Suvendrini Kakuchi
TOKYO , Feb 22 2006 (IPS) – For the past two years Suzuko Yasue, a diminutive but energetic woman, has been walking the streets of Tokyo, talking to Japan s growing homeless community and distributing pamphlets on the dangers of tuberculosis (TB).
The homeless in Japan, mostly elderly people who live alone, are particularly vulnerable to being infected with TB. This is the reason why it is important that we reach them, she says.
As Yasue s work illustrates, Japan maybe the world s second richest country but continues to grapple with alarmingly high rates of TB infection and mortality among the vulnerable, especially its homeless people.
Japan s social safety net, once firmly rooted in its strong corporations, has been shaken as unemployment grows and the country grapples with economic decline.
Homeless people are an unobtrusive lot that live where possible- in tents, cardboard shelters, railway stations, parks and public spaces and are an embarrassment for the government.
Among them are to be found jobless construction labourers as well as former white collar workers equally rendered unemployed by tough times and left to fend for themselves against hunger and disease, including tuberculosis.
Economic disparity has encouraged the spread of new infections among the disadvantaged such as the homeless community. As well, with increasing HIV rates among the young, we fear that TB will become a national issue again, explained Ikushi Onozaki, deputy director at the Research Institute of Tuberculosis (RIT).
Statistics indicate that Japan now records 30,000 new TB infections and more than 2,300 deaths annually from the disease despite the availability of low-cost treatment drugs and vaccines.
Many of the victims are unable or unwilling to seek medical help. Last year, the total number of TB patients in Japan stood at 72,079, the highest number among industrialised countries.
But according to national data, most cases of new infections are reported among people who are over 60 years old- over 60 percent of the total patients-with 43 percent and 23.8 percent of detections in their seventies and eighties respectively.
Weak immune systems that result from ageing, poor nutrition, disease and high levels of stress are seen as responsible for the TB cases.
A strong government campaign, led by the imperial family in the sixties, helped near eradication of the disease, but doctors say the complexities of containing the now resurgent disease calls for innovative approaches.
While the vast majority of patients caught the infection in the 1950s, when Japan faced a poor economy and inadequate health services, factors such as rising economic disparity in society and HIV infections among the youth are now fostering the resurgence.
Indeed, TB rates among the homeless -people with no regular jobs reached 20 percent in 2004. Corresponding data shows that cities, such as Tokyo and Osaka where large numbers of this community live, host the highest number of infections.
In a bid to cope, experts have begun to collaborate with social workers like Yasue to implement a Japanese version of the World Health Organisation s Directly Observed Treatment Short-Course (DOTS) programme, pointing out that drugs or vaccines, abundantly available in Japan, have proved to be insufficient.
Community support for high risk people such as the homeless who do not go to hospitals on their own, have been effective, explained Nobutaka Ishikawa, a director at the RTI.
Patients need to take four kinds of drugs for 6-12 months to complete the regimen. This is hard for people on daily wages and quite often they give up on medication, raising risks to themselves and to the community from multi-drug resistant strains.
Support groups for the homeless talk about the difficulty of convincing people not to discontinue treatment and cooperate with regular assessments of the course of the disease.
Yasue, a public health nurse, says taking medicine to the infected can be effective as homeless people tend to be day labourers and avoid long hospital stay that can reduce their incomes.
There should be a medication programme that takes into consideration the special needs of the homeless people that are different, she says.
Onozaki says Japan s TB problem and the way it is being handled can offer cues to developing countries which are also trying to cope with the disease.
There are similarities between Japan and other Asian countries grappling with effective programmes for vulnerable groups and community work does help to reach the poor better than a heavy focus on distributing free drugs, he points out.