ASRI's Commitment to TB Recovery: Overcoming Health Challenges in Sukadana
Tuberculosis also referred to as TB, is a potentially serious infectious bacterial disease that most commonly affects the lungs. The treatment for patients with an active infection involves a long course of antibiotic treatment. Most TB cases are treated for a sixth-month period. Moreover, patients who are diagnosed with Multidrug-resistant TB disease (MDR TB) can lead to additional months of treatment or changes in medicine. Even if it is difficult for the patient to follow the strict schedule it is crucial to take every dose as instructed and complete the full course of treatment
Indonesia has the second highest rate of TB in the world with approximately 724,300 tuberculosis cases reported in Indonesia in the year 2022. The local government in Sukadana places a big priority on health. The government works closely with organizations such as ASRI treating TB. They provide free medicine and healthcare for the locals. I visited Puskesmas Sukadana and RSUD Sultan Muhammad Jamaludin I, both government-run medical institutions that partner with ASRI to enhance the TB treatment programs.
One of the many difficulties providers find while dealing with TB treatment is patient consistency. After the intensive treatment phase spanning the first 2 months, many patients will discontinue the treatment after feeling their symptoms ease. If discontinued too early, symptoms will come back and the immune system will develop drug resistance making any hope for future treatment more difficult. In order to combat this problem, it has become common practice to employ designated people to Directly Observed Therapy (DOT) for each patient. DOT means that a health worker or person observes the patient swallow each dose of TB medication based on prescribed drugs.
At ASRI, these individuals are called Cadres or health guardians. They are responsible for overseeing the drug intake 3 times a week for the full 6 months or more. They provide service directly to the patient’s houses. They are employed by ASRI but are also used in partnership with the local public health centers. I had the pleasure of meeting them in their monthly meeting where they discuss progress and problems they have encountered in their region. Problems such as new diagnoses of additional conditions are made known to the team and also additional treatments are advised by the doctors.
I had the privilege to follow a Cadre around on a daily shift to see the patients. We observed three different patients from around the region. Two of the patients were in their first two weeks of treatment while the other was finishing her last week. One of the patients was not able to maintain the strict schedule, causing possible complications in future treatment. This in combination with lifestyle choices such as smoking made their symptoms more intense. Another patient was diagnosed with HIV and therefore was more susceptible to the active infection. Medicine for HIV is a lifelong commitment and an additional problem for fighting the spread of TB.
Seeing the commitment the Cadre exhibited towards the patient’s well-being was really encouraging to see. The woman who finished her treatment explained that her relationship with her Cadre grew into a friendship and she is forever grateful for the care she received. The one-on-one care ensures that the patients continue their treatment but also that they have someone looking out for them in this difficult time in their lives. Through my observations, I was inspired by ASRI’s commitment to one-on-one care and the prioritization of treatment by the local government. I hope to continue to study this disease around the world and I am grateful for the information I gained here at ASRI.
