Puccini’s La Bohème/Abanxaxhi by Isango Ensemble

The Japan Center for International Exchange/Friends of the Global Fund, Japan—in collaboration with the Tokyo Metropolitan Theatre—was pleased to bring the famed Isango Ensemble‘s La Bohème/Abanxaxhi to Japan for its Asian premiere in December 2013. The work was created by the South Africa–based Isango Ensemble in partnership with the Global Fund to Fight AIDS, Tuberculosis and Malaria to help attract attention to the global threat of tuberculosis through the re-imagining of Puccini’s classic “La Bohème,” whose heroine dies of the disease.

The work is a musical triumph as well as a timely reminder that tuberculosis is not a disease of the past but very much a modern day reality that continues to devastate much of the developing world, causing widespread suffering and death. By setting the opera in the recognizable setting of a contemporary South African township, Isango infuses the popular classic with new relevance and urgency.

“I’ve had a lot of friends and relatives who have died of tuberculosis,” says Pauline Malefane, who plays the tragic heroine in Isango’s production. “It’s a very sensitive issue and it’s an issue that is very close to everybody’s lives. I really do hope that La Bohème becomes another medium, another way of communicating to people about tuberculosis. We’ve done a lot of projects, but this one is really very special.”

• Isango Ensemble’s rendition of Puccini’s La Boheme/Abanxaxhi | Opening night reception
• The Global Fund’s page for La Bohème and the Isango Ensemble

Tuberculosis: A Continuing Threat to Our Everyday Lives

Tuberculosis (TB), once so common in Japan that it was referred to as a “national disease,” is seen today by most people in Japan as a disease of the past. But it still ranks as one of the world’s three major infectious diseases—together with AIDS and malaria—and poses a serious threat to human health, as evidenced by the approximately 9 million new TB cases and some 1.4 million deaths from the disease that occur globally every year. This situation persists, despite the fact that TB can be both prevented and cured. The majority of TB infections and fatalities occur among people in their most productive years, making TB—along with HIV/AIDS—a major factor inhibiting economic and social growth in developing countries.

South Africa, with a population of more than 50 million people, currently ranks third highest in the world in terms of the burden of TB, after India and China. While the World Health Organization’s latest assessment of the 22 highest-burden countries shows TB incidence rates falling in 10 countries and stable in 11 others, the number of new TB cases each year in South Africa is slowly increasing. The TB epidemic in South Africa is to a great extent fuelled by high rates of HIV infection, whereby individuals whose immune systems are weakened because of HIV are much more vulnerable to becoming ill from TB. The national government provides the bulk of financing for TB care and control in South Africa, supplemented by the Global Fund, but these resources are insufficient to expand treatment for the emerging increase in the difficult to treat multi-drug resistant strains of TB.

In Japan, the issue is very close to home despite many beliefs to the contrary. There are approximately 20,000 new cases detected and more than 2,000 deaths reported each year. The key populations most vulnerable to TB are the elderly, those with diabetes, and the marginalized suffering from poverty or coming from countries with high TB burdens. Japan, where 17.7 (in 2011) out of every 100,000 people fall ill with TB, lags behind other industrialized countries, all of which have rates below 10 per 100,000 people.

In an ongoing effort to fight the epidemic, the Global Fund accounts for 82 percent of all international funding for TB control worldwide.