Wednesday, July 14, 2010

The TB Clinic

The tuberculosis (TB) clinic at IDI has come along way since its founding in 2008. Back then, only one nurse, Ariko Immaculate, was charged with caring for, and managing the files of, every TB patient that came to IDI. The clinic was housed in one small, cramped room indoors, a severe health risk considering TB is transmitted through the air.

When the clinic finally moved to an open-air space, Immaculate and her colleagues encountered a new problem: the rain. Housed underneath flimsy tents, rain would pour in to the clinic, soaking the doctors, nurses and patients, along with their files and medicine.

Almost two years after its founding, the TB clinic now has six full-time staff, sees up to 50 patients per day, accepts 30 new patients per month, and is looking to expand. The staff does integral work, treating patients co-infected with HIV/AIDS and TB, many of whom are in dire need of care. The HIV virus breaks down the immune system, approximately doubling one’s risk of acquiring TB. When a patient becomes dually infected, administering medication becomes increasingly difficult. Side effects intensify, more pills must be taken, and there are only certain kinds of ARVs that can be prescribed with TB drugs.

Faced with vexing challenges and forced to make difficult choices, the only way the TB team can survive is by working together. Medical officers Catherine Katabira and Peter Mbidde work closely with three nurses and one full-time staffer to make sure the clinic runs smoothly, and patients get the care they need.

Additionally, peer counselors at the IDI clinics interview new incoming patients, asking them if they are showing symptoms of TB, such as weight loss, constant coughing, or a high fever. If so, they are immediately taken to the TB clinic to be examined by a nurse. Then, the patient sees one of the two medical officers, before seeing a nurse to get their prescription and receive counseling if needed.

It’s an efficient, streamlined effort that requires maximum cooperation from the entire team, particularly at a time when money is tight. While a grant from a European organization has lessened the financial burden on the TB clinic, there is still tremendous need. There is no outdoor toilet for patients to use, forcing them to go back into the clinic and, in the process, risk the transmittal of TB to other patients. An x-ray reading box and other general supplies are also needed. Perhaps most importantly, there is no separate space to provide urgent care for TB patients who need immediate medical attention.

Despite the needs, the TB clinic staff dedicates themselves to providing excellent care to every patient they see, every day.

“This team has been great at improvising and trying to implement new things,” said coordinator Sabine Hermans. “We are constantly working to raise the level of care, and do it with minimum cost.”

One example of the team devising ways to do more with less is the food delivery program. Funded almost exclusively by donations, one of the nurses, Jennifer, delivers packages of food to the homes of patients who are too sick to venture out. It’s a cost-effective way to ensure that immobile patients have enough to eat.

The TB clinic also plays an important role in the research portion of IDI. As the team works hard to devise new and improved strategies to treat dually-infected patients, observations and trends are entered into a database and examined. A recent study showed that after only one year at the TB clinic, about 14% of patients were not finishing their treatment, down from 30%, a remarkable improvement. Two more studies are planned in the near future at the TB clinic.

Treating TB presents difficult challenges for the clinic staff, but because the disease is curable, unlike, HIV/AIDS the rewards are tangible. Dr. Katabira said that watching a patient diagnosed with TB correctly take their medication and recover is extremely gratifying.

“When you see someone get better, some one make it, that encourages us as a team,” Dr. Katabira said.

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