Tuberculosis: Are healthcare workers tuberculosis proof?
‘I had to choose between being deaf and being dead’, this is what Dalene von Delft, a Medical Doctor from Stellenbosch University in South Africa, said in her testimony at a two-day Southern Africa meeting held recently to strengthen and scale up TB /HIV responses in the workplace. The meet was supported under the TB Care II program by University Research Company in collaboration with USAID. In the meeting, Swaziland, Namibia, South Africa were represented by their government, workers and employers’ organizations working in the field of TB.
Dr Delft is one of the few doctors who work in high risk
healthcare facilities and thus are constantly exposed to TB. She
contracted the disease from her workplace and was diagnosed with
Multiple Drug Resistant Tuberculosis (MDR-TB). Despite being a
doctor, she was unfortunate enough to be burdened by an
irreparable side effects of MDR-TB treatment—deafness. She
noted that tuberculosis needs to be considered seriously as an
occupational health concern and more importantly as a
preventable risk.
In the same meeting a presentation by Dr. Babatunde from the
World Health Organization indicated that an employee with TB
loses 3-4 months of work in a year, amounting to 30%-40% of
annual household income. His presentation highlighted the
magnitude of TB in the countries present at the meeting, where
HIV prevalence has prepared a fertile ground for MDR-TB. TB is
indeed affecting productivity in the workplace as well as the
quality of life in the extended community through the affected
families. As Dr Fujiwara, a Scientific Director at the
International Union Against Tuberculosis and Lung Disease
(The Union) expressed, “In countries with resources,
people are often given a tuberculin skin test and a Chest X-ray
(CXR). If the skin test is positive and the CXR is
negative, they can be placed on preventive therapy.
However, people with HIV may have a negative skin test
and/or a negative CXR, even though they have ACTIVE TB."
Dr Babatunde noted that workplaces have to scale up and
strengthen their infection control methods and TB responses. He
explained that in workplaces there is already an easy access to
a large number of people who can be a ready audience for
communication. There are also existing structures and systems to
build in TB-HIV support systems that can manage stigma and
discrimination.
The Swaziland Business Coalition on HIV-AIDS
(SWABCHA), an employer established institution, has introduced
TB-HIV awareness dialogues and adopted the national basic
screening tools through a mobile wellness clinic for most at
risk populations, like migrant workers who live in congested
environments and have long labour intensive working hours in
textile factories, construction sector and as cane cutters in
agriculture sector. In particular for healthcare workers,
Swaziland has established a Wellness Center, and provides TB-HIV
screening services for them at their workplace itself. Further,
the wellness center is equipped to provide HIV counseling and
testing, antiretroviral treatment (ART) for HIV, as well as
Directly Observed Treatment Short course (DOTS) for TB. This has
helped to minimize healthcare workers fear of queuing up at the
same healthcare centre with their own patients. It has also
helped them in forming support system groups with other health
care workers managing the same disease and, in some cases, both
HIV and TB treatment.
National TB programmes still face many challenges, which include
limited funding for the workplace since TB-HIV are still not
highly rated as an occupational hazard; stigma and
discrimination associated with TB-HIV resulting in poor access
to services and non- completion of treatment which further fuels
MDR-TB—the latter making it more difficult to treat and
reduce mortality rates due to TB. The high burden of HIV in
majority of Southern African countries has prepared a fertile
ground for easy spread of both drug susceptible and drug
resistant TB that is difficult to diagnose as well as to treat
as expressed by Dr.Fujiwara from The Union. Then again, there
are most at risk populations, who work long labour intensive
hours and they are a highly mobile and migrant workforce working
in factories, and as agricultural seasonal workers and
construction workers.
In the light of the challenges noted above, SWABCHA has proposed
possible future responses for TB-HIV in the workplace. Firstly
there is a need to expand the use of GeneXpert for point of care
diagnosis of basic TB and MDR-TB. Secondly, we will have to
intensify infection control in congested workplaces and focus on
geographic targeting of hot spots of TB, with a view to maximize
programme investments. Thirdly, there is need to strengthen
partnerships and multi-sectoral responses, addressing TB as not
only a medical challenge but also as a social and economic
threat. And lastly, establishing mobile data collection and
management to increase efficiency in patient tracking and
strengthening data collection for continuous research on TB
drugs especially drug resistant TB is also necessary. SWABCHA
will be launching a mobile phone data collection, linked to an
electronic data base this August 2013.
TB is a preventable and, most importantly, a curable disease and
there should be no deaths as a result of poor diagnosis (or no
diagnosis at all) and/or lack of access to quality treatment.
Source:
Citizen News Service
