Tuberculosis (TB) remains a devastating disease that disproportionately affects developing countries: today, over 95% of TB deaths occur in low- and middle-income countries. World TB Day is commemorated each year on March 24th to raise awareness around the devastating consequences of tuberculosis (TB).
Access to health is a fundamental human right – skilled health professionals are the leaders who can help prevent, treat, and end TB around the world. Nurses, midwives, doctors and health providers on the ground, in developing countries have a clear view of how TB affects their communities.
The Kingdom of Swaziland has the world’s highest incidence rate of TB, with 80% of TB cases co-infected with HIV. We interviewed Volunteer Educator Yohannes Wondimagegnehu, RN, BSN, MPH who teaches community health nursing at the University of Swaziland as a guest lecturer through the Global Health Service Partnership (GHSP) and Seed Global Health. We asked him about World TB Day, and how TB affects his work as a health professional in Swaziland.
Yohannes, why do you do this work?
I believe nurses and midwives are critical in the delivery of essential health services and are core to strengthening the health system. Seed’s objective of addressing health inequalities by training health professionals in low resource counties really resonated with me — I knew I had to get involved.
Tell us what it’s like on a typical day at your hospital/clinic? What is a typical situation you face?
As a community health nurse, I help my nursing students gain clinical experience based on the knowledge they learned in class. We travel to low-resource communities and support their health needs. During my students’ time with the community, they go in pairs to each family home to do their health assessment. Students have an opportunity to trace family members with a health problem. They may identify a debilitated TB patient, which they can then refer to the district hospital and patient will be admitted. The students continue to follow their client until they are ready to be discharged to their home after they are no longer infected. It’s cases like this that my students usually come across while doing their community practice.
What do you think is the reason for a large number of TB diagnoses in Swaziland?
I think the high prevalence of HIV is the reason for a large number of TB cases. Of course, the low socioeconomic condition also plays a significant role. People in a rural community live in crowded situations with little to no ventilation. These communities often do not understand how TB transmits and how HIV and TB can be present at the same time. The scary part is not only the high prevalence of TB but the development of multi-drug resistant (MDR) and extensively drug resistant (XDR) TB cases. According to WHO analysis, the incidence of TB has increased five-fold, from what it was in 1990 (267/100,000) in Swaziland.
What do you think are the most important solution to eliminate TB in Swaziland?
TB is a treatable and preventable disease but requires informed community participation, committed and well-trained health professionals, high government input and leadership, and of course global support. It is also equally important to empower the community and help them detect and treat HIV and TB. Voluntary Counselling and Testing (VCT) of HIV and TB detection and treatment programs should go together. Treating positive cases with potent and appropriate drugs and educating TB and HIV patients on the adherence to treatment, and its precautionary measures are vital.
Are there any programs informing the community about TB and where to find treatment?
Yes, there are trained “health cadres” within the community. The cadres are able to detect suspicious TB cases based on clinical symptoms. Their job is to connect them to health centers for further tests.
If you had a magic wand, how would you change your tactics to eliminate TB in Swaziland?
I would launch TB detection campaigns all over Swaziland and treat cases under close supervision until they are no longer infectious. Health education campaigns and training health professionals in community health services are crucial to success. I would also include an advanced community health practice for Family Nurse Practitioner education.
Volunteers like Yohannes share their knowledge with in-country health professionals and together with local colleagues help to strengthen access to quality health care where resources are scarce. This type of work is crucial, especially when combatting prevalent yet preventable diseases like TB.