TB

The past two days, I have begun to appreciate the enormity of the task of tuberculosis control in this post-war country. I spent Wednesday with Dr. Karen, a Canadian doctor who works as the medical director at the Rio de Huila clinic. While most cases are seen by nurses, who initiate and monitor DOT (Directly Observed Therapy) for multi-drug treatment of this disease, the more complicated cases are referred to her. We saw cases of extra-pulmonary TB, some HIV positive patients, plus some cases where the patient has not been getting better despite treatment, and a drug resistant strain is suspected. Much patient education is needed, since new patients have to commit to spending the first 2 months in a TB sanitorium, where they undergo an intensive treatment phase and are isolated from their communities to prevent further transmission. Often their families will camp out nearby for the duration of that time. After the initial 2 months, they will then be “sent home” for another 6 months of therapy, and required to come to the clinic at least 3 times a week for direct observation of them swallowing each dose. This is pretty much a world-wide practice, because non-compliance with therapy is the biggest contributor to drug resistance. Understandably, the 6 months of “home” therapy, plus follow-up afterwards, is extremely hard to monitor, and such challenges may only be overcome with improvement of transportation and healthcare infrastructure.

Thursday, I worked with Dr. Rijk, a Dutch “double doctor” (he holds both an MD and a PhD) working with SOLE and TEARfund. He is involved in tuberculosis control for this province, and has spent the past year traveling to various health outposts to help with development of TB treatment and public health education. Many of these outposts are operated by churches, some with funding assistance from foreign NGOs.

Thursday, we drove 130 km to the health post at Quipungo, a village of 20,000 people, to collect statistics on their tuberculosis treatment program. Sr. Jonas, a nurse trained at Kalukembe Hospital, is the medical director there, and operates quite an effective healthcare delivery system on very limited resources. With 3 other nurses on staff, plus laboratory and pharmacy technicians, they serve a very large region (we met a family who walked 30 km). Sr. Jonas has been at the health post for 15 years now, and very much dedicated to improving the health of his community. We hope to help him establish some public health education programs, as it is apparent that most people here have very little knowledge of disease prevention. One example is that bednet use is almost unheard-of, despite convincing evidence that they prevent malaria and other insect-borne diseases. With thousands of children under 5 dying EVERYDAY from malaria, it’d be way cool to see more Africans use them. (I must be tired – I just departed from my documentary-style writing form)