Training Day(s)

Field Workers and Nurses learning about HIV Counseling

OK.  So just a little background on CMMB’s TB project before I get into the important part of this post.  CMMB started their TB project, which involves door-to-door screening for TB and HIV testing aiding in the South African Department of Health’s intensified TB case finding campaign, in late August and really had to hit the ground running.  Approval for the project was wrapped up in red tape for quite some time (shocking, I know) so as soon as it was approved there was a lot of ground to make up from the original plan.  Because of this, there was little time to prep our field workers and nurses leaving most of them to have the bulk of their training on the job. 

Mama Gwiji Demonstrating how to collect Sputum

In order to make sure all the teams were on the same page and adequately armed with the information about HIV and TB, a mass 3-day training was held last week for all of our field workers and nurses.  Topics included a review of HIV and TB symptoms and disease processes, counseling methods, HIV testing procedures, specimen collection, etc.   Questions were addressed and solutions for some of the issues being experienced in the field were implemented. 

Overall it was an extremely successful training.  Our Field workers are so motivated and were so enthusiastic about participating in the training sessions.  I think they all left with a much better picture of HIV and TB as well as the impact they can have on their communities through CMMB’s project.  I am really excited to see the progress we make over the next year! 

Happy Thanksgiving!!!!!

Yes, yes I know I am a few days late but since it was just another workday in South Africa, festivities with my host family had to wait until Friday night.  Can I just say, I found it somewhat difficult to properly describe Thanksgiving.  I feel like I must not be doing it justice because most of my coworkers said it sounded a whole lot like Christmas to them.  Even more challenging was describing Black Friday, and now I’m pretty sure they think Americans are crazy.  They might be right… 

Anyway, last night I cooked a small feast and my family and some friends came over to partake in my make-shift holiday.  I of course made everyone join in with the cliché Thanksgiving tradition of going around the table and say what you are thankful for this past year and it was pretty clear that we are one lucky group of people who have been blessed with love, family, and wonderful experiences. 

Turkey Day Spread

I think the success of my Thanksgiving was best summed up by my host mom, Bomza.  This morning she told me,  “Nikki, your Thanksgiving meal was so wonderful last night, but I ate so much I almost died!”

And now just a few things that I am thankful for this year:

I’m thankful for a host family that entertains my requests for celebrating American holidays.

I’m thankful for the friends that I have made in South Africa, I don’t think I would be surviving without them.  

I’m thankful that I have such wonderful friends at home who have made me feel like we are just in different cities not on different continents.

 I’m thankful for my wonderful host family that has made me feel right at home since Day 1.

 I’m thankful for my family back home who has been so supportive and encouraging of this adventure.

 I’m so thankful to have this opportunity and excited to see what will happen during the rest of my time here! 

TB or not TB?

Many of you who know me, especially my fellow MPHers, know that I have a ridiculous obsession with Tuberculosis.  It's truly a fascinating and quite complicated disease posing many issues in the way of both treatment and prevention.  South Africa has one of the highest rates of TB in the world mainly due to its massive population of individuals infected with HIV.  TB treatment and prevention is one of South Africa's Department of Health's top priorities, which is why CMMB has recently started their TB project which consists of going door to door to screen people for the disease.  Naturally I gravitated to this project and I have been trying to use what I learned in my Masters program and what I gained from my experiences working in TB in Kenya to contribute its development

TB Poster in Grey Hospital Clinic KWT

I know finding and treating someone with TB seems simple enough, but its really a quite complex process.  The first round of screening is a questionnaire about TB related symptoms.  If someone appears to have symptoms, then our field workers collect sputum and send it to be tested.  But, of course, that can't be the end of it.  Because TB is difficult to detect, the standard procedure is to collect 2 samples from each patient on 2 separate days, meaning two trips to each person's house for our field workers.  Once this step is complete, the samples are sent to the lab where they are observed under the microscope.  From this the lab gives you a positive result (they saw TB bacteria under the microscope) or a negative result (no TB seen here!).  Simple right? Wrong.  Now there is the issue of using microscopy to diagnose TB.  It really isn't that great of a test.  For one, TB is easy to miss under the microscope not to mention the many issue that can arise with sample quality and contamination issues.

So what do you do if a patient has a negative lab result but suffers from TB symptoms?  Some of the rural clinics in my area say "that's it, nothing more we can do" while others will refer the patient for an xray and doctors visit.  However this happens at another clinic, which adds cost and travel time for patients that have little time or money to spare.  At every turn TB control becomes more and more difficult.

Sign on Exam Room Door Zwelitsha Clinic

Now lets say your patient's test comes back positive.  Great! They have TB so let's start them on treatment, problem solved.  If only it were that simple... First off, to cure TB a person needs to be on treatment for at least 6-9 months.  That's taking a pill every single day for at least 180 days straight.  If you start missing doses then your problems get WAY worse.  Improper TB regimens lead to drug resistance, and let me tell you, drug resistant TB is not something you want to mess with.  You'll have to go back on treatment for much longer and you're going to have to take more drugs than you did before.  Drop the ball again, you are likely to cause further resistance leaving you with very few options for treatment.

Much more than making sure that drugs and doctors are available goes into successful TB treatment and prevention.  You have to think about the barriers patients face when it comes to accessing these services.  Do I have transport to get to the clinic? Can I afford the associated costs? Can I leave work? Am I worried about stigma if someone sees me in the TB section of the clinic? How will I make sure I I have a continuous supply of medication?

The list seems ENDLESS.  My hope is that through this program we can address and eliminate many of these barriers by bringing clinic services directly to the people in our communities and having a well-defined referral system for the services that are beyond the scope of what CMMB can provide.  Establishing this should make for a VERY busy year.