Maria Eloisa Zepeda Teng – ‘Louie’ – was all set for a career architecture. But in 2007, just after completing her architectural studies in Manila, she was struck down with tuberculosis (TB) meningitis. 
 
“I almost died,” Louie calmly says. “My family was told by the doctor to get me blessed by a priest because I was going to die. I survived, but was left with just two per cent of functioning optic nerves.“ 
 
Louie has now been legally blind for almost 20 years. She was soon obliged to abandon any chance of a career in architecture, but her disability has not prevented her from living a happy and fulfilling life. 

Blindness drives her determination
Far from it. In fact, from the outset her blindness has driven her determination to prevent others from suffering the same fate, throwing all her energies into becoming a health advocate.

She is the founder and president of TBpeople Philippines, a national ‘chapter’ of TBpeople Global, which has 25 chapters across the world. National chapters mobilise TB survivors and people affected by TB, strengthen links between the global network and grassroots communities, overcome local language and cultural barriers and support community participation in national TB responses and advocacy. TBpeople Philippines was the first national chapter to be established in Asia. 

“My life story was featured on national television for surviving a very severe case of TB meningitis. Actually, I was the first person in Asia to survive the condition,” Louie says.

An advocate for blind people and people living with TB  
If her achievements around TB were not enough, she also helped to create Manila’s Disability Federation and became an advocate for the Philippine Blind Union, the national arm of the World Blind Union.

She is not, however, stopping there. After marrying her teenage sweetheart, “Yes, I have seen his beautiful face,” she says with a cheeky grin, she also had to undergo fertility treatment because her ultrasound showed a cystic ovary. In 2008 she was unable to menstruate for a whole year because of her TB medications.  

Louie was borderline diabetes by the time she gave birth to her daughter in 2013, and diagnosed with gestational diabetes, was prescribed metformin, which she had to drink three times per day. Her metabolism was adversely affected, however, and she found it increasingly difficult to lose weight. She then chose to fast without taking any medications at all, before becoming pregnant with her second child, a son. But the weight returned and she had even higher sugar and cholesterol levels. 

“Fat is a really hard thing for me to burn,” she says, “even if I do my cardio exercises on a regular basis. As a blind person, I cannot do resistance training that much because I might have accidents at the gym.“ 

‘None of the weight-loss options seemed to work’
“It’s also really hard for me to eat the right food because I cannot prepare my own. I have tried the ketogenic vegan diet. I had a number of ‘Lemon Bottle’ fat-dissolving injections followed by sessions in the sauna in an effort to break down the fat in my tummy. But none of these really seemed to work.”

She was also troubled by the high cost of these procedures. “I didn’t really know how much they were billing a blind person like me. The staff were saying ‘Oh, we added something else’, and you just have to swipe your card. I don’t know if really they were being dishonest with me.”

“Eventually,” she says, “I asked my nurse if there was any way for me to just not feel the hunger because by now I had spent almost half-a-million Philippine Pesos [approximately equivalent to $US 8,000] for all the sessions of ironing my stomach, arms and hips. Even when I did lose some weight, it just plumped back up again.”

“I do a lot of international consultations, so I still need to look presentable, even if I’m blind!” Louie says with a smile. But her attempts to lose weight were far from mere vanity. Her new condition adversely affected her health. Louie suffered from breathlessness, found it increasingly difficult to walk and was concerned about developing heart disease or diabetes. “My ECG showed arrhythmia,” Louie calmly says. “That was when I asked my doctor for a different solution.”  

It was for these reasons that her doctor prescribed her the GLP-1 receptor agonist tirzepatide, “After just one week I lost eight pounds, and since I began the course of medication, I have lost a total of 50 pounds.” 

GLP-1s could also benefit people living with TB 
Louie quickly realised that GLP-1 receptor agonists could benefit some of her TB advocatees. A 2019 study by the World Health Organization (WHO) suggested that as many as 15 per cent of people across the world living with TB also have diabetes. The Philippines, which in 2019 saw 6.3 per cent of its population living with diabetes, has a crossover diabetes prevalence among TB patients of at least 9.2 per cent. 
 
Louie explains that: “If you have a problem with your blood-sugar levels, as with diabetes, it is often the case that TB medication will not work. The TB treatment simply does not oxidise. TB medication also increases craving for sweets and other sugar-based products. GLP-1s really kill that craving,” she continues. “So I began to consider why GLP-1s were not included as support for TB treatment.“ 
 
The importance of healthy nutrition and a balanced diet  
Louie is quick to point out that GLP-1s on their own should never be seen as the only solution for weight loss. She ensures that the people she works with understand the importance of healthy nutrition, encouraging them to follow a balanced, Mediterranean diet. “You’re not supposed to eat just anything!” she laughs.  
 
But this is an important point, because nutrition guidelines for patients are not included in the Philippines’ Department of Health’s response to TB. Many people, Louie says, “Assume sugar is the only villain in the obesity piece. They often don’t know that rice, which is a staple of the Filipino diet, can be converted to glucose. Or that fruits contain glucose too.” 
 
“They often have no idea that carbohydrates can also cause acid reflux, which becomes even more of a challenge as TB medication makes all the carbohydrates burn much faster. They’re supposed to be on a high protein diet and not eating so many carbohydrates.“ 

WHO guidelines on GLP-1s to treat obesity 
These are compelling reasons for PhilHealth, the country’s provider of social health insurance, to include GLP-1s on its list of reimbursable medications, especially as WHO published its first global guidelines for GLP-1s for the treatment of obesity last December. 
 
As things stand, however, the monthly cost of a course of GLP-1s in the Philippines is approximately $US 75 per month, which has to be paid for by the patients out–of–pocket. According to the Philippine Statistics Authority, in 2023, the most recent year for which figures are available, the average family income in the Philippines was 353,230 pesos, equivalent to US$ 475–480 per month. At 15 per cent of a family’s income, this is clearly too high.  
 
“We have to advocate for GLP-1s to be included as part of the insurance package as soon as possible,” Louie says. “We hope that the government takes care of us holistically, of the individual undergoing all of these challenges in their body. That way, we can go back to economic growth and we can definitely help create a safer environment for the country.“

‘I’m ready to support MPP’
Louie is also well aware that the current cost of GLP-1s may be unduly prohibitive for the Philippines’ government. “I’m ready to support MPP in its efforts to secure greater access to affordable oral doses of GLP-1s for obesity in countries like the Philippines,” she says. “GLP-1s can not only help people living with obesity and diabetes, but also TB. It’s vital that the cost of these medicines is reduced for people living in low- and middle-income countries. MPP can help drive down those costs.“ 

Louie Zepeda is nothing if not optimistic. From TB to blindness to obesity, Louie takes on every challenge certain she can win. The faith she has in herself and the possibilities of science is inspiring, as is her belief that there is no reason that things need to stay the way they are. 

 “I’m praying and praying that one day I will be able to see my daughter and my son,” she says. “Even if I’m 60 or 80, I don’t care. I just really want to see them before I die.“