Tuberculosis (TB) is curable and yet it kills three people every minute globally. On March 24th, we marked World TB Day to build public awareness for this global health challenge. With a theme of “Unite to End TB”, partners called for a global effort to end TB once and for all by helping educate others about TB and by urging governments to take action.
Wanting to help make a difference in the fight against TB in rural Malawi is what motivated Chrissie Murray to become a Health Surveillance Assistant (HSA). In Malawi, Health Surveillance Assistants provide essential health services and a life-saving link between communities and the health care systems. More than 10,000 Health Surveillance Assistants (HSAs) are deployed in rural parts of the country.
When Chrissie first started working at Likangala Health Centre in Zomba district over three years ago, she was alarmed to discover a poor medical personnel to patient ratio, particularly for patients seeking both TB and HIV services. TB is a leading killer of people with HIV, causing one fourth of all HIV-related deaths.
“The facility was severely understaffed despite the fact that it served a large patient population. I came to realize that this was the case for many of the health centres across the country,” Chrissie said.
She also added that the TB consultation rooms used to be packed with people that needed to be screened for the disease. It was really difficult to assist patients because the facility only had access to sputum smear microscopy – a test that analyzes the thick fluid that is produced in the lungs and airways leading to the lungs – to detect TB. With this type of microscopy, a patient suspected of having TB must give an initial sputum sample and another early morning sample, requiring the patient to visit the health facility at least twice. Sputum smear microscopy has been the primary method for the diagnosing pulmonary TB in most low-income countries.
To further compound the problem, samples from rural health centres are sometimes sent to district or referral hospitals to be assessed with better equipment. In these cases, patients are asked to come at a later date to find out the results.
“Our health facility used to register high default rates because our patients, especially those who lived far away, could not return to provide another sample or get the results. The situation is identical in other health facilities where there is limited resources for TB detection and treatment,” explained Chrissie.
She fears that those individuals could easily spread TB in their community before being diagnosed. The World Health Organization reports that every year more than one third of all TB cases go undiagnosed. There is a significant detection and treatment gap, particularly in low-income countries.
As part of Dignitas’ efforts to strengthen the delivery of health services in Malawi’s southeast region, we have been scaling up efforts to integrate TB-HIV care. With support from the U.S. Agency for International Development, Dignitas has delivered TB trainings over the past several months to medical personnel, HSAs, laboratory assistants and other hospital staff. Chrissie benefitted from this training.
“We have trained over 30 health workers in TB screening and control. These people are already working in various government and Christian Health Association (CHAM) hospitals where we operate,” said Mike Liomba, Dignitas’ Laboratory Services Coordinator.
In addition to training, Dignitas has been providing TB drugs and other medical supplies to health centres to buffer against stock-outs. Fluorescence microscopes were also recently procured for six district hospitals/health centres including Likangala Health Centre in Zomba, where Chrissie works. Florescence microscopes help speed up test results for patients because of their ability to help identify cells and cellular components with a high level of specificity. Certain antibodies and disease conditions, for example, can be studied with a higher level of detail thanks to fluorescence microscopy.
Equipped with the skills obtained from the TB training, Chrissie now assists the facility’s TB specialist with TB screening and treatment.
“We are now completing work that used to take one or more hours in less than 30 minutes. Thus a lot of samples are being diagnosed in a single day. This means people are getting diagnosed sooner and starting treatment faster,” she explained.