In the face of an outbreak of drug resistant TB at the end of 2009, which resulted in the United States Centers for Disease Control being called in to help, staff at Ebeye Island hospital screened more than 1,000 people on the island but were not provided with an adequate amount of test kits to determine the type of TB they found in the initial screening nor medicine to treat people with the preventable illness.
So serious was the drug and supply shortage on Ebeye that Ministry of Health TB program officials on Ebeye complained to the ministry’s headquarters on Majuro, the capital, to make sure that supplies are sent to Ebeye on a regular basis.
“Yes I saw it,” said Kwajalein Sen. Tony deBrum of the report. “I still do not know when to stop laughing and start crying.”
Despite the supply problems at Ebeye, no additional cases of multi-drug resistant TB have been identified in the Marshall Islands, said CDC spokeswoman Rachel L.C. Powell. She added that CDC, which is based in Atlanta, Georgia, does not fund test supplies or medicines, but has sent TB officials to the Marshall Islands four times in 2010 to follow up on the problem.
While no new drug resistant cases were identified, more than 170 suspected new cases of regular TB were identified by screening on Ebeye.
Ebeye is an overcrowded island where workers live who are employed at the U.S. Army’s Kwajalein missile testing range. Recently, a U.S. Army report said most of the island’s infrastructure is dysfunctional, with raw sewage pumped into the lagoon.
The Ebeye TB program reported it had an inadequate supply of TB drugs and test kits to fight the spread of tuberculosis during the first months of this year. This report from Ebeye came despite the government’s cabinet approving last December the Ministry of Health’s emergency request for additional funds and other support in response to the CDC’s confirmation of 10 drug resistant TB cases in Majuro and Ebeye late last year. TB that is resistant to drugs routinely used to control the disease requires use of drugs that can cost as much as $175,000 a year per patient to treat, according to ministry officials.
In early February, the U.S. Interior Department approved a Ministry of Health request to reprogram $1.4 million in U.S. grants to respond to the TB problem.
But from January to March, Ebeye’s TB program languished for lack of support from Majuro, according to the Ministry of Health’s second quarter Compact report to the U.S. government that was released by the Department of the Interior.
The lack of support did not stop Ebeye health workers from conducting a contact screening program. They reported screening more than 1,200 students and adults, 171 of whom tested positive on the initial screening. But lack of test kits hampered further assessment of the problem.
“The TB team is really good in contact tracing and Directly Observed Treatment but the main problem we are facing is lack of TB drugs and tests,” an Ebeye TB official said.
“We faced shortage of anti-TB drugs like PZA (Pyrazinamide, one of the routinely used drugs to treat TB),” the official said. “We received some PZA from Majuro, but it cannot cover our regular patients.”
