba kumwa mankhwala. Choncho, odwala ambiri amakhulupirira kuti tsopano achira ndiye amaleka kumwa mankhwala.
Kuti athetse vuto limeneli, a bungwe la WHO akulimbikitsa programu yotchedwa DOTS, kutanthauza kuti “kupereka mankhwala ndi kupenyerera, kwa nthaŵi yochepa.” Monga momwe dzinalo likusonyezera, azachipatala amaonerera kuti atsimikizire kuti odwala akumwa mankhwala onse, makamaka kwa miyezi iŵiri yoyamba. Komabe, izi sizapafupi kuchita nthaŵi zonse chifukwa ambiri mwa amene amagwidwa ndi TB amakhala kutali. Popeza moyo wawo ngwamavuto okhaokha—ena a iwo alibe ngakhale nyumba—zoti nkumaona nthaŵi zonse kuti akumwa mankhwala nzovuta kwambiri.
Choncho kodi nkotheka kuti mliri umenewu udzathetsedwe pakati pa mtundu wa anthu?
[Bokosi patsamba 5]
Chikalata Chonena za TB
Tanthauzo: TB ndi matenda amene amagwira ndi kuwononga mapapo, koma ikhoza kufalikira ku mbali zina za thupi, makamaka ku bongo, impso, ndi mafupa.
Zizindikiro: TB ya m’mapapo ikhoza kuyambitsa kutsokomola, kuwonda ndi kupanda chilakolako chakudya, kuchita thukuta kwambiri usiku, kufooka, kubanika, ndiponso kupweteka kwa m’chifuwa.
Mmene Amapimira: Kupima khungu kungasonyeze ngati munthuyo wagwidwa ndi kachilombo ka nthendayi kotchedwa bacillus. Kuwunika ndi X ray pa chifuwa kukhoza kusonyeza kuwonongeka kwa mapapo, zimene zingasonyeze kuti ali ndi TB. Njira yodalirika ndiyo kupima mankhololodwa m’laboletale kuti aone ngati ali ndi bacillus yoyambitsa TB.
Yemwe ayenera kupimidwa: Omwe ali ndi zizindikiro za TB kapena amene akhala oyandikana kwa nthaŵi yaitali ndi odwala chifuwachi—makamaka m’nyumba zopanda moloŵera mphepo mokwanira.
Katemera: Pali katemera mmodzi yekha—wotchedwa BCG. Amateteza TB kwa ana koma sathandiza kwenikweni ana okulirapo ndi akulu. Katemerayo amateteza kwa zaka 15. BCG amathandiza omwe alibe chifuwacho; koma sathandiza amene ali nacho kale.
[Bokosi patsamba 6]
TB ndi Fashoni
Ngakhale zingaoneke zachilendo, m’zaka za zana la 19 anthu ankanyadira TB, chifukwa anthu anali kukhulupirira kuti zizindikiro za nthendayi zimapangitsa munthu kukhala wosachedwa kukhumudwa ndiponso wanzeru.
Wolemba maseŵero wa ku France, Alexandre Dumas analemba za zochitika m’ma 1820 m’buku lake lotchedwa Mémoires: “Zinali m’fashoni kudwala matenda a m’chifuwa; aliyense anali wowonda, makamaka olemba ndakatulo; zinkaonedwa zoyenera kufa usanakwanitse zaka makumi atatu.”
Wolemba ndakatulo wachingelezi Lord Byron anati: “Ndingakonde kufa ndi [TB] . . . chifukwa akazi onse angamati, ‘Onani Byron wovutikayo, mmene akuonekera bwino pakufa!’”
Mlembi wachimereka Henry David Thoreau, amene mwachionekere anafa ndi TB, analemba kuti: “Kaŵirikaŵiri umakongola ukamadwala ndi kuwonda, monga . . . kufiirira bwino kochititsidwa ndi TB.”
Pothirirapo ndemanga za kuchita chidwi kwa anthu ndi TB kumeneku, nkhani ya mu The Journal of the American Medical Association inati: Kukonda matenda kodabwitsaku kunali fashoni; azimayi ankafuna kuoneka otumbuluka ndi ofookerapo, ankagwiritsira ntchito zodzoladzola zoyera, ndipo ankakonda madiresi a nsalu zopsapsala.—monga muja akhalira akazi amakono omwe amaima pachionetsero, omwe amasala chakudya kuopera kunenepa.”
[Bokosi patsamba 7]
Kodi Nkwapafupi Kutenga TB?
“Palibe komwe mungabisale kuthaŵa bakiteriya yopangitsa TB,” akuchenjeza choncho Dr. Arata Kochi, mkulu wa WHO Global TB Programme. “Aliyense akhoza kutenga TB mwa kungopuma kachilombo koyambitsa nthendayi kamene wina akakotsomolera kapena kukayetsemulira mumpweya. Tizilomboti tikhoza kukhalabe mumpweya kwa maola ambiri; ngakhale zaka. Tonsefe tili pangozi.”
Komabe, kuti munthu adwale TB, payenera kuchitika kaye zinthu ziŵiri. Choyamba, mabakiteriya oyambitsa TB ayenera ayambe amuloŵa m’thupi. Chachiŵiri, ayenera kuti achulukane kufika poyambitsa matenda.
Ngakhale kuti nzotheka kutenga chifuwachi mwa kukhalira pamodzi nthaŵi yochepa ndi munthu wodwala kwambiri, kaŵirikaŵiri TB imafalikira mwa kukhalira naye pamodzi munthu wodwalayo kwa nthaŵi yaitali, monga muja zikhalira ndi anthu a banja limodzi okhala m’kanyumba kakang’ono.
Tizilombo ta bacilli tomwe wapuma munthu yemwe akhoza kudwala nato, timachulukana m’chifuwa. Komabe pa anthu asanu ndi anayi mwa khumi, chitetezo cha m’thupi chimalepheretsa kuti tizilomboto tisafalikire, motero munthuyo sadwala. Komabe, nthaŵi zina bacilli yemwe ali khaleyo akhoza kuyamba kuwononga ngati chitetezo cha m’thupi chafooketsedwa ndi HIV, matenda a shuga, mankhwala ochiritsira kansa otchedwa chemotherapy, kapena pa zifukwa zina.
[Mawu a Chithunzi patsamba 4]
New Jersey Medical School—National Tuberculosis Center
[Chithunzi patsamba 7]
Tizilombo ta “bacilli” toyambitsa TB tomasulidwa ndi kachilombo ka AIDS tili ngati amamba omwe awavundukula m’madengu.