Treatment of Tb Essay
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Tuberculosis, they say, is a disease of the poor and truly it is a disease that puts us high above other nations in the world. We are currently among the 22nd high TB burdened countries and are under the WHO TB watch list. Tuberculosis is such a problem for us. Imagine, 75 of our fellowmen die each day because of TB. Tuberculosis, however, is not a terminal disease. Before, people thought once you have TB you’ll just die not cured with the disease.
But now, it is actually very curable. Our government, in addressing to this dreaded disease, formulated the National Tuberculosis Program or NTP.
This program envisions our nation as a country where TB is no longer a public health problem. The goal therefore is to reduce the prevalence and mortality from TB by half by the year 2015. Now, this is where DOTS comes in. At first, I thought DOTS is just about making sure that the patient is really taking in his TB regimens – like literally swallowing the medicines on schedule. It, however, is not just as simple as that. DOTS or Direct Observed Treatment, Short-Course is the WHO-recommended strategy for diagnosis, treatment and management of TB.
Since TB is curable, the WHO believes that the best way to cure TB is through DOTS. It is a health strategy made up of five important components: Political Commitment for TB Control; Facilities for Microscopic Diagnosis of Sputum Positive Smear Patient; Unlimited Supply of Good Quality Anti-TB Drugs; Direct Observation of Therapy; and, Good Record Keeping. Through these components, it is made sure that the program is managed properly and that the sputum microscopy is of good quality. The program is embraced by the government and made sure it is implemented.
Health professionals are taught and trained well on the importance of the program, precautionary measures, how to deal with the TB patient, and, most importantly, on the proper identification and reporting of sputum microscopy results. There is therefore uniformity in the reporting of laboratory results. The government has also allotted a specific monetary budget for the services of the health professionals under this program. There is also the regular supply of drugs, not only just drugs but medications that are of good quality and recommended by the WHO.
More importantly, these drugs are FREE! All the patient has to do is to comply with the treatment. But, there are still patients who are, well, “human” – remarkably wise, talented entrepreneur (because some sell their TB medicines to others who also present with TB symptoms as they have). They have a mind of their own; they have their own treatment strategy. These make TB treatment difficult and pose threat on the development of resistant organisms because the medications are not taken on proper dosage and duration.
It is because of this that there is this 4th element of the DOTS strategy – the direct observation of the treatment partner (treatment partners could either be a Staff of the Health Center, Member of the Community , or Member of the patient’s family (last priority)) of the patient taking in the TB medications. With good record keeping, the patients are properly monitored and followed up wherever they may be in the country. With just one missed appearance on treatment appointments, the in-charge health partner is alerted.
There’s no reason at all for non compliance. What is more wonderful with DOTS in our country is that we have this PPMD or the Private – Public Mixed DOTS. This is very important because even the private health institutions apply DOTS so that wherever may the patient consult he or she is directed to the same treatment strategy for TB which ensures patient receives proper treatment and program benefits. Upon enrollment with the DOTS program, there is an allotted box of medications both for the intensive phase and the maintenance phase – the Stop TB Kit.
With those new pulmonary smear positive cases and new seriously ill pulmonary smear negative cases, the intensive treatment is made up of four regimens: Isoniazid, Rifampicin, Pyrazinamide and Ethambutol. The number of capsules taken will depend on the weight of the patient (since usually the four drugs mentioned are formulated on a single capsule). Like for example, a patient weighing between 38-54 kg will be taking 3 tablets each appointment time with the treatment partner. The intensive treatment lasts for 2 months then a sputum smear will be requested.
If patient is still sputum AFB smear positive there will be a month extension for the intensive phase. Afterwhich is the 4 months of maintenance phase. The regimen usually is composed of Isoniazid and Rifampicin. The kind and number of treatment regimens for tuberculosis is such because the TB bacilli, although TB is curable, is very difficult to eradicate and are prone to resistance. This is also why compliance is very important to prevent further development of resistant organisms. Whenever there are MDR TB patients (Multi Drug Resistant TB), they are referred to a higher center in Manila.
There, patients are housed for 24 months, still free treatment. I think each MDR patient is budgeted with 500 – 1 million pesos – such a huge amount. It is important therefore for us to prevent the development of such resistant organisms if we want our taxes serve the majority and give us better lives. Through the exposures regarding the DOTS, I now have a great appreciation for this program of the government. Whenever I will have an encounter with a possible TB patient, I could confidently refer him to a DOTS facility. I am hoping that we will truly be able to achieve our vision with regards to tuberculosis control as a nation.