Quezon and TB

Manuel L. Quezon was born on Aug. 19, which is why the month of August is dedicated to three of his most important advocacies: a national language, a new urban center (Quezon City) and tuberculosis (TB).

That last advocacy is perhaps the least well known today. We do have August declared as National TB Awareness Month, but the disease continues to be a major public health problem in the country, costing us billions of pesos each year from lost labor productivity, since TB hits most people at the prime of their lives.

TB was one of Quezon’s other major advocacies; he died of it on Aug. 1, 1944. Sadly, he was in exile because of World War II, dying in Saranac Lake, New York.

I had always thought he died in a TB sanitarium in the United States, similar to the Quezon Institute, popularly known as QI, on E. Rodriguez Avenue in Quezon City. But it turns out Saranac Lake was an entire town filled with “cure cottages,” residences devoted to the “rest cure” for TB. Quezon Institute and other TB sanitaria of that period all used this “rest cure” as well, with fairly good results. But, in 1945, with the introduction of streptomycin, the first effective anti-TB drug, these sanitaria were phased out.

Before I discuss the “rest cure,” let me just fill you in on some information about Quezon Institute.  This was put up in 1918 initially as the Santol Sanitarium, Santol being the name of the street parallel to E. Rodriguez. The sanitarium was actually a complex of buildings, designed in Art Deco style by no less than the renowned architect Juan Nakpil.

The funds to maintain what later was renamed as the QI came from all kinds of fund-raising activities and government subsidies, including the Sweepstakes Law, which allocated 25 percent of sweepstakes sales to the Philippine Tuberculosis Society.

There are no more patients in Quezon Institute these days, but the buildings still stand and are considered a national heritage site, although some of the land has been leased to private developers.

From 1977 to 1983, I worked with Dr. Mita Pardo de Tavera, an expert on TB and director of QI. Mamita, as she was affectionately known to many, had actually left QI for many different reasons. She felt that QI was contributing to the stigmatization of TB, fanning public fears about the contagiousness of TB. (Don’t breath, my father used to say, as we drove past QI.)

Mamita always reminded people that she worked inside QI for many years but never got TB. A person’s vulnerability to the illness was due much more to socioeconomic status. The poor were more vulnerable to getting an infection mainly because they lived in congested slums, with constant exposure to the germs.

I thought about Mamita’s observation when I dug up information on both Saranac Lake and QI.  I saw photographs of the cure cottages, and could understand why Saranac Lake was so conducive to helping TB patients get well. The entire town catered to TB patients seeking the rest cure, becoming a kind of resort village that was accessible to rich and poor alike.

The rest cure did not work for patients with advanced TB, and so the anti-TB drugs were almost miraculous in controlling TB in many countries.

But the problem remained in countries like the Philippines, despite the availability of free drugs that cost up to P200,000 per patient, for those with drug-resistant TB. With these free drugs in the Philippines, the death rates dropped dramatically for a few years (2000 to about 2007), but have been inching down much too slowly in the last few years. It’s almost a race against time, because the rates of very serious multi-drug resistant TB keep growing.

Again, I thought of Mamita’s wise observation about TB being a disease of the poor, which drove her to start TB control programs in communities, with emphasis on training health workers to run the TB control programs, including supervising, on a house-to-house basis, the taking of TB medicines. This all happened long before the DOTS (directly observed treatment, short-course) program, which now requires patients to report to hospitals and DOTS centers to get their medicines.

Yes, we need the anti-TB drugs. Yes, we need more public education, including fighting the  discrimination and stigma attached to the illness—perhaps by pointing out that President Quezon had TB.

Most of all, though, the “rest cure” should not be sidelined as a quaint and old-fashioned remedy. TB patients do benefit from rest, access to fresh air and social support.  Can we bring all that back into our national TB eradication program?

mtan@inquirer.com.ph