Donor Impact: TB care in Tondo, Manila

The ride from Doctors Without Borders/Médecins Sans Frontières (MSF)’s office in Manila, Philippines, to the drop-off point is a short one. It’s filled with a mix of patient history updates, frequent pauses for car karaoke, and discussions on patients’ struggles to get their tuberculosis (TB) medication. We’re on our way to conduct home visits for a handful of patients and inform them about their TB diagnosis.

The Philippines has one of the highest incidence rates of TB in the world. In collaboration with the Manila Department of Health, MSF teams launched an active case-finding (ACF) project in 2021 to detect TB with an x-ray truck in the district of Tondo, one of Manila’s most impoverished areas.

As we drive, Arnel Bonga, an MSF outreach nurse sitting in front of me, points down a skinny street, past school children and a large gate, “That’s where I went to high school!”

The building he points to is minutes away from our next patient’s house.

Ninety percent of MSF’s nearly 68,000 staff around the world are locally hired, meaning they’re a part of the same community they’re treating. It wasn’t until I visited the project in Tondo that I fully understood the scope of this fact. For Arnel and so many of his colleagues, working in Tondo is personal. They’re not just treating patients or people in need; they’re treating their neighbors. And being from Manila myself, I’m moved that the people of my hometown have access to high-quality care provided by staff members like Arnel.

The Philippines has the highest incidence rate of TB in all of Asia. In collaboration with the Manila Department of Health, MSF teams launched an active case-finding (ACF) project in 2021 to detect TB with an x-ray truck in the district of Tondo, one of the capital’s most impoverished areas. The aim is to screen people, trace contact cases and refer TB-positive patients to local health centers. Tondo, one of the mostly densely populated areas in the Philippines, is particularly susceptible to outbreaks of contagious diseases.

The team visits each patient and walks them through the next steps after their diagnosis–a feat made incredibly tricky since home addresses aren’t standardized and people often move. We’re guided by local volunteers or barangay captains—local elected officials who serve as focal points for specific neighborhoods.

The streets are narrow, fitting only one car at a time—with their side mirrors always folded in. But we find every single patient who needs to be notified, their neighbors guiding us when we get turned around. Once we reach the patients, Arnel and other nurses explain what their treatment will look like, from the projected duration of care to where they can pick up medication.

One of the patients tries to rush Arnel through his explanation and is resistant to starting treatment. He tries to brush us off, saying that he didn’t have any symptoms and wasn’t interested in receiving treatment. Arnel slows down, explaining the dangers of TB, both to him and to those around him, and trying to figure out the reason for his resistance. It’s crucial for the man to start treatment. They speak more, and Arnel explains that MSF can provide him transportation to the health center and that we can coordinate with someone in his household to make sure he doesn’t miss his appointments. We will do everything we can to get him the care that he needs. Eventually, the man admits he doesn’t like needles.

Arnel lights up, “The medicine is taken orally, sir!”

This is the work you are supporting. You’re not just putting scalpels into hands, or helping distribute clean water. You are powering patient-first, community-centric work. Our teams are able to provide compassionate care because of you.