Tuberculosis in El Salvador
Profile of Julio Garay
“When we began this program in the 90s, 12 percent [of TB patients] would die. Now, only two percent of people with tuberculosis die.”
In the last ten years, El Salvador has improved its ability to fight tuberculosis, says Julio Garay, MD. When he began as National Program Manager of Tuberculosis about 15 years ago, just 68 percent of patients with TB in El Salvador completed treatment. In 2014, 94 percent completed treatment. “When we began this program in the 90s, 12 percent [of TB patients] would die. Now, only two percent of people with tuberculosis die,” he explained.
Dr. Garay has been instrumental in the change. He has worked for almost two decades against TB in El Salvador. He established a new directive on the treatment of TB, requiring more strictly supervised treatment and the use of information and analysis systems, he said.
Dr. Garay is proud of the country’s model. “El Salvador has an honorable position at a worldwide level by having the best tuberculosis program of the Americas and perhaps the world,” he said. “The country has a lot to show, lots to teach.”
An International Course on TB Epidemiology and Control, offered by the International Union Against Tuberculosis and Lung Disease, is regularly held in San Salvador, the capital of El Salvador.
Dr. Garay also collaborates with numerous international bodies, nearby countries, and local actors to improve TB treatment in the Americas, he says. “That doesn’t mean that we don’t have tuberculosis” cases, he clarified. “Being a country where we have lots of social constraints that affect us, means we have TB — but we do things right.” He hopes that El Salvador can become “a regional center for education, training, and collaboration…to do better in the diagnosis, treatment, and care of tuberculosis and chronic respiratory disease.”
Despite the robust program, Dr. Garay says the country’s TB patients still struggle. “The most difficult problem [for people affected with TB] is stigma and discrimination,” Dr. Garay says. “The symptoms and signs are so unspecific, like cough, fever, weight loss,” that clinicians may miss the diagnosis. He also notes that the decrease in cases of TB has meant that it has been “removed from the minds of many health professionals that tuberculosis is an important public health problem.” Dr. Garay wishes to combat this laxity, by reaching providers during their training at universities and elsewhere, and by campaigning to the general public through radio or TV to improve public awareness, “to convince them that is completely curable, and that they do not [have to] feel marginalized, stigmatized, [or] discriminated” against, Dr. Garay said.
Dr. Garay has worked extensively with international partners like Migrant Clinicians Network to assure that migrants with TB returning to El Salvador receive prompt treatment. For about the last five years, Dr. Garay has also worked closely with the US Embassy in a program repatriating migrants from the US with TB, he says. He notes that a successful international partnership requires high levels of discipline and coordination, but he is motivated by the many lives his programs have saved.
Future international collaborations are key to improving the health of his migrant population, he says, envisioning continuing education resources and internships where doctors can come to El Salvador to better understand the patients and the country’s approach to TB.
“I’ve always been involved with the issue of immigrants and the diseases that produce more of a stigma, and discrimination, [in addition to] tuberculosis, such as HIV, Chagas, and other diseases,” he explained. He stays in the migrant health arena for “humanitarian reasons,” and for the reaction of the individual patient, he stated. “I believe that what is most rewarding is seeing the smile and the joy of a patient when one says, ‘You’re healed — you’re completely free of tuberculosis. Continue your work and normal life,’” Dr. Garay said.
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Profile originally published on MCN’s website as part of 30 Clinicians Making a Difference, a project celebrating Migrant Clinicians Network’s 30th anniversary through the life stories of 30 clinicians making a difference in migrant health.
