Bali Tuberculosis Project

Every 24 hours, over 400 Indonesians die from a treatable infectious disease - tuberculosis. Almost 600,000 new cases are reported across the archipelago each year, and far too many of these cases go undiagnosed until the individual is too sick to work. Almost 80% of the tuberculosis cases fall within the age group 15-54 years, the most economically active group. As there is no social security or unemployment benefits - no work, no pay - the family unit may suffer enormous hardship.

Tuberculosis thrives in situations where people live in close habitation and with poor nutrition. The closeness of living of the people of Bali where the population density is 542 people per square kilometer (compared with 105 people per square km for the whole of Indonesia) exacerbates the problem. In addition, there are 150,000 itinerant workers from Java moving to Bali each year. These people are poor, unemployed and have limited access to health care, further adding to the burden of TB in Bali.

Diagnosis and treatment is vital for two reasons:

1. for the community - to reduce the transmission of tuberculosis infection to other members of the community
2. for the individual with tuberculosis - to cure their disease, to enable them to return to work and daily living, and to restore them to their family and community.

The key World Health Organisation strategies to control tuberculosis in countries like Indonesia are the DOTS principles of accurate and efficient sputum microscopy to detect the tuberculosis organism, and directly observed therapy to ensure the patient completes the treatment.

The DOTS principles emphasise the delivery of free tuberculosis services. In Bali the Indonesian National Tuberculosis Program provides free medication, but laboratory testing for diagnosis usually incur a cost to the patient. This leads to under-diagnosis amongst people who are unable to pay.

The Foundation is part of an Australian-based Consortium consisting of Westcare Incorporated, Australian Tuberculosis & Chest Association, Royal Adelaide Hospital, Institute of Medical and Veterinary Science, Royal Perth Hospital, Curtin University Faculty of International Health, which is running a six-year training program for laboratory technicians in microscopy techniques AND DOTS management workers to enable better diagnosis and treatment of tuberculosis. This training program, which commenced in 2005, is being carried out in conjunction with the central laboratory in Bali (BLK) and the WHO DOTS system of treatment.