Herostory Dr. Rosa Herrera, Mexicali, Tuberculosis, QFT, QuantiFERON
Infectious Disease | Tuberculosis

Fighting the stigma. The key to eliminating TB.

13 October 2021

All local recommended safety guidelines followed at the time of interview.

After surviving an earthquake, Dr. Rosa Herrera thought the worst was over, but she had contracted tuberculosis after sheltering in a crowded ER with patients and other residents. It took her 10 months to recover physically from the disease, but the emotional strain, the stigma that comes with the illness, was especially difficult. Now, Herrera is doing all she can to reach out and treat the hardest hit communities.
It took Dr. Rosa Herrera eight years before she could openly admit that she had once been ill with tuberculosis. Such was the stigma surrounding the disease in her home city of Mexicali, on the US-Mexico border, that even an educated medical professional was made to feel shame for something utterly beyond her control. For having been infected while healing other people.

Herrera, now a mother of two young children aged four and six, was 25 years old when she contracted TB, while working as an intern in a local hospital. Following an earthquake, all the hospital's patients had to be evacuated and re-located to the Emergency Room. This sudden overcrowding proved a fertile environment for spreading the illness, and Dr. Herrera was one of its victims. "So during this time, I realized what it is like to be a sick person," she says, "and what the challenges are that we have to face."

Over the following months she ignored her symptoms, attributing her shortness of breath and fatigue "to the long hours that I was working on the ER when I didn't have much time to rest or to eat properly." When she could no longer walk more than two or three metres, it took one of her patients - a woman in labor - to point out that she clearly was not okay. Finally, she admitted to herself that there was a problem, and a chest x-ray revealed a pleural effusion across her right lung.

The diagnosis was "a shock". Not only that, but active TB, one that presents as symptomatic, is often contagious.
Dr. Rosa Herrera spent four months suffering from exhaustion and shortness of breath before testing positive for tuberculosis. The diagnosis came as a shock, but what was even more difficult than overcoming the illness, was the stigma that followed. She was avoided by her family and even medical colleagues well after she could no longer have been contagious. Now, Herrera uses her experience as motivation to help fight the disease and the stigma. And she has the tools to do so in even the hardest-to-reach communities.
I just had shortness of breath and I was always so tired. Later, in an X-ray, I saw a pleural effusion almost take over my right lung. I immediately knew I had tuberculosis.
Dr. Rosa Herrera, Mycobacteriosis Program Coordinator, Mexicali Institute of Public Health

Lack of empathy and diagnosis tools

Herrera’s full recovery took almost a year, involving surgery and complications due to adverse reactions to some of her treatments, and what she calls "a huge lack of diagnosis tools". Worse, though, was the reaction of some colleagues and family members. "I suffered in many ways from the stigma," she says, "even from my own colleagues around the hospital. They were asking me to wear a mask even when I was not contagious."

Herrera's family also didn't understand how the disease works, and avoided her completely. "That caused so much pain for me," she stresses, "it was so lonely…not to be with all my family. Only my mother took care of me. I was isolated and alone in my room for a month, it was really difficult."

Herrera learnt much from her time in recovery, and was now determined to devote her career to fighting tuberculosis. She altered her course of study to focus on TB, and says that although she "suffered through hard times" as a patient, "they taught me a lot about the importance of being empathetic, and how that support gives the patient the opportunity to get the cure, or finish their treatment. And it showed me first-hand how people are not really well educated about the disease."

Knowing that even friends and family can react so severely when they find out you have TB is one of the challenges in encouraging patients to get tested.
doctor herrera smiles at the profile picture
Dr. Rosa Herrera works for the Mexican government as a tuberculosis controller in Mexicali, but also voluntarily works for the TB Zero Initiative. When she's not working, she loves to spend time with her kids: "I'm a mother of two, so I'm a full-time mother when I finish work. I love to be around them. They are so young right now, so I don't want to miss anything. But I also love to read a lot and also to meditate. I really need to take some time and put everything to one side because as a working mom some things are hard, but it is always fun."
One of the huge problems that we are facing that people are struggling to receive access to health care.
Dr. Rosa Herrera, Mycobacteriosis Program Coordinator, Mexicali Institute of Public Health

It's time to talk about TB

"There's not only this stigma when it comes to talking about the disease," she says, "but also to talking about the stigma itself, or the situations you have to face. In the past I felt ashamed because I had tuberculosis and it took me around eight years to say openly that I had had TB, and that I had recovered." The way forward, Herrera believes, is to talk about the disease. To explain that there is no shame in getting tested and treated, since treating latent TB is simple. Much simpler than dealing with the risk of getting sick and infecting others.

Herrera now works with the Zero TB Initiative's mobile unit to reach those communities that not only need educating about TB, but testing and treatment for it too. One of largest groups vulnerable to TB in Mexicali are drug abusers and the homeless population, who have the highest incidence of both active and latent forms of tuberculosis. "And when you have this disease together with having a drug problem, it's really hard to look after yourself. You are only going to receive health care when you are severely ill. So that means they have been contagious for a long period of time before they get treatment,” says Herrera.
Vulnerable populations, Tuberculosis
One of largest groups vulnerable to tuberculosis in Mexicali are drug abusers and homeless populations who have the highest incidence of both active and latent forms of TB. "I think one of the huge problems is that these people are struggling to receive access to health care," says Dr. Herrera. "And when you have this disease together with having a drug problem, it's really hard to look after yourself. You are only going to receive health care when you are severely ill. So that means they have been contagious for a long period of time before they get treatment and may have infected a lot of people during that time - it can be extremely challenging."
There's also this stigma to talk about the disease… but it is so important that the survivors of TB share their experiences. That they know they will be OK after being tested.
Dr. Rosa Herrera, Mycobacteriosis Program Coordinator, Mexicali Institute of Public Health

Quicker tests mean quicker treatment

QIAGEN is currently developing a new test that is specifically designed for high-TB-burden countries like Mexico that do not always have access to complex testing labs.

The QIAreach QuantiFERON-TB Test not only will deliver similar accuracy to other TB blood testing methods, but it will also be much more accessible. "It is portable, you don't need to invest a lot of money to make this possible," she says. "So we can envision making these tests available in communities where the resources are pretty low."

The test will also eliminate the need for a second visit. "We can diagnose the infection and we don't have to go back - we can take action immediately, because the test result is ready in 20 minutes. We don't need a lot of staff or to invest in extra resources, and we don't need cold storage, which is a big point in a place like Mexicali - it can get up to 50 degrees in the summer."

A single visit is particularly important in a place like Mexicali because, Herrera explains, "we have lost the follow-up on several patients who for various reasons can't show up for a second visit." Also, with a TST test "it is really hard to ensure we are going to come back 72 hours after the first application. If the staff are not well trained, you won't be sure the correct duration between visits is properly observed." QIAreach, though, "will be easy. You only need one visit, one tube and one millilitre of blood, and you will have accurate results in 20 minutes.
herrera while viewing the photo of the lungs
Patients with TB may develop drug resistant versions of the diseases, especially if the treatment plan is not followed properly. Drug resistant TB requires longer and more difficult treatment to eliminate the infection, and can also spread amongst the population. Early detection of the infection with IGRAs like QFT-Plus can help reduce the course of treatment by enabling earlier intervention. Testing and education is key when it comes to stifling the flow of the illness. But patients must be willing to participate. And that is half the battle.
COVID-19 has made tuberculosis even more invisible than it already was. It's really hard because instead of moving forward on control and elimination, we are right now just trying to put a bandage on tuberculosis care and control.
Dr. Rosa Herrera, Mycobacteriosis Program Coordinator, Mexicali Institute of Public Health

We can eliminate TB

At present, medical staff on the tuberculosis frontline need all the help they can get. Dr. Herrera believes that the international response to the corona virus is evidence that, when humanity puts its mind to a problem, it can find a long-term cure. After all, for COVID-19 it came up with multiple vaccines in just one year.

"We already know that TB is a highly preventable and one hundred per cent curable disease. It is so important that the survivors share their experience so other survivors raise their hands and say, 'I have it too, and you can survive through this and we can be supportive of each other.”

“It is so clear that we need to put our resources together as we have done with COVID-19, and maybe if we do something with that amount of effort, we could really eliminate tuberculosis... We will change history and we will save so many millions of lives."
doctor rosa herrera
Zero TB Initiative is a non-profit, global organization that aims to try to control tuberculosis and eliminate it through a pathway of search, prevent and treat. In Mexicali, Dr. Herrera’s team targets specific communities and tries to give TB victims health care they would otherwise struggle to receive because of poverty, lack of access, or through being in rehab.
In need of taking latent TB testing out of the lab?
Learn more about taking TB testing into remote communities.