A woman walks to an open tent and stands before a “camera” on a tripod, with a green curtain serving as her backdrop. 

“One, two, three…hold still…deep breath,” instructs the man in a black vest, speaking in Filipino, then presses the shutter.

Within five minutes, the photo is ready. But this is no ordinary snapshot from a photo booth. It is an image of the woman’s lungs taken by a portable X-ray machine.

A radiologist examines the image, and it is clear. The woman doesn’t have tuberculosis and is able to leave the tent feeling relieved. 

With the help of artificial intelligence, this portable X-ray can screen for possible cases of tuberculosis (TB) – even without a radiologist being present.

But while an X-ray is a valuable screening tool, it does not provide confirmatory results. This is where the rapid molecular test machine, Truenat, steps in.

Diagnosis of TB takes just an hour with the Truenat machine, which can run 10 to 12 specimens in eight hours, testing two specimens simultaneously. Compact and portable, it eliminates the need for patients to travel to hospitals or diagnostic centers – and it too can run on batteries.

The portable X-ray machine offering free TB screening was a blockbuster hit, particularly amongst the elderly residents of Valenzuela, a city north of Manila, the capital of Philippines. 

The Philippines has the fourth highest TB burden in the world and contributes 7% of global cases, behind India (27%), Indonesia (10%), and China (7.1%), according to the World Health Organization’s (WHO) Global Tuberculosis Report 2021.  

But for the archipelagic country with 7,640 islands, citizens’ access to healthcare and diagnostic  tools has been one of the greatest barriers to addressing tuberculosis. 

The portable X-ray machine, which is compact enough to fit in a regular-sized backpack and runs of batteries that each have the capacity to capture at least 100 images, has the potential to change that – along with the portable rapid tests. 

“In metro Manila, our streets can be very narrow. Where a regular car cannot [enter], But these (X-ray and Truenat machines) can be brought in a suit[case] so we can reach the unreachable,” said Dr Lalaine Mortera, of the United States Agency for International Development (USAID)  Tuberculosis Innovations and Health Systems Strengthening programme.

USAID and Stop TB Partnership have donated eight portable X-ray machines to the country. The other seven machines have been strategically distributed to geographically isolated regions and areas with high TB prevalence, including Bataan, Cebu, Laguna, Tarlac, Pampanga and South Cotabato.

Mortera told Health Policy Watch that during their visit to Minglanilla, an area near the city of Cebu, a 93-year-old woman had her chest X-rayed for the first time in her life. 

The X-ray machine can screen out those whose lungs are healthy, identifying those who should be tested for TB. Because of these new technologies, Valenzuela was able to achieve a 135% increase in case notification rate for tuberculosis.

Once diagnosed with TB, the city government provides free medication to the patients.

Aside from portable X-rays and Truenat machines, the health department also has mobile clinics. Like an ice cream truck, these mobile clinics go around the country providing basic health diagnosis. 

Tackling TB in the workplace

Valenzuela, with a population of around 675,000 residents, is home to numerous factories employing thousands of workers. As an industrial city, it became the first in the Philippines to adopt the Workplaces #WorkTBFree initiative run by the labor and health departments.

The initiative offers online resources to assist human resources and occupational safety officers to implement tuberculosis programs in workplaces.

“We hope that these learning tools will help the business sector in Valenzuela City find and treat workers with TB, toward our goal of maintaining healthy workplaces,” USAID Director of Health Michelle Lang-Alli said.

Dr Marthony Basco, Valenzuela’s health officer, said that company nurses also serve as their partners.  

“We just provide them with meds. The patient can take the medicine within their workplaces. We ask for the assistance of their nurses so this doesn’t compromise the continuity of the work,” Basco said.

To sustain TB treatment, the city government also allocates around $17,700 annually, augmenting aid from the national government and external agencies.

“It is not enough that we rely on what the region[al office] or Department of Health give us but also to augment because we do not want any diagnosed patients that are not treated timely,” said Dr Ma Cecilia  Aquino, National TB Medical Coordinator for Valenzuela City.

Recognizing the financial burden on individuals reliant on daily income, the city government also provides financial assistance to workers diagnosed with tuberculosis to ensure treatment continuity.

Moreover, the city has implemented an ordinance aimed at eradicating workplace discrimination which protects workers diagnosed with TB from unjust termination.

Fighting stigma

The stigma and discrimination surrounding tuberculosis present significant challenges in both diagnosis and treatment. The Philippines addresses this issue creatively, presenting TB screening as a routine check-up.

With the slogan “Para healthy lungs, pa-check ka lungs” (For healthy lungs, just check your lungs), the initiative aims to encourage individuals to prioritize their lung health without stigma.

“If you talk about TB screening, people will not come even if it’s free,” Mortera said. “You have to package it like a general check-up. Because the stigma is very high.”

The health department also launched a catchy informative jingle on how to take care of your lungs. 

TB prevalence in the Western Pacific

Despite concerted efforts, the fight against tuberculosis (TB) in the Philippines, as well as in countries around the world, remains an uphill battle. 

According to Health Secretary Teodoro Herbosa, the country recorded 612,534 new TB cases in 2023. This alarming figure represents a significant increase, with 549 cases per 100,000 population compared to 2022’s 439 cases per 100,000 people.

In 2022, the Western Pacific region had an estimated 1.9 million TB cases and 104,000 fatalities. This morbidity figure surpasses the pre-COVID-19 toll recorded in 2019, which stood at 92,000 deaths.

The WHO estimates that around 280 people lose their lives to TB and close to 5,000 people fall ill with this preventable and curable disease every day. 

In response, the 2023 UN General Assembly High-Level Meeting on TB outlined ambitious targets, aiming to accelerate the end of TB by 2027. These goals emphasize comprehensive care, rapid diagnosis, and closing funding gaps.

Image Credits: James Cruz.