TB Trails and Tails

00:00:30
Detective Seguin: Sarge, do you mean like a rat, like a mole? Like someone’s working on the inside?

00:00:34
Sargeant: No, no. I mean, a rat. Four legs, scaly tail. There it is. Get it. Got you now, you sandwich thief.

00:00:44
Detective Byers: No stop.

00:00:44
Sargeant: Byers. I should have known this was your handy work.

00:00:48
Detective Byers: No, Sarge. It’s not what you think. He’s been working undercover with me.

00:00:53
Sargeant: I don’t remember approving this.

00:00:55
Detective Byers: This little guy, he’s a hero.

00:00:57
Sargeant: Why do I have a feeling we’re about to go down a huge rat hole?

00:01:03
Kaylee Byers: You’re listening to Nice Genes, the podcast that sniffs out the scientific clues brought to you by Genome British Columbia. I’m your host, Dr. Kaylee Byers and a rat detective, obviously, scurrying through the world of genomics. It wouldn’t be a nice genes season if we didn’t talk about rats at least once. And in the detective world especially, rats have a bad reputation.

00:01:28
Clip: Mountain taking your dirty yellow belly rattle, I’ll give it to you through the door.

00:01:32
Kaylee Byers: But not here. Not on this podcast. The rats I want to tell you about are heroic.

00:01:39
Samalanga: My name, Samalanga. I’m working APOPO as a rodent trainer.

00:01:45
Kaylee Byers: That’s Samalanga and his colleague, Lilly. They work at APOPO, an organization that trains what they call HeroRATs to sniff out things that threaten human life from buried landmines to deadly diseases. This rat’s particular disease specialty, tuberculosis or TB.

00:02:02
Samalanga: The bar which contains the samples, the rat will start sniffing the sample from number one and number 10 by order one.

00:02:14
Kaylee Byers: And the rat he’s training? His name is Paris.

00:02:16
Samalanga: The rat, which I trained today, is Paris.

00:02:20
Kaylee Byers: He moves along his cage in front of a row of metal trays, each one holding a small sample of human sputum.

00:02:28
Samalanga: When the rat hit the positive sample, I will call and the observer will creak. The rat will go back to the feeding hole, taking the reward.

00:02:38
Kaylee Byers: When Paris detects the scent signature of mycobacterium tuberculosis, he pauses and scratches at the sample. Get it right? He’s rewarded with a tasty treat. And they’re fast. In just nine minutes, Paris tests 60 samples in the cage, correctly identifying four out of five positive TB cases and flags seven suspect samples that then go back for more testing.

00:03:03
Samalanga: And that’s 29.

00:03:06
Kaylee Byers: Paris is in training, still learning the ropes, but some of APOPO’s most experienced HeroRATs have screened over 200,000 samples in their careers and identified thousands of positive TB cases. So you might be thinking, “Okay, that’s radical.” But why exactly are we using rats to do this work?

Well, tuberculosis can hide in plain sight, often going undetected and slipping through the cracks. And even though some of us might think of tuberculosis as a disease of the past, that couldn’t be further from the truth. TB has been our constant companion for millennia. Some of the earliest traces we’ve found come from ancient human remains dating back nearly 9, 000 years. For much of this history, TB spread slowly until the Industrial Revolution. As people crowded into rapidly growing cities, tuberculosis ran rampant. And by the end of the 18th century, it’s estimated that one out of four people in big cities across Europe and North America were dying of tuberculosis. Back then, it was called consumption, named for the way people would just waste away as if the disease consumed you. And in classic people fashion, TB became almost romanticized. Pale skin, gaunt features, they were in style, inspired by poets and painters who were suffering from the disease. But that illusion didn’t last. By the late 19th century, tuberculosis was recognized as contagious and deadly. Without a cure, patients were sent away to facilities called sanatoriums. Remote hospitals built on the belief that clean air and rest could heal the lungs. For a long time, that was the best treatment medicine had. And then came a scientific breakthrough. In the 1940s, a soil microbe gave rise to streptomycin, the first effective antibiotic treatment for TB. Slowly, the sanatoria began to empty. Some still stand abandoned today, relics of a bygone era. But even with a new antibiotic treatment, TB never really went away.

00:05:22
Dr. Jennifer Guthrie: It’s been throughout history and probably impacted a lot of things in a lot of people, maybe even in ways that we didn’t know.

00:05:28
Kaylee Byers: That’s Dr. Jennifer Guthrie.

00:05:30
Dr. Jennifer Guthrie: And I am an assistant professor of microbiology and immunology at Western University in London, Ontario. And I also hold an adjunct scientist appointment at Public Health Ontario in Toronto.

00:05:43
Kaylee Byers: Dr. Guthrie’s work uses genomics to learn more about tuberculosis, how it spreads, and how we can better treat it. But before we get into that, let’s take a step back. So, very first question, what is tuberculosis?

00:05:58
Dr. Jennifer Guthrie: It’s a big question. Many people have probably heard of tuberculosis or TB for sure, but don’t necessarily know what exactly it is. So it’s a bacteria and causes infection, quite serious infection in many cases. So it’s most often respiratory infection, although TB can travel pretty much anywhere in the body and cause disease, but most people would have an infection in their lungs that’s transmitted via aerosols through coughing or speaking. Usually in a pretty contained space to get TB requires a pretty prolonged time together with someone that’s pretty infectious.

00:06:36
Kaylee Byers: And you mentioned it can travel throughout the body. I think you can even get it in your bones. Is that right?

00:06:41
Dr. Jennifer Guthrie: You can get it in your bones, your brain, pretty much everywhere. It always starts in the lungs, so that’s how transmission occurs, but it may travel for various reasons to different parts. So there’s two major forms of TB. They’re probably not as binary as we make it out to be. It’s probably a little bit more on a spectrum, but essentially for ease of discussion, latent TB and active TB. So when that TB bug reaches into your lungs, your body’s immune system effectively can wall it off. And if it does so successfully, which in most cases it will, then it can be dormant or what we call latent, potentially the entirety of your life where you have a TB infection, but you don’t have an active infection, you have no symptoms, you don’t require treatment. Only about 5 to 10% of people actually go on to an active infection in which they are infectious, they’re going to be unwell and require treatment. So there are a lot of people out there with TB, probably many of which are unknown to themselves.

00:07:44
Kaylee Byers: About a quarter of the world’s population carries TB, though that number is hard to pin down since most infections remain dormant, but every year around 10 to 12 million people develop active infections that need treatment. And from those cases, roughly 1. 2 million will die, making TB the world’s deadliest infectious disease. The COVID-19 pandemic briefly knocked TB off its throne, but now it’s reclaimed its bloody crown. Why do you think TB is in that number one leading spot? Like this is the podium of champions you never want to be at the top of, but why is it there?

00:08:24
Dr. Jennifer Guthrie: There’s a few different reasons. So it’s a highly successful bacteria. So just from a biological perspective, TB is just really good at being a bacteria and infecting humans. Its only reservoir is humans, so it’s really good at doing what it does. And our immune system is actually reasonably decent at walling it off, but not necessarily eliminating it completely. Because it can lie dormant and it’s a very slow growing bacteria compared to say E. coli, which doubles about every 20 minutes, it doubles about every 20 hours. So that means it can cause a very grumbly disease that many people will think, “Oh, I just have a bit of a cough.” And so it again allows itself to transmit unknown.

A lot of people do think there is a TB vaccine and why don’t we just eradicate it through vaccine? And so there is what’s called a BCG vaccine that in countries that are high incidents, they often give to young children. Clearly it doesn’t work all that well because we wouldn’t still have the number one infectious disease killer in the world if it worked fabulously and people don’t realize that there is not a good, highly effective TB vaccine. Then there’s the whole flip side of the sort of just social aspect to it. People who live in crowded housing situations, a lot of in poverty and so on. And then, of course, since the ’80s with the HIV/AIDS epidemic, because of course when you have the immune system go down, that is a case in which TB can become an active disease. And so unfortunately in the areas of the world that probably experience much of the overcrowded housing and other social determinants of health, they coincide with those areas of the world that also have been hit hard by the HIV epidemic.

00:10:08
Kaylee Byers: And so what does this look like in Canada? What does our TB landscape look like here?

00:10:13
Dr. Jennifer Guthrie: In Canada, we’re considered a low incidence country. So we hover around five or six per 100, 000, but we’re a very large country. And so it’s very regionally different. There are definitely pockets in the country that are very high incidence of TB. So some of our northern regions, particularly Nunavut has unfortunately had very high incidence of TB, some of the northern areas of many provinces, as well as some areas related to being unhoused and other situations that may give rise to, again, that crowding, which allows for transmission to occur. And then individuals who may not necessarily have the same access to healthcare or the same trust in healthcare. In Canada and elsewhere, TB has a long history of some populations in which there is a very huge mistrust of healthcare, particularly in relation to TB.

00:11:06
Kaylee Byers: TB is relatively rare across most of Canada, but who it impacts is not evenly distributed. Indigenous communities have been disproportionately affected, shaped by a long history of colonial practices, racism, and systemic neglect. Over the 19th and 20th centuries, forced relocations to reserves, residential schools, crowded living conditions, and policies that drove food insecurity put communities at a higher risk of getting TB. And many were sent to distant sanatoria for treatment, sometimes never returning. And these experiences cause deep and lasting impacts. In 2023, First Nations communities were over three times more likely to get TB than the national average. And for Inuit communities, that multiplier climbs to over 37 times. This is why when we talk about TB, you can’t understand the problem without looking at social inequities. We’ll circle back to that. But as Dr. Guthrie mentioned, part of TB’s stubborn rain is because the bacteria itself is, well, kind of a diva. You’ve given us a look at what TB looks like globally and then what it looks like here in Canada. How’s your work fit into all that? What is it that your lab does?

00:12:19
Dr. Jennifer Guthrie: So my lab mostly is focused on within Canada. Part of the work that I do is in what I would call genomic epidemiology, in which we use genomics, where we sequence the genome of any individual who has TB, so they get tested, their sample goes off to the lab, we identify that it’s tuberculosis, we have that bacteria, and so we sequence the genome of each person’s infection. We use that then to identify clusters where people’s TB looks very similar or identical and look at other factors in which that might be transmission clusters and use that to identify hotspots and also to understand how TB moves and where and what populations, what are high risk factors, could we intervene in some of our outbreaks faster to stop them? Because it’s a sort of a grumbly disease, there is opportunities if we understand how and where transmission is occurring.

00:13:15
Kaylee Byers: So Dr. Guthrie’s lab uses genomics to track how tuberculosis spreads, finding ways to stay one step ahead of the disease. But TB is not just spreading. It’s also evolving, becoming tougher to treat.

00:13:28
Dr. Jennifer Guthrie: TB is also really good at being antibiotic resistant. So we use that genomic information to map that to different drugs. So we identify genes and mutations in which resistance conferring mutations occur. Then we can use that to maybe quickly identify patterns of antimicrobial resistance. There’s not a lot of TB drugs, unfortunately. So changing treatment can be very difficult, but you need all the information you can get. And so we’ve been able to learn a lot more about drug resistance in relation to using genomics to study it.

00:14:04
Kaylee Byers: So one project that you’re working on is CRyPTIC. Can you tell us a little bit about what CRyPTIC is?

00:14:10
Dr. Jennifer Guthrie: CRyPTIC is a global consortium rounding up a whole lot of people to be able to take all the genome sequencing we’ve been doing of TB infections, as well as in the laboratory, in many countries, we do what we call susceptibility testing. So that means we take the bacteria and we do a series of tests to the major antibiotics to determine if it’s susceptible to them. So could you treat someone with that or does it have resistance? So this project amassed all that data to map the genes and mutations to be able to understand, do those confer resistance. And WHO has endorsed the catalog. It’s now on version two. Many of the mutations and genes that are responsible for resistance, we know, but there’s still some that you’ll see resistance on the bacteria in the laboratory, but we can’t find any known mutation that should give that resistance. And so there’s still some unknowns there that work is continuing on that as part of this international consortium.

00:15:10
Kaylee Byers: Scientists are racing to stay one step ahead of TB. Tracking resistance to the drugs we have actually work, but even when treatment is effective, the road to recovery isn’t easy.

00:15:22
Dr. Zolelwa Sifumba: I am many things.

00:15:24
Kaylee Byers: Meet Dr. Zolelwa Sifumba.

00:15:26
Dr. Zolelwa Sifumba: I am qualified as a medical doctor, but I’m currently working as a lecturer and I am a survivor of multidrug resistant tuberculosis and an activist.

00:15:37
Kaylee Byers: Back in 2012, Dr. Sifumba was in her fourth year of medical school in South Africa, working out of the classroom and in the hospital for the first time.

00:15:46
Dr. Zolelwa Sifumba: I guess what’s interesting about our program is that when we get to later on in the program, we start to see actual patients rather than just textbooks. And this hospital was quite an old hospital and it didn’t have sort of enough isolation rooms. A lot of the windows bolted shut and it was very hard to find N95 respirators.

00:16:06
Kaylee Byers: Being the eager med student that she was, Dr. Sifumba dove right into treating patients, but she had no idea that just doing her job could put her at risk.

00:16:15
Dr. Zolelwa Sifumba: They don’t really teach us at medical school that as health workers, we are at increased risk in comparison to the rest of the population. So I’m just the medical student doing my medical student thing and I wake up one morning and I have a lump on my neck. I was confused. I was a bit scared. I spoke to my friends about it and we made a joke about it being TB, and we’re like, “Ha, ha, ha. No, that doesn’t happen to us.”

00:16:42
Kaylee Byers: One way that TB can show up is in the lymph nodes, creating a bump under your skin and the lump on Dr. Sifumba’s neck kept growing. Eventually, she went to get it checked out.

00:16:54
Dr. Zolelwa Sifumba: So not very easy to get a break from medical school, but I took one, the doctor put a needle in it, took some cells, said that if it gets bigger or more painful, I should come back. It did get bigger and more painful, so I did come back. And then what they did was they did a biopsy. And so the doctor knew that I was a medical student, so he decided to turn it into a lesson. And so he said to me, “If I said the case is necrosis, what would that make you think of?” The part that studied that chapter was like TB. I was like, “Yep, I’m seeing case is necrosis here.” And I was like, “No, no, no, no, no, no.” From there, I was told that I’d have to await the results first.

So I got a phone call on a Saturday while I was hanging out with my friends and the lady told me that I had TB and that my TB was resistant to both Isoniazid and Rifampicin, and that meant I had multidrug resistant TB. So I was just kind of very in denial. Yeah, I didn’t believe it.

00:18:01
Kaylee Byers: Dr. Sifumba had to begin taking medication for multi-drug resistant tuberculosis or MDR, a turning point in her life that’s still difficult to revisit.

00:18:11
Dr. Zolelwa Sifumba: Treatment.

00:18:14
Kaylee Byers: When we come back, Dr. Sifumba takes us inside her journey from diagnosis to recovery, plus TB and world conflict, where we’re headed globally and what we need to do. Don’t go anywhere.

You’re listening to Nice Genes, a podcast all about the fascinating world of genomics and the evolving science behind it, brought to you by Genome British Columbia. I’m your host, Dr. Kaylee Byers. And if you like Nice Genes, hit follow on Apple Podcasts or wherever you get your shows and leave us a review. If you like this episode, share it with your pals and spread the love of science.

As a medical student, Dr. Sifumba understood what multi-drug resistant tuberculosis meant. She knew that treatment would be complicated, but no amount of training could prepare her for what was to come.

00:19:03
Dr. Zolelwa Sifumba: The treatment process is the worst part of the TB for me personally. I mean, I know I was sick when I had the TB, but I just had a lymph node. I wasn’t losing weight. I wasn’t coughing, but I got to the clinic, they put 21 tablets on the table, each different colors and different sizes, and I was like, “Whoa.” And then I took the pills. They were so hard to swallow. Some of them made me nauseous on impact. So I’m getting ready to leave and the nurse is like, “No, no, honey, there’s an injection.” I always describe this injection as hot lava being injected into you because on impact, it burns, that pain shoots up your back, it shoots down your legs, so it’s painful.

00:19:49
Kaylee Byers: This was just the first of many trips to the clinic for these meds. For people with MDR tuberculosis, treatment can last up to two years, often requiring daily visits in those first few months.

00:20:00
Dr. Zolelwa Sifumba: This was going to be my life for 24 months, and then I went and read the side effect. Oh, my word. I was so shocked. What do you mean? I’m taking these pills to make this TB go away, but I could also lose my hearing. So I’m feeling sick. I’m feeling nauseous. I’ve got diarrhea. I’m in pain. I am also plagued by the fact that I might go into fulminant liver failure, because of course, I understand everything that’s written in the side effect pack. And my pain was that nobody explained to me. It was just like this thing that I should take the treatment. So that was really rough, but I found some relief when I met other TB survivors, other people that were on TB treatment who could help me to navigate the side effects. It helped me to express what I was going through and to gather the kind of support that I needed, especially knowing that at that stage, it was said that 40% of people on treatment die. You have TB and you’re on the treatment and you die. So it was like 50/50 whether I live or not.

So every day I wanted to quit. And the scary thing was that I knew what quitting would mean. So treatment was really a depressing time for me. I knew that if the TB didn’t kill me, then the treatment would kill me. And I think it really helped me to gain an understanding of what as a health worker then, as a doctor, what this asking my patients to adhere to medication actually meant. I got to learn actually how challenging it is and we have no business shouting at people for not taking medication. It’s important to understand.

00:21:51
Kaylee Byers: What do you think, from your perspective, people tend to get wrong about TB?

00:21:55
Dr. Zolelwa Sifumba: There’s a lot. I think the biggest thing for me is that just medication is enough. I’ve given you the medication, there it is. It’s easy, just take your pills and you’ll be okay. But it’s like they discount the fact that the pills are really hard to take. And for me, that is why people are still dying because we’re not supporting people. And I mean social support, I mean psychological support.

The one thing about me becoming this activist and advocate for TB, it helped me to share my story and enlist support basically because I couldn’t see the end of treatment. So that social support from people who understood, who weren’t just going to gaslight me and say, “Oh no, it’s easy.” So I found so much help from a support group. And I guess the usual stigmas are that TB happens to a certain kind of person, which is not true. TB doesn’t care about your race, it doesn’t care about your socioeconomic status, TB doesn’t choose. But fine, we know that there are certain socioeconomic circumstances that leave you at a higher risk of contracting TB, but it’s not to say that you can’t, but it’s tough because it’s not just stigma that you get from people. You also self- stigmatize. So there’s internal stigma where you are stigmatizing yourself and you’re assuming that people will think, “Oh, you’re dirty because you’ve got TB.” But if everyone had this general knowledge about it, then it would be like, “No, you got it because you breathe.”

00:23:23
Kaylee Byers: Tuberculosis doesn’t play favorites. Anyone anywhere can get it. But as Dr. Guthrie pointed out earlier, some areas and populations are hit harder than others. There’s a new book called Everything Is Tuberculosis, written by John Green. Yes, the same John Green behind your favorite YA tear-jerkers and educational YouTube channel, Crash Course. And in the book he writes, “The disease is where the cure isn’t,” because while the bacteria doesn’t discriminate, the world it spreads through certainly does. Many people around the world still lack access to proper TB diagnostics and treatment, and that problem only gets worse in places affected by conflict. Take Russia and Ukraine, for example. Both have some of the highest tuberculosis rates in Europe, with Russia ranking 11th in the world and facing rising levels of drug-resistant TB. In times of war, it’s nearly impossible to track tuberculosis cases and infections are likely going underdocumented. Here’s Dr. Guthrie again.

00:24:23
Dr. Jennifer Guthrie: That’s a region of the world that I’m quite concerned about when it comes to TB because there is a history there of Russia and former USSR countries in having higher rates of multidrug resistant TB. That could be a whole nother podcast in itself, I’m sure, of why that occurred. And so in having conflict in these regions, meaning that people are perhaps not able to access care and diagnostics in the way even they previously were, it is quite the concern that there are bigger issues than TB or infectious diseases in general in some areas of the world.

00:24:57
Kaylee Byers: With that, I mean, the WHO has this goal of reducing TB by, what is it? 80% by 2035. So what do you think? Can we do it?

00:25:07
Dr. Jennifer Guthrie: I’d love to say yes. Some miracle will happen, but unfortunately, to be honest, we weren’t on track prior to the pandemic, even in Canada. And then with the pandemic, that’s definitely set us back. There’s a lot going on right now and resources just aren’t being put into TB, so we could continue to fall further and further behind if that’s not rectified. I don’t think we’re going to make the WHO targets. I do think we will get back on track, but I think we still have a lot of investments that need to be made to make this a priority. It’s doable. It’s just very challenging.

00:25:46
Kaylee Byers: The really frustrating thing about TB is that if we all collectively put our minds and our dollars to it, we could probably reach those global targets, but progress keeps stalling because research and better care costs money and tuberculosis just doesn’t get the same attention as other infectious diseases. But from that gap out of pure necessity comes some wildly creative solutions. Case in point, the work we saw at APOPO, where they’re training HeroRATs to sniff out TB. And honestly, they kind of rock at it.

In Mozambique, clinics relying on microscope screening and outdated techniques from over a century ago were missing over half of all TB cases according to a former national TV program officer with the WHO. But when APOPO’s rats recheck samples from about 12, 500 patients, they uncovered an extra 764 cases that had slipped through the cracks. That’s a 44% jump in detection. I mean, just give those rats tiny capes already.

In Tanzania, these whiskered diagnosticians are now working across 21 medical centers, double checking about three quarters of all suspected TB cases. And rats, like our friend, Paris, who’s still finishing up his training, will eventually be able to screen around 50 samples in under 10 minutes.

So yes, these rats are an affordable right now approach that’s making a real difference, especially in places with limited capacity and resources. But even still, there’s only so much they can do. These rats can’t differentiate between TB and drug-resistant TB, for example, and their work is limited to detection. So understanding how TB evolves becomes more resistant and how we can treat it. Well, that’s going to need investment and advancements from all sides of science. What role is genomics really playing in all of this? What would be your pitch for the role of genomics in TB prevention and treatment?

00:27:32
Dr. Jennifer Guthrie: I mean, I’m completely biased, of course. It’s a tool in our toolbox to be able to understand, one, drug resistance, of course. And if we can do targeted genome sequencing upfront, because it’s a very slow grown bacteria, it takes about six to eight weeks before we would even be able to test for susceptibilities. So that means someone is on a treatment that may be inappropriate for sometimes several months, right? So genomics can definitely play a role there in developing better and faster and more accurate diagnostics. Also, a lot of research for vaccine and so on, knowing what the genomics are can really help us understand. There are different lineages that have co-evolved with humans as humans have migrated around the world, and so there’s a lot still to learn, probably pairing both the human genomics with the bacterial genomics. And then as I said, I use it a lot for understanding transmission, which if we can limit transmission, then obviously at a certain point with all these other tools, we can really reduce the numbers of TB and hopefully someday reach the targets for TB elimination in the world.

00:28:39
Kaylee Byers: Beyond genomics, what other approaches are advancing TB research?

00:28:45
Dr. Jennifer Guthrie: I would say vaccines would be fantastic if a vaccine could be made, even if it’s more effective than BCG but not perfect, that certainly could curb some of the TB cases. TB is a level three pathogen, meaning they require special laboratories to be able to handle the live bacteria and so on. So we definitely need more rapid molecular-based tests and that can be offered at point of care. So people who are working on point of care and biomarkers tests I think are great. And then, of course, just improving the drugs that we have available. There’s a lot of research on new regimens, so can we shorten them? TB treatment is very difficult treatment. So to be able to have shorter, better regimens would be great. Chest x-rays is one of the main ways that we still diagnose TB and the extent of TB infection, and is it improving? So now, there’s a lot of things we can do with AI to be able to more accurately interpret in many cases. So there’s a lot of room to improve our TB situation globally.

00:29:44
Kaylee Byers: Working in the field must come with its fair share of hard days. So what keeps you motivated to keep going forward?

00:29:50
Dr. Jennifer Guthrie: I think I always have hope. We’ve got a lot of really smart brains working on this problem. And so somebody will think of the thing that will really propel us forward at a faster rate. And one of the things in doing my research, seeing TB survivors and knowing that they reached probably the lowest points in their life and their treatment, but when I go to TB conferences and hear them speak on supports in their community and as well as the people who are providing that care, that gives me hope.

00:30:21
Kaylee Byers: Well, Dr. Guthrie, thank you so much for coming on and talking to us about TB. I learned a lot.

00:30:26
Dr. Jennifer Guthrie: Thank you for having me.

00:30:28
Kaylee Byers: As we’ve seen, there are so many hurdles in this story, the bacteria, stigma, politics, not enough funding, and social inequities. But for Dr. Sifumba, the most significant stumbling block is the lack of education.

00:30:42
Dr. Zolelwa Sifumba: I got into advocacy activism to educate people, and I think it’s important that we hear from people who have the experience to say, “Hey, this is my story, and these were the struggles that I faced, and you can also contract this thing. But the lovely thing is you can protect yourself from it. These are the signs and symptoms. This is what you need to do.” So I think I wish there’d be health education around TB, but not health education to scare, not like the kind of punitive things, but health education to say, “Hey, open a window.”

The amazing thing about the preventative measures for TB is that they can also prevent other airborne illnesses. So I would say let us empower people with the education, give them the stats, let them know this is something that’s going on now, and empowering them to say, “This is how you can protect yourself. This is how you can protect your community.” And protecting your community is not just the preventative measures, but making sure people finish treatment is also prevention. So what is the community doing to actually support people in taking their treatment, to support people in helping them not to feel othered in spaces? I told myself when I got TB that I’d like to understand. I went to all these conferences and you see all these different role players.

So I’ve been fortunate enough to see how things are done. And I think the most painful thing is that it’s not laid by those of us with firsthand experience. But one thing about being in the activism space, the civil society space in South Africa is just like this amazing space. And it’s so lovely to have seen the power of collective action, the power of individuals and organizations that really, really, really believe that something needs to change. And I guess I wanted to mention that as something that could be really powerful, like just listening to people.

00:32:44
Kaylee Byers: Zolelwa, thank you so much for taking the time to share your story with us and also your advocacy in the space and the need for more attention, more conversation. I just really appreciate you.

00:32:56
Dr. Jennifer Guthrie: Oh, thank you. Thank you.

00:33:00
Kaylee Byers: Tuberculosis has been at the top of the podium of infectious disease killers long enough, even with our best genomic detectives and some heroic rats working the case file. As we’ve seen throughout this season, there’s no single fix for the complex health challenges we face, but where genomics really shines is when it’s part of something bigger, when researchers, medical workers, policymakers, and communities all work together, because when it comes to our health, everything is connected.

Our guests for today were Dr. Jennifer Guthrie, assistant professor of microbiology and immunology at Western University, an adjunct scientist appointee at Public Health Ontario, and multi-drug-resistant tuberculosis survivor, medical doctor, advocate, lecturer, and researcher, Dr. Zolelwa Sifumba. Special thanks to our friends at APOPO and their HeroRATs for providing audio and for the incredible work they do.

You’ve been listening to Nice Genes, a podcast brought to you by Genome British Columbia. If you like this episode, go check out some of our previous ones wherever you listen from. Share us with your friends and leave us a review. You can also DM the show on social media by going to @GenomeBC.

We hope you’ve enjoyed playing DNA detective with us this season, but don’t hang up your lab coat just yet, we’ll be sneaking back into your feeds very soon with a special live episode and some sharp gene shorts. Before we close the case, a few names on the record. Our producer this season is Jenny Cunningham. Sound design is by Sam Seguin. Project lead is Maria St. Aubin. Marketing specialists are Safa Shakhalili and Phil Lemieux. Jen Moss is our executive producer.

From Genome BC, our production consultant is Sarah Lando and our begrudging Sergeant is Reaon Ford.

And, of course, a huge thank you to you, our brilliant listeners. Your curiosity keeps the investigations alive. So until next time, stay vigilant, stay questioning, and keep following the DNA trail. I am Dr. Kaylee Byers.

00:34:59
Sargeant: Where is that rat?

00:35:00
Detective Byers: Got to go.

00:35:00
Sargeant: Come here.

00:35:00
Detective Byers: See you next time, detectives.

00:35:05
Sargeant: Byers!