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TB Hospital in Somalia |
The Patient Stories:
Making A Difference with fidelis
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TB Hospital in Somalia |
A tuberculosis patient living in Kibera slum, Nairobi, was visited during a fidelis technical monitoring visit. The 36 year-old male patient developed cough and throat discomfort in March 2004. He visited a traditional healer and had his uvula cut, which according to local belief would potentially relieve his symptoms. Unfortunately, his symptoms persisted and fever subsequently developed. He visited a pharmacy in July 2004 and anti-malaria drugs were prescribed, which also failed to relieve his discomfort.
He was informed by a community volunteer of the fidelis project and visited Kibera Health Center, where he submitted three sputa for microscopic examinations, which were positive for acid-fast bacilli. He began anti-tuberculosis treatment on July 8, 2004. His wife earns on average 6000 Shillings (1 US dollar = 80 Shillings) income per month, a small amount of money for a family with 4 children. The patient spent about 400 Shillings for medical consultation before he was correctly diagnosed with tuberculosis. He was unable to work due to the illness, which is economically detrimental to his family.
His experience is typical in the Kibera slum: a delay in seeking proper health care and a prolonged period of transmission of tuberculosis in the community, which are the very constraints of tuberculosis control among urban poor that the Nairobi fidelis project is targeting.
2004_fid_3_006 Jogjakarta Province, Indonesia
As part of a fidelis monitoring trip, a 35 year-old woman was visited at her home nearby the primary health centre. She was diagnosed as a new smear positive case in July, 2004. She had been unwell for five months – symptoms including a persistent cough, hemoptysis, weight loss of 4 kg and chest pain. She sought care repeatedly from a private practitioner (1-2 visits each week during the five month period). The private practitioner ordered three chest X-rays during the five months and provided symptomatic treatment.
After five months, the private practitioner referred the patient to the health centre where a sputum test was done and a diagnosis was made. The woman spent approximately 8,000,000 Rupiah (~1,000 USD) on care prior to receiving her diagnosis at the health centre. The patient became quite emotional as she described how her family had to sell their land to pay for the treatment.
Through fidelis in this region, important links are being developed between private practitioners and the primary health care system to ensure that such delays are reduced or eliminated.
As part of a recent fidelis monitoring visit, a 20 year-old woman was visited in a District TB Hospital. The patient had recently been diagnosed as a new smear positive tuberculosis case. She had a one-month history of chest pain and cough. There was no reported hemoptysis, fever or weight loss. The patient’s father was recently admitted to the same hospital with tuberculosis and recommended that his daughter come for assessment because of her symptoms. She reported that no money had been spent on her diagnosis and treatment. The patient was aware that the length of her treatment was six months. She denied any stigma related to the diagnosis for her or her father.
In the absence of the fidelis initiative, this patient would remain hospitalized for the full duration of treatment in line with current country policy. One main objective of the fidelis activities in this region is to transfer treatment to the ambulatory setting. These efforts should greatly reduce the required length of hospitalization for this young woman with its obvious social and economic benefits.
2004_fid_3_008 Laksham District, Bangladesh
As part of a fidelis monitoring trip, a 42 year-old woman was visited at her home nearby the primary health centre. She was diagnosed as a new smear positive case in January, 2004. She had experienced symptoms for 10 months prior to diagnosis, including chronic cough, hemoptysis and fever. The woman visited a village doctor who provided her with pills. Subsequently, she saw a private doctor who also gave her medications. Still unwell, she attended the main primary health centre which is now targeted by the fidelis project.
The attending medical officer ordered a chest x-ray and blood work and told her the results were normal (no microscopy was ordered). Finally, after 10 months, the local community health worker recommended she go for microscopy which was positive for tuberculosis. In all, the patient spent a total of 670 taka (~13 USD) before she was properly diagnosed. This is significant for her as she is living with her son and has no fixed income.
Through fidelis in this region, enhanced training of health centre staff and orientation for private practitioners and village doctors is taking place. These efforts should limit these unnecessary delays and reduce transmission of tuberculosis in the community. This improved diagnosis and case management will also have a tremendous financial impact at the patient level.
As part of a fidelis monitoring visit, a patient was visited at his home nearby the local clinic. He was a 50-year old man who was diagnosed as a new smear positive case in June, 2004. He had experienced symptoms for one month – including cough and hemoptysis. He did not seek any care prior to his diagnosis at the fidelis clinic.
The main fidelis activities in the area are the training of local community workers - Health Cadres (HC) - to increase case finding and support treatment completion. A neighbor of this patient is a recently trained HC who instructed him to go to the clinic for care. He knows he must take medication for the full six months. His brother makes sure he takes his medication regularly.
The patient does not feel stigma from the community, but still feels ashamed about the disease. He spent no money to date on diagnosis and treatment. The patient card was in agreement with the patient history and completed properly. The implementation of this fidelis approach should result in increased suspect identification and reduced delay to treatment as evident in this case report.
