Tuesday, March 25, 2008
World TB Day: The Power of Individuals
Promotores de salud raise awareness about
TB in Chiapas.
TB in Chiapas.
I Am Stopping TB is the theme of this year’s World TB Day.
At Doctors of the World-USA (DOW), we celebrate the individual efforts of thousands of people who are leaving a personal impact in the fight against TB. It is not just scientists and doctors, but also local leaders and community members that are playing a major role in the movement to control a disease that in 2006 killed 1.7 million people.
At Doctors of the World-USA (DOW), we celebrate the individual efforts of thousands of people who are leaving a personal impact in the fight against TB. It is not just scientists and doctors, but also local leaders and community members that are playing a major role in the movement to control a disease that in 2006 killed 1.7 million people.
Community members are vital partners in each of DOW’s TB projects around the world. A major component of the model of care we developed in Kosovo and Romania is the training of community members to become Peer Health Educators (PHEs). Our first PHE graduates were teens from the Roma ethnic minority in Romania, who energetically raised TB awareness in communities with little education or access to health care. The success of this model led to replications on two more continents. In rural Kenya, where the HIV epidemic fuels TB, we train traditional birth attendants to be cough monitors, to diagnose those infected, and to refer people for care. In Chiapas, Mexico, where TB prevalence is twice the national rate, we train promotores de salud to visit local families and teach them about TB, detect coughs, and collect sputum samples, where appropriate, for testing.
The Power of the Community
In 2007, DOW launched a community TB education and active case finding campaign in the Ocosingo jurisdiction of Chiapas. One hundred and four promotores de salud (community health workers) are carrying out this campaign after three months training with DOW, studying topics like health communication and case finding, based on the WHO’s Directly Observed Therapy-Shortcourse (DOTS) strategy.
Community members in Chiapas garner more trust from local residents than a health or government authority could; they speak indigenous languages and understand local culture. These communities have been politically and culturally isolated for decades, with little access to accurate health information or TB health services. Promotores serve as an essential link in helping local communities to access health care and to receive life-saving information. They visit every family in a community, looking for signs of TB, dispelling myths and educating them about prevention. They also collect sputum samples where appropriate and transport them to laboratories for testing, and they visit TB patients to monitor treatment adherence and prevent the development of drug-resistant TB.
The Value of the Individual
Like many of the residents of Chiapas, Manual used to work as a farmer. And like many, he was disturbed by the unmet needs of the sick in his community. In order to play an active role in solving the problems around him, he decided to become a community health volunteer. He participated in trainings with the Secretaria de Salud in subjects like hygiene and reproductive health. Then he went out into the community and talked to his peers about how to improve their health and prevent diseases. Very quickly, he saw that TB was a major problem in the community, but he did not have information to give people about detection or prevention.
When a friend told Manual about DOW’s trainings for promotores de salud, he enrolled right away. After three months, he now knows how to listen to coughs to detect TB and how to collect sputum samples, which he brings to a nearby laboratory for testing. He refers people to the casa de salud for medical services, and he visits TB patients regularly to make sure that they adhere to their treatment regimens. The total number of visits he makes has also increased greatly since he trained with DOW.
“Before I became a promotor,” says Manual, “I visited families only when I knew someone was sick. But now I visit every family in my community. I look for coughs that might mean TB, and I try to teach each person how he or she can prevent TB.”