With the beginning of the war in Ukraine, the Robert Koch Institute (RKI) drew attention to the widespread spread of tuberculosis (TB) – accordingly, it delivers RKI a catalog of measures to ensure the care of Ukrainian refugees suffering from TB. The upcoming Ebersberg General Practitioner Forum is also dedicated to TB, an “almost forgotten” disease, as it says there. In an interview with the SZ, the organizer and medical coordinator of the practices in the district of Ebersberg, Marc Block, explains why Germany should deal more with tuberculosis regardless of the war and why he fears that employees will turn away from the healthcare system.
SZ: Mr. Block, have you ever treated a patient with tuberculosis?
Marc Block: Yes, we have treated several tuberculosis patients in recent years. This always took place in excellent cooperation between the special clinic, lung specialists and us as the supervising general practitioners.
Tuberculosis is much more widespread in Ukraine than in Germany: According to the WHO, the incidence in 2020 was in the Ukraine at 73.in Germany at 5.5. Has it already happened that Ukrainians with TB or suspected TB have visited a practice in the district of Ebersberg?
So far, no patient has come to our practice with this diagnosis or suspected TB. The health department also confirmed to me today that so far no case of active, open pulmonary tuberculosis in the context of the current movement of refugees from Ukraine has been reported or is known.
Refugees in collective accommodation must have a current one anyway TB screening show. So why the RKI report? Is the caution exaggerated?
I think we’ve just been lucky so far – the first case will come. TB is very widespread worldwide, Germany has so far been an island of the blessed in this regard. However, with increasing general migration, it is important that we too learn more about this disease and how to treat it.
What are the triggers of tuberculosis, or to put it another way: Why are there more of these triggers in Ukraine, but hardly in Germany?
In general, a weak immune system, poor hygiene and a poor diet are risk factors for infection. Correspondingly, tuberculosis spreads above all in places where inadequate hygiene standards are more common, i.e. in poorer countries and in crisis and war zones, as is currently the case in Ukraine. Since tuberculosis is a “droplet infection”, the risk of infection increases where people live together in a confined space under poor hygienic conditions.
Marc Block runs a general practice in Zorneding together with his wife Stefani Lordick-Block.
(Photo: Peter Hinz-Rosin)
To what extent does the immune system you mentioned play a role?
With an intact immune system, our body is able to fight the infection, so the disease does not break out in the first place. If the immune system is weakened by accompanying diseases, such as poorly controlled diabetes, HIV or poor nutrition, the pathogens can penetrate the lungs more easily and cause the disease there. Corona infection can also increase susceptibility to tuberculosis.
How does the treatment of tuberculosis differ from that of other bacterial infectious diseases?
It is treated with antibiotics. The therapy takes a very long time, between six and 18 months, and consists of administering a combination of different drugs that have to be dosed individually several times a day. If the treatment is interrupted for a longer period of time, it may be necessary to start the therapy all over again. Often, however, the drugs are no longer effective because the tuberculosis bacteria have developed resistance to antibiotics.
How common is such resistance?
Three percent of all new cases of tuberculosis worldwide are in Europe. Eastern European countries are most affected, especially Ukraine, which had around 35,000 new infections per year before the war. According to the WHO, about 10,000 of those infected have a multi-resistant form of tuberculosis – that’s almost 29 percent.
Apart from tuberculosis, which other diseases are likely to play an increasingly important role as a result of the war in Ukraine?
Among refugees – be it from the Ukraine or other countries of origin – there is a higher rate of diabetes than in the rest of the population. The flight also poses a higher risk of infectious diseases, as the refugees are more exposed to pathogens, have little or no access to health care and have to live in unfavorable conditions. With regard to the refugees from Ukraine, there is concern that among them there are more people with measles and poliomyelitis, but also with Corona. The reason for this is a lower level of protection from vaccinations carried out in the home country.
the Corona vaccination rate in Ukraine was recently around 35 percent. As medical coordinator of the established practices, you have a special task during the pandemic. Do you have any plans as to how you and your medical colleagues can close the large vaccination gaps among the refugees?
Both the employees of the health department and we, the resident doctors, address the need for further vaccinations when we come into contact with the refugees. But that doesn’t always happen at first contact. Because there are usually acute and serious illnesses that prompted a visit to the practice, and the patients are still very exhausted from their escape in the first few days after their arrival.
What about mental health?
In most cases, people come to us with acute physical problems or chronic illnesses. Injuries caused by the horror experienced and the efforts of the expulsion usually remain hidden at first and probably only become conscious over time or lead to mental illnesses. I doubt that our healthcare system will quickly be able to cover this great need with appropriate care for those affected – especially since the range of psychotherapy is already far from sufficient.
The additional burden on the practice teams caused by Corona has not yet been overcome, and you are already facing the next challenge. How do you rate the situation?
Health policy must finally tame bureaucratic monsters: We expect billing regulations to be simplified and nonsensical specifications of half-baked digitization to be ended so that we can concentrate on our actual work again: treating the sick. In addition, it is necessary for doctors and medical assistants to be valued in their work and for the considerable additional workload that has existed for years to be rewarded accordingly. If this does not happen, I fear that many nurses, medical assistants and doctors will not be willing to endure this constant burden and will turn their backs on their profession. But that must not happen under any circumstances.