By Alexia Evripidou
WITH EBOLA headlining global newspapers daily, attention to other serious infectious diseases run the risk of being eclipsed. Yet we don’t need to look past our back yards to discover that since 2004, cases of one of the top five infectious killers – Tuberculosis (TB) – has increased worryingly here in Cyprus.
Concerned about another TB epidemic, doctors and health officials last year presented to parliament a plan to upgrade the old, but-still-operational sanatorium in Kyperounda in the mountains. Parliament agreed with the proposal, yet a year on nothing has happened.
Although only on a small scale, numbers of TB cases have risen over the last ten years, from near zero at the turn of this century, to 33 reported cases in 2007 rising to 58 cases in 2012. In 2007, 28 were of foreign origin, which rose to 31 in 2012. At one point the statistics showed that 83 per cent of the sick were foreigners who had come to Cyprus, mainly from Bulgaria, Romania and the Philippines. All were referred to the specialist TB sanatorium in Kyperounda Hospital for a minimum of two months treatment.
Unfortunately, TB has advanced. The World Health Organisation states that “TB has evolved to be more challenging to cure, as evidenced by increasing cases of drug-resistant TB strains now present in almost all countries surveyed worldwide”. This, with the increase in TB cases, has stretched the hospital’s already limited resources.
Doctor George Georgiades, a specialist in respiratory and critical care medicine at Nicosia General Hospital, believes that “Cyprus is a platform in the Mediterranean where we can accept people from everywhere around the world. We do not know what diseases might be arriving the next day.”
Although 2013 saw the first drop in TB cases – likely because immigrants have been leaving Cyprus since the financial crisis – Georgiades explained that figures from one year could not determine whether or not a disease had been genuinely dealt with. The mean result over several years’ statistics needs to be determined in order to assess progress of elimination of the disease.
“Therefore precautionary measures need to be put into place to eliminate this disease and deal with other diseases that might enter the country,” Georgiades stressed.
TB has been an ever-present threat to mankind. Throughout history, it has come under many names, for instance, the ‘Great White Plague’, as it emaciates its victims, turning them a deathly shade of white. Also known as consumption, it killed Jane Austen, four of the five Bronte sisters, Anton Chekhov and George Orwell.
Cyprus is no stranger to the airborne TB, which consumed nearly 300 lives a year during the 19th and early 20th centuries. At the time poverty predominated and large families lived together in small dwellings, therefore helping the disease to spread. Up until the turn of the 21st century, with the improvement of food, health, finances, environment and modern medicine in Cyprus, TB had been nearly eradicated.
The sanatorium at Kyperounda had played a huge role in what had appeared to be the successful fight against TB. Opening in 1940, it operated solely to treat TB patients; it was a well respected sanatorium with 100 beds.
In the late 20th century with TB apparently beaten, the sanatorium became the regional hospital serving nearly 20,000 people in 25 communities.
But when TB resurged with a stronger strain in 2004, Kyperounda hospital, famous for its clean air with health giving properties, was turned to for help. Yet it now has just 16 beds dedicated to TB patients. At times, 3-4 patients are forced to share an overcrowded room, which goes against World Health Organisation (WHO) guidelines recommending one person per room. The sanatorium also needs negative pressure rooms, which are vital in combating and constraining the disease from spreading through the air.
As a result, medical experts, and health officials and MPs came together in September 2013, (including Georgiades, Kyperounda’s Hospital director Dr Andreas Kafkalias, the then Health Minister Petros Petrides, AKEL MP Adamos Adamou and DIKO MP Athena Kyriakidou), to address the issues at hand. A thorough investigation was carried out at the hospital and it was decided by all parties involved, that a larger and better equipped sanatorium was a necessity.
The existing three storey stone building, previously the nurses sleeping quarters on the hospital premises, was both empty and perfect for renovation. Transforming it into a high tech sanatorium, with negative pressure rooms, complying with WHO requirements would be cheaper and more suitable than building a new building. This proposal, requiring only one million euros, was drafted and presented to Parliament.
“Even though our hospital services are high by European standards, we still always need to improve to meet these drug resistant strains. Parliament accepted the proposal and was keen to help,” Georgiades says. “However, it seems that one million was too much and project did not proceed.”
With murmurs that there was no money due to the financial crisis, Georgiades and the doctors took it upon themselves to try and raise the money through private donations but were not able to do so.
The deputy director of Medical and Public Health Services Dr Elizabeth Constantinou informed the Sunday Mail of the ministry’s desire for a new sanatorium by saying that “the ministry of health requested commitment of funds in their budgets to meet this need in 2012 and 2013. The request was not approved by the ministry of finance.” However, senior economic officer at the finance ministry, Maria Tsiakka, denied her department was to blame for the delay. “We did not say no to the funding. Every April, the Council of Ministers approves a ceiling of funding for each ministry, determined by governmental priorities. It is then up to each ministry to prioritise their own needs,” she explained.
So what next? Georgiades is still appealing to private donators and hopes that the government will see true to their word, giving them the funds to renovate the sanatorium.
“TB here may not be an epidemic again but we can have the sanatorium ready to prevent other diseases that might come up. Having the right facilities and therefore medicines helps eliminate further spread of disease. Even if we eliminated TB, the sanatorium could also be used as a respiratory unit, which is highly needed,” Georgiades said. “The mountainous area of Kyperounda is suitable for these problems. We have such a huge problem of asthma, allergies and obstructive pulmonary disease here in Cyprus. When we look at it this way, it is correct to have this sanatorium.”
He uses as examples renovated sanatoriums around the world, which are used to treat many other serous ailments as well as TB.
“As everyone has acknowledged the need for this sanatorium, why not go ahead with it? Why wait till the final minute and when the problems arise to discover that we are not equipped to handle them. We need to be prepared.”