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FROM THE FIELD

Tuberculosis: easy to get, difficult to cure

23 Mar 2007 07:27:00 GMT
Source: International Federation of Red Cross and Red Crescent Societies (IFRC) - Switzerland
by Magdalena Slastushinskaya, photos by Vladimir Melnik

Website: Website: http://www.ifrc.org

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Elena Korolyeva, the Russian Red Cross nurse is providing the TB drugs to the patient, Volodya Postnikov, 41. “I come here almost a year, now once a week-every Friday. Lena is the greatest woman, I wish there were more people like her. The food parcel is a big help for me and my family”. (p15523)

The Russian Red Cross programme to fight tuberculosis (TB) has been running in the town of Belgorod and the region since December 2002. In just over four years, the regional state laboratory has been fully equipped and 1,969 TB patients have been supported through their treatment. Today, the Belgorod regional administration fully funds the programme and the rate of patients defaulting on treatment has fallen from 28% to 4% in the region.

"TB does not choose its victims according to their social group," says Zlatko Kovac, the International Federation Russia Delegation's health delegate. "Practically anyone can get infected." The Russian Red Cross programme serves the most vulnerable groups, which account for a third of registered TB patients in Belgorod. According to Russian Red Cross statistics, the average TB patient is male and aged 38 to 44; only a third are women.

The programme aims to reduce the number of people who do not complete treatment prescribed by doctors in the state health institutions. Patients who default risk developing multidrug-resistant bacteria (MDR), which means stronger symptoms, longer and more expensive treatment and an increased risk of infecting other people.

The programme is based on the internationally recognized Directly observed treatment system (DOTS), by which patients are observed by a nurse when taking the medications. The Russian Red Cross has also added a unique element by having its nurses working in Red Cross medical rooms, which provide more human contact. This structure was widely used in Soviet times and complemented the state public health system.

"I have worked at the TB dispensary for many years," explains Russian Red Cross nurse Elena Korolyeva. "Patients often ask to talk to me and I am always ready to explain. Most people know nothing about TB or prefer not to think about it. My job is to comfort them, help them understand the disease and encourage them to care about their health. It is easier to fight TB when the patients are motivated to be healthy because they are less likely to default."

This communication and psychosocial support are vital in helping patients to complete what can be a difficult treatment. "I come here once a week and take 11 pills at once," says 41-year-old Volodya Postnikov. "The pills affect my immune system, which is already hurt by the tuberculosis. I get sick and often catch cold. The antibiotics harm my liver and stomach. It's frustrating".

Through the nurse, the Russian Red Cross learns more about patients' needs and this knowledge has resulted in adaptations and innovations. One example is the introduction of food parcels, which are distributed to patients when they come in for their treatment. These motivate patients to come, particularly the most socially vulnerable, and, in addition, the high-protein diet provided helps strengthen their immune systems.

"Every situation is different," says Elena. "One man used to wait until I turned away before spitting the pill out. He was tired of the side-effects. After much talking and care on my side, we became friends and he didn't cheat any more. He thought he was taking the pills for me but really he was doing it for his own health."

"This is a classic problem," explains Nina Ushakova, chairlady of the Belgorod branch. "Patients don't see their lungs being cured and pay more attention to the visible negative impact of the antibiotics. That's why the DOTS is so important."

The Belgorod branch has also begun producing soy milk at its own mini-factory. This is distributed daily in two-litre bottles to the beneficiaries of the anti-TB and other programmes run at the branch.

"Sometimes I feel that patients come here just to collect the food parcel," says Elena. "For some, it is an essential bonus to their family household but whatever the reason, the most important thing for us is that their treatment is controlled."

Tuberculosis patients find many other advantages in having their treatment in the Red Cross medical room. "The TB dispensary in Belgorod where we should receive the medicines is outside Belgorod and would take me four hours to reach," says 51-year-old Olga Goravaeva. "I like coming to the Red Cross because it's close to where I live and I have made friends with the nurse. She is very kind, always smiling and very concerned about my health. I appreciate her human touch, which really helps me not to lose hope."

************************************************************** Russian Red Cross TB programmes

Tuberculosis patients from Khakassia

Student Sergeev Egor Alexandrovich lives with his grandmother, having been abandoned by his parents. Their main source of income was his grandmother's pension and guardian benefit, so it was vital that Egor and his grandmother were given the support he needed to be able to complete his tuberculosis treatment.

Egor, who was born in 1990, began the treatment at the Abakan branch of the Russian Red Cross on 10 May 2006. Between then and 4 September 2006, he underwent the full course of chemotherapy and was given 140 doses of tuberculosis drugs, missing only two days in four months.

That he was able to do this was in large part due to the practical and emotional support provided by the Red Cross. This included protein additives, hygiene articles, second-hand clothes and shoes, and the cost of travelling to and from treatment. Equally important was the emotional support and respect given by the Red Cross nurse, who encouraged Egor to keep going. Having successfully completed the treatment, Egor is now at senior school and he is tuberculosis free.

***********

Pensioner Romanov Leonid Dmitrievich was initially reluctant to start treatment, convinced that the Red Cross would take possession of his flat in return. His misunderstanding had arisen because of the detailed interest the visiting Red Cross nurse had taken in his living conditions. He had not realised that this was simply to assess what practical support could be provided to encourage him to complete his treatment.

Staff from the Abakan branch of the Russian Red Cross, including the lawyer, the psychologist and the branch chairman, spent time carefully explaining the process to Leonid and his wife. They explained that their motive was purely humanitarian and that the social support offered was simply to encourage and enable Leonid to complete the course through directly observed treatment.

Leonid was finally convinced and started treatment on 23 March 2006. Within weeks, he was spending more and more time at the branch, enjoying having people to talk to and appreciating his discussions with visiting nurses. He and his wife also appreciated the protein additives and hygiene articles provided, while the payment of transport costs to and from treatment was very important, since the couple were living on small pensions.

Leonid completed his course of chemotherapy and received 120 doses of the drugs without interruption. He finished the treatment on 1 August 2006 and is now completely recovered.

*********** Tuberculosis patents from Belgorod region

Born in 1986, Antonina Alexandrovna Lutsenko is an orphan. Her tuberculosis meant that she had never worked. She lived in a hostel, sharing a room with two others, both of whom disliked sharing the premises with someone who had tuberculosis. There were frequent quarrels, the atmosphere was tense and Antonina was at risk of losing her hostel place through the stigma associated with tuberculosis.

Antonina started the Red Cross treatment programme on 22 January 2003, one of the first at the branch. The visiting nurse, Elena Valeryevna Koroleva, helped Antonina to improve her living conditions by meeting with the two who shared her room and the head of the hostel to dispel some of the myths about tuberculosis and explain preventive measures. She also emphasised how important it is for patients following long-term treatment to feel supported to see it through to the end. The Red Cross also provided daily protein additives, which were vital, given that Antonina was unemployed.

With practical and emotional support, Antonina successfully completed the treatment. She found work as a cleaner at the hospital and the Red Cross lawyer helped her to complete the documents necessary to get a flat. Today, she is married, working and completely recovered.

******************

When Nekhaev Igor Ivanovich was in prison, he lost his home and therefore had nowhere to go when he was released. Relations with his family became increasingly difficult as the stigma of tuberculosis led to arguments and isolation. He tried to find work where he could and managed to earn wages from time to time but became seriously depressed.

On 8 December 2003, he made a decision that was to change his life when he began the Red Cross tuberculosis treatment programme. The social support such as daily protein additives helped encourage him to complete the programme but the emotional support was particularly important to Igor. The visiting nurse and psychologist from the Red Cross branch spent a lot of time with Igor, helping him to overcome his depression, while the lawyer helped him to register for a home.

Igor successfully completed his treatment. Relations with his family have improved. Today, he is working full time, married with a young son and feels like a valuable member of society.

[ Any views expressed in this article are those of the writer and not of Reuters. ]

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Last updated:Fri Mar 23 07:31:20 2007