Research Paper on Tuberculosis - Signs and Treatment

Tuberculosis is the leading cause of mortality from infectious diseases all over the world.  Though it is not highly infectious in general it is possible for Mycobacterium Tuberculosis, the cause of TB, to infect people via the respiratory tract.  By coughing, the organism is released into the air which may be inhaled by others and may cause infection.  But the people who are in more serous risk of TB are those who have had prolonged contact with an infectious person.

After a person inhales this organism, the bacteria starts to multiply in the lungs and then spread through the body.  In most cases, however, the body’s immune system is able to sensitize or control the bacteria.  The tuberculin or PPD skin test and the QuantiFERON blood test can directly measure the body’s sensitization to the bacteria. In some cases, however, persons infected with the bacteria merely carry the infection in its dormant form called the Latent Tuberculosis Infection (LBTI).  If the latent infection becomes active, TB Disease follows.  Among the indications of the presence of TB disease are: cough productive of sputum, fevers, weight loss, night sweats and general fatigue; swollen lymph nodes, and tuberculous meningitis. 

TB is also closely associated with HIV.  According to Bernard and Roncarati, those who have HIV have a higher risk of exposure to TB and TB disease. Because HIV weakens the body’s immune system, it allows the entry of TB infection into the body.  In some cases, it can also re-activate the latent TB infection for those who have been previously infected.

Bernard and Roncarati suggest that treatment for TB should vary depending on whether the person has TB infection or a TB disease.  If the person has TB infection or has LBTI, they must undergo what Bernard and Roncarati calls “preventive therapy.”  Preventive therapy targets those persons having TB infection who are at risk of reactivating their LBTI to develop into active TB disease.  This usually consists of a nine-month daily intake of isoniazid.  On the other hand, for those persons who have TB disease, medical treatment consists of taking different drugs administered daily for at least six months.  The treatment regimen includes four anti-tuberculosis drugs: INH, RIF, PZA, and either ethambutol or streptomycin. 

The article written by Bernard and Roncarati is quite exhaustive as it deals extensively with the different issues surrounding TB infection and TB diseases including its treatment and its association with HIV.  I disagree however on two important points.  The first is that there are other indicators of the presence of TB infection aside from those mentioned.  I also would like to add that aside from the other indicators mentioned by Bernard and Roncarati, other indicators that may suggest TB infection are abdominal pain, blurred vision, dark urine, loss of appetite, fever, nausea, vomiting, rash or itching tingling or burning feeling in hands and feet and yellow color of eyes or skin. 

The second point is that Bernard and Roncarati seem to have forgotten or ignored the tuberculosis treatment for children.  They may have committed the same mistakes as the other health experts by ignoring the importance of tuberculosis treatment for young children who according to recent research comprises at least 20% of the new cases for active tuberculosis (Hindustan Times, 2008, p.1).  I think young children should be included and made part of every long-term solution or plan to the treatment of Tuberculosis. 

It can be concluded that Tuberculosis is a deadly disease.  It is not something that should be taken for granted.  Without treatment, quality of life may be affected and may even lead to death.  TB is curable.  The patient must keep in mind that once he has the infection or the disease he must follow the prescriptions by the doctor and finish it as the doctor advised.  Starting the therapy without finishing it properly or taking the medications as doctors advised will only make it drug-resistant making therapy more difficult. 

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Technological and Global Challenges for Potable Water in Third-World Countries

The Philippines is a country in South East Asia that has a population of more than 88 million.  As an archipelago it is endowed with rich natural resources.  One of them is its water resources.   It is very surprising however that in this country access to clean and potable water is very difficult both in rural areas and urban areas. 

Consider the case of Flora Heruela whose picture is shown below as Appendix ‘A.’  She and her family live in a remote province in the Philippines whose access to clean and potable water is very poor (Rianne C. Tecson, 2007, p.1).  Since they do not have access to piped water supply, they have to get their water from the nearest spring which takes her and her family four hours every day just to fetch water for their daily consumption.  They would usually go to the spring four times a day for their daily needs. 

In contrast, however, access to water supply is not difficult in the country’s capital as in Metro Manila wherein water supply coverage is relatively high at 84% in 2000 (B.B. Magtibay, 2004, p.2).  Its problem lies, however, in the delivery of safe and potable water to its residents.  In 2003, because of poor management by the water utility companies, a cholera outbreak occurred in one of cities in Metro Manila.  Health authorities found out that the cause of the cholera outbreak is the contaminated and illegally connected water pipes causing a scare in the use of water from water pipes.

Because of the problems of accessibility of clean and potable water supply, residents in the provinces and rural areas and in the urban cities have started to look for alternative sources of clean and potable.  Because the use of household filters remains very expensive, those in the rural and in the urban areas have started to patronize water refilling stations (Cris-Ann Ordonia, 2007, p.1). 

Water refilling stations offer the advantage of easy access to safe and potable water to the people.  It is worth noting though that in rural areas the services of these water refilling stations are more expensive compared to the cost of connection with the existing water utilities.  For them, this is a small price to pay for their own safety.  In Urban areas, water refilling stations offer an advantage of being a cheaper alternative compared to the cost of buying bottled water or using household filters.  The table below as Annex ‘B’ shows the cost of water supply in Metro Manila in 2004 alone. 

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This essay seeks to discuss the ethical implications for the use of technology by water refilling stations.  The problems resulting from the proliferation of water refilling stations will be also be discussed together with the proposed solutions.  The objective of this paper is to show that while technology may have brought changes in the lives of the people in Third-World Countries like the Philippines, such technology, if not regulated, could also bring serious danger to the environment and the safety of the people. 

Technology

Water Refilling stations has become a good business in the Philippines.  The need for safe and potable water has led to the proliferation of water refilling stations not only in urban areas but in rural areas as well.  Consumers would bring their own containers to these establishments and fill them for a per-gallon fee.  The demand was so high that most stores nowadays offer free home delivery for regular customers. 

Water Refilling stations either purchase their raw water from water utilities or they opt to use private deep wells.  This raw water is then purified by utilizing a combination of water treatment equipment such as the sediment filters, carbon filters, water softeners, reverse osmosis membranes, ultra-violet lamps, and ozone generators.  Water refilling stations rely on several equipments to process raw water.  The first is the Multi-media sediment filter which functions to remove sediments such as rust, sand and other particles that are invisible to the naked eye but are harmful to the consumers.  The second equipment is the Ion Exchanger which functions to replace hard minerals with soft minerals.  The third is the Activated Carbon Filter which serves to remove all organic chemicals like herbicide, pesticide, offensive odor and bad taste that may be present in the raw water.  The fourth equipment is the Reverse Osmosis Membrane which is the heart of the system and serves to remove inorganic minerals, bacteria and viruses while retaining its oxygen content.  The fifth equipment is the Post-carbon filter which helps to improve the taste of the water.  The sixth equipment is the ultraviolet lamp which ensures that the water is free from disease-carrying microorganisms.  The seventh is the Ozone generator which inhibits the growth of bacteria while the water is stored in the tank and prolongs the shelf life of the water. 

Ethical Issues with the Use of Technology

In view of the proliferation of these water refilling stations in rural and urban areas, the regulation and monitoring of these businesses have become very difficult not only for the national government but for the local government as well.  These water refilling stations have started to abuse the lax regulation by government authorities.  As a result, several ethical concerns have surfaced.  The first is the question of safety of the drinking water being delivered to the consumers (R. Tecson and L. Ramos, 2007, A13).  In the desire of the owners of these businesses to earn more they have found a way to operate their business even in the absence of sanitary permits.  Recently, an article was released saying that one of the provinces in the said country has 113 registered water refilling stations.  It is very surprising that only 23 of these stations have sanitary permits from the Department of Health (DOH) (Maricar M. Calubiran, 2008, p.1).  Sanitary permits are essential prior to the operation of the water refilling station since it is the written permission issued by the local health officer certifying that the establishment complies with the minimum requirement of safety under existing laws.    

The second issue that must be addressed is that the proliferation of the water refilling stations has led to the depletion of its groundwater reserves.  It has been mentioned that water refilling stations either purchase raw water from water utilities or they construct private deep wells.  Most of these establishments, in order to save cost, source their water supply from private deep wells.  This has resulted to the depletion of the groundwater reserves.  Though we do not see the presence of groundwater, it performs a very important role in our eco-system.  It bears stressing that groundwater supplies water to springs, ponds, marshlands, swamps, streams, rivers and bays.  It is still considered as a dependable source of uncontaminated water (“Importance of Goundwater,”p.4).  Because of the overuse of groundwater for urban and rural it is possible that in the future we may not have enough groundwater to supply our daily needs. 

In addition, land subsidence, which is the condition of lowering of the land surface elevation from changes that take place underground, also results from the overuse of groundwater (US Geological Survey p.1).   It usually happens when large amounts of groundwater have been withdrawn from certain types of rocks.  Because of the depletion of water, the rocks begin to compact and fall in on itself. This is a problem not only in Third World countries but also even in Industrialized countries. 

Proposed Solutions

Water is a very important natural resource not only for Third-World countries but for industrialized countries as well.  Sustainable supply of clean and potable water should be made the country’s priority.  Efforts must be made to address the problem of sustainable source of clean and potable water before it becomes too late.  It must be stressed that water refilling stations do not provide a sustainable solution to the problem.  In fact time will come when the country will realize the immensity of the problem of allowing the proliferation of water-refilling stations. 

It is suggested that the strict regulation be implemented to ensure the protection of the groundwater supply.  Sufficient safeguards must be instituted so as to avoid the exploitation of groundwater resources.  Until now, there is still no initiative coming from the national or local government of the said country to regulate the establishment of water refilling stations.  The present policy would seem that any person who has the capital can operate water refilling stations.  It is suggested that laws must be passed that will regulate the number water refilling stations in a certain locality. 

Also, there is currently no law that seeks to regulate the construction of private deep wells which is the source of the water supply of some water refilling stations.  In fact, even private individuals can construct their own deep wells for non-commercial use without the need of securing permit from government entities.  There is also no action on the part of the government to restrict use of existing private deep wells.  It is suggested that the government should outlaw the construction of new private deep wells especially in areas where there is already a large number of deep wells.  As for the existing deep wells, it is suggested that the government should restrict the use of the existing deep wells.

Also, while it is true that local health officials monitor the water refilling stations by conducting water testing and analysis on these establishments, the regularity of the performance of their duties is still questionable.  Under the law, local health officials are enjoined to conduct testing for bacteriological quality at least monthly, testing for physical quality must be conducted at least once every six months and the testing for chemical quality must be done at least once every six (6) months.  In some localities however, this is not being observed.  The sheer number of water refilling stations makes it very difficult for the local government to monitor every one of them.  It is suggested that the local government and the city government should strictly enforce the monitoring of these water refilling stations.  Additional manpower should be provided in order to facilitate monitoring. 

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