Reporting from a practicum in southern Africa.
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| Miriam E. Reda, MD, MPH 2013' |
Lesotho
is one of the countries with very high burden of co-infection currently being
supported by ICAP at Columbia University. A small country in southern Africa
with the world’s third highest HIV prevalence at 23% and the fifth highest
incidence of TB in the world, Lesotho bears
this double challenge.
In
addition, with a very limited employment opportunities for men in Lesotho, the
South African mining sector represents a prospect for many Basotho men to cross
the borders and work on making a better living to support their families. However,
this opportunity comes with substantial occupational hazards for acquiring TB. Miners work in closed poorly ventilated mine
shafts with prolonged exposure to silica dust and
are exposed to the social consequences of living away from their families for
extended period of time. The combination of all these different factors leads
to a disproportionately high disease burden among miners with TB incidence in
gold mines in South Africa being the highest in the world and in Lesotho 10 %
of TB patient and 25% of MDR-TB patients are either current miners or
ex-miners.
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| TB REACH care supporter performing TB screening
for a miner and his wife at TEBA Maseru |
Less than a year after this declaration, ICAP,
in collaboration with the Lesotho Ministry of Health (MOH) and The Employment
Bureau if Africa (TEBA), worked extensively on the design and implementation of
the TB REACH project which targets 26,000 miners and their families through
establishing TB clinics at TEBA sites to provide TB education, counseling, on-site
prompt diagnosis and same day treatment initiation with close follow up and
contact tracing. The project is innovative in its nature since it is able to
catch the highly mobile population of miners through establishing points of
care at TEBA where miners report regularly to get their deferred payments,
offering services over the weekend and making use of the latest advancement in
TB diagnosis with onsite GeneXpert machines.
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| TB REACH laboratory technician running sputum samples on the GeneXpert machine at TEBA Maseru |
I
had the opportunity to contribute to this project in Lesotho as my practicum
for completing my Masters in Public Health graduation requirements. My
experience in Lesotho and with TB REACH has been highly interesting and enriching.
Despite
the fact that Lesotho is a small country with various challenges, it is full of
very friendly people. I was overwhelmed by the kindness I was welcomed with to
the country and by the approachable and pleasant way people interacted with.
Moreover, Lesotho offers breathtaking sceneries; gorgeous mountains and some
parts of Lesotho are a very concrete example of rural villages with rocky
roads, basic lifestyle, poor access to transportation and scarce health clinics
all of which make the provision of medical services extremely challenging. I
had to chance to visit some of the most remote health clinics abundantly
mentioned in public health textbooks.
As
for setting up the TB REACH project, my experience was vastly educational and
fulfilling on various levels. Initially, I was involved in drafting, revising
and finalizing the nurses’ and health care workers’ training curricula. It was
a challenging task taking the WHO guidelines and trying to contextualize them
to suit Lesotho’s National guidelines and regulations however through
discussions with several clinical advisors I was able to further understand the
process and I learned greatly on the mechanisms of integrating both the medical
and public health aspects of one disease.
Then,
I was heavily involved in delivering the actual training which was a very
exciting experience as I was able to interact with the nurses, understand their
perspective about patients’ management, explore their creativity in resource
limited settings and touch the difference in their knowledge by the end of the
training. After this training I realized that capacity building is a
fascinating area in public health that I plan on developing further as it is a
process of mutual exchange of information, knowledge and skills.
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| TB REACH launching with Dr. Wafaa El-Sadr and ICAP staff is Lesotho, TEBA Country Representative Mr. Kikini Kikini and WHO Country Representative Prof. Mufunda |
Moreover,
I was involved helping establish Monitoring and Evaluation tools and
indicators, procurement of medical supplies for clinics, supervision and
mentorship of clinic’s staff and creation of educational material that would
convey comprehensive yet simple, understandable messages to miners. Despite
learning extensively about all these aspects of a project throughout my courses
at school, the actual realities of adequately implementing the theory on the
ground with heavy stakeholder involvement are worth hundreds of hours of
classroom experience. A few hours spent with the people and the communities
addressed can prove to be the best way to learn how to design and implement a
successful intervention.
The
TB Reach project was launched by the Lesotho Minister of Health and Dr. Wafaa
El-Sadr in late July and is currently running in three districts in Lesotho.
Moreover this project represents the first step towards a more holistic
approach of the TB/HIV co-infection among miners and in Lesotho in general as
ICAP will continue working on expanding services to integrate the inseparable
TB and HIV services in accordance with its overall goals and mission.
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|
Top
picture: Dr. Wafaa El-Sadr with the Lesotho Minister of Health Dr. Pinkie
Manamolela
Bottom
right: Ribbon cutting during TB REACH launching by Dr. Wafaa El-Sadr, Dr.
Pinkie Manamolela (Minister of Health) and Mr. Kikini Kikini
Bottom
left: ICAP Lesotho Country Director Ms. Blanche Pitt (right), ICAP global
director Dr. Wafaa El-Sadr (middle) and ICAP Lesotho Technical Director Dr.
Koen Frederix (left)
|
Mariam E. Reda, MD
MPH Candidate, Mailman School of Public Health
