TB-CARE ACTIVITY, AN EFFECTIVE DEVELOPMENT AID BY ENHANCHING STUDENTS PARTICIPATION IN DIRECTLY OBSERVED TERAPHY (DOT) PROGRAM TO MINIMIZE TB-CASE

By: Sri Hindriyastuti

It was rainy day, I traveled a mile away, following my student by her motorcycle. We were going to specific village, namely Jabungan. It was the first time for me finding this remote area around a crowded area, our campus. Finally, an hour later, we reached for a weird place, a muddy area around, a small and modest house with a dusty wall. What a place!. Then we entered a house and met with the person we want to meet. He is an old man, 63 years old, wearing the mask covering his mouth. Surely he did it to prevent the spread of his disease through the air. That old man, Mr Paijo, suffer from Tuberculosis (TB).
We are not a doctor, but we are academicians, a teacher and a student of nursing program of Diponegoro University. We came there to observe and guide the medication of TB to Mr Paijo as our program in TB-care activity. This is not only the first time for us of doing the same procedure, guiding and monitoring the treatment of TB case. We want to make sure that patient has already drunk their food prescribed from the doctor simultaneously.
It is difficult to understand how could we so brave to do this kind of activity while we are not a doctor. But absolutely this is the best choice we can do as an effective way to minimize TB-case. As we know that from year to year, the number of TB sufferer is always increase not only in my country, Indonesia, but also in other countries in the world.
In global terms, there are one billion people infected with tuberculosis at any one time. Eight million new cases arise annually making a prevalence of 16 million cases. Three million people die annually from TB. The annual risk of TB infection in South East Asia is 1 to 2.5 per cent. This represents an upward trend. This case shows that countries with TB case and other health problems need an effective aid to tackles the problem occurred.
Health problems then become the priority of development and effective aid in international program. About 80-85% of developmental aid comes from government sources as Official Development Assistance (ODA). The remaining 15-20% comes from private organizations such as Non Governmental Organizations (NGOs), foundations and other development charities.
Indonesia is in the third rank of the number of TB sufferers in the world after China and India. Every year, there are at least half a million new cases of TB per year and 175,000. Tuberculosis is the second killer of adults after cardiovascular disease and the most important killer out of all the communicable diseases. TB is very easy to spread out. It can infect people easily by air. Unfortunately, the societies still do not have enough understanding about this disease. They still consider that TB is not harmful.
I am working as a teacher of nursing program, especially in community nursing department. Knowing the problem of TB case in Indonesia, my colleagues and I then inspired to do something useful for TB sufferer.
Actually, our government has established some action to solve TB case in Indonesia. The actions vary like giving health education, free medication, monitoring the medication by DOT program. DOT is a Directy Observed Teraphy, where a health worker/ doctor or a family of the patient monitors the medication of the patient with TB. But unfortunately, these programs could not run well. First because there are many people who are do not care with their health then they do not want to go to the nearest health care system. The effect, they also do not know about how the harmful the TB is. The second, some medical workers do not want to do home visit to patient home continously because of the location is so far away. Then they just asked the patient’s family to do DOT.
Some countries, such as Canada and the USA prefer to concentrate their preventative efforts against TB by monitoring the spread of TB and treating these who prove positive to TB rather than immunizing the whole population. They feel that a positive Mantoux/Tine test then fails to differentiate those who have been immunized from those who actually have the disease. They believe the vaccine to be ineffective and it complicates diagnosis (diagnosis can take many weeks to be confirmed and can be difficult. It is difficult to make sure who are infecting by this disease because someone in the same family will have a big opportunity to suffer from TB.
For a simple case, my friend and I also find the same case in Jangli Krajan village. My friends and I try to make a community group for screening and giving health education to TBC sufferers in Jangli Krajan Village. Beyond our expectation, the phenomena of Ice Mount do not only happen to HIV cases, but also to this Disease. When we tried to make a database of the TBC sufferers of those villages by collecting data from Ngesrep Public Health Centre (Puskesmas Ngesrep), we just found about 18 persons who are infected by TBC. However, in a fact, when we checked to the community directly, there were many families whose members are infected by the disease too. It is terrible I think. Unfortunately, no medical workers come to them and give them information about this disease. They just supply the medication if there are some people go to public health centre and are positively diagnosed as the TBC sufferers. It indicates that preventive program is not the priority. The medical workers still focus to heal it. They keep themselves away from doing actions to prevent the disease or keep it away from infecting other people.
In fact, for the curative aspects of TB case, the DOT program for patient of TB is also ineffective because almost all of medical workers do not care with DOT program and they just gave the responsibility of monitoring the medication of the patient to their families at home, while the families also do not want to care with the patients. It means that the difficulties to tackles these problems are by doing preventive and curative actions for TB case.
My Colleagues and I are not doctor, but we are also health provider. As a teacher, my partner and I in who are in Community Nursing department, a place I work try to make a new strategy to handle these problems. We cannot do it by ourselves, because of a dense schedule in our working place, as a teacher we try to persuade and ask students to be involved in this case. We want to help government to minimize TB case, we laso want to achieve the goals of Millennium Development Goals (MDGs), especially in 6th Point, minimize the communicable disease. With our routine coordination, we finally held a special activity, namely TBC Activity or TB-care Activity. Huge of students involved in this social nonprofit activity as an extra-campus activity. The story I told in the first paragraph is a TB care Activity while doing DOT program.
It is particularly important role in improving health to achieve the Millennium Development Goals (MDGs) point 6th – minimize communicable disease. While to achieve this 6th point, we also need to make it balance with the 8th – Promote Global Partnership for Development. In health system, focusing on TB case the effective aid is not only just by strengthening the global partnership but also need to directly distribute the aid to the patient.
TB-care Activity tries to actively involve the nursing students in some programs, preventive and curative programs. The preventive program is like giving health education to TB patients while the curative program is like doing home visit as a Directly Observed Therapy (DOT). It seems so simple, but by enhancing student’s participation in this case it will improve the increase of health quality and also will improve to achieve MDGs point 6th and 8th.
Why did we involve our students? It is because we understand well the real condition in society. By involving our students, it will easy to control TB patients as our students able to come to patient’s house everyday for monitoring the successful of TB medication. Although it seems simple, just by asking students to come to patients’ house, but surely, it will help the DOT program because we do not need a doctor or event ask the patient to come to public health service per day. We also do not need to worry about the family of the patient just in case to remain them to monitor the medication of patient. Surely, it does not work effectively. Program of TB-care Activity is so simple. But it is so effective to monitor the patient. My biggest wish is to make this program become success one day.
By some activities that we do, we hope that it will inspire many other medical workers to improve their services to society. There is a wise word which says that the best of us is the most contributing to others. My friends and I try to touch the community directly. And we hope that one day; there is awareness from the society and medical workers of how important a preventive program is. While in another case, we also want to help a doctor or the government of minimizing TB case by doing DOT as we know that the number of doctor is limited if they need to do the DOT by themselves. . Next step, we hope that this action can minimize the proportion of TBC in Indonesia. In 2010, I hope that Indonesia will not be in the top 3 for the TBC prevalence in the world. I do hope so.
My country is a developing country; it means that this country still needs to promote global partnership for development such a bilateral and multilateral cooperation especially in funding aspect. Up to know, we always heard that we need to tackles the problems appear in this era and try to achieve the Millenium Development Goals. I am pretty sure that MDGs will be achieved if a rich country helps a poor country, or a developed country helps a developing country. But unfortunately, sometimes the aid is not like what we want to be. Problems in some developing countries are about the funding they got from World Bank or the International Monetary Fund or from Rich Country. They booked that their aid is a development aid while the developing country get it as a loan because they need to pay back the money in doubled.
In health system like TB case, Students are a big commodity, a bridge of distributing an effective aid. Provision of effective aid at sector level must be underpinned with strong links to the broader development agenda – both "economic" and "human". In economic aspects, government can try to distribute some aid for TB patient through the students who are involved in TB care activity. It will be more effective than give the aid through health system while sometimes could not delivered to the patients well. As Gary Jacob and Harland Cleveland said that social development can be summarily described as the process of organizing human energies and activities at higher levels to achieve greater results, I really hope that by enhancing student’s participation in TB case, it will improve the health quality of people who suffer from TB so the MDGs could be achieve soon. Is it just a dream? Of course not. Hopefully.

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