Some of the reasons why it's hard to treat TB in rural areas

Here at our clinic in rural Indonesia, we send an ambulance out with doctors and nurses twice a week to run mobile clinics in remote villages. This morning, one of my fellow American doctors told me with frustration that many of the patients she saw yesterday clearly had TB, but that she wasn't able to prescribe DOTS ("directly observed treatment short course," for tuberculosis) because there is no DOTS worker in that village.

Turns out it isn't quite that simple. That village has had DOTS workers in the past, but there have been bad logistical barriers to them doing their jobs. For one thing, the roads to that village are bad at the best of times, and sometimes well-nigh impassable. For another, that village isn't covered by cell phone service, so our clinic's DOTS coordinator can't easily communicate with them. And many of the villagers leave for weeks at a time to work on palm oil plantations, where they are out of reach of even the most dedicated local DOTS worker.

Lack of infrastructure is largely to blame here. But it also seems to me to be a clear example of how environmental devastation (in this case, the clearing of rainforest for palm plantations) can erode public health.

The road to a village in rural Kalimantan, Indonesia.

One of the bridges along the way.