In an area where TB recently had the highest statistics in the world. The issue of medication compliance persists for a mix of reasons, and each month another 55 people are diagnosed with TB. The amount of people living with TB and HIV is growing and has been an important factor in the rise of Multi-Drug Resistant TB. A pressing issue facing the people of Grabouw, and many African cities, towns, and villages as these regions are plagued with factors that contribute to the spread of TB.
Yesterday, we had an early start as we made our way to the day hospital for 0730. However our early start was not so early n comparison to the people who start waiting to be seen at the doctors from dawn, and may still go home at the end of the day with out being seen or having collected their medication.
Today though we where not waiting for the children to see the doctors and nurses, we where volunteering at the TB clinic. The TB clinic is run each morning to support people living with TB, patients come on their way to or from work, to be given or take their medication for the day.
When diagnosed with TB the nurses access your competency and determine whether or not taking a months supply of medication home is practical or not. If not, the hope is that they will arrive each morning to take their medication. Some patients take a more autonomous approach to their illness, although they don’t have a supply at home. They turn up routinely each morning, and are able to take their own medication once at the clinic. While others have their medications handed to them.
I was fortunate yesterday, to revert back to my student nurse days as i observed a nurse in the clinic. I was like a sponge absorbing all the information i could. She was so forthcoming and willing to share her knowledge, i appreciated the experience even more. She explained about the different levels of nurses in South Africa, which in a round about way translates to either being a Registered or an Enrolled nurse. In the TB clinic the ‘enrolled nurse’ equivalent has much more autonomy. This maybe the case in the TB clinic, as the TB doctor visits on a monthly basis, and between visits when necessary the team communicate via phone.
The TB nurse told me bout the diagnosis process, whilst we accessed an elderly man newly diagnosed with TB. He presented to the doctor over a month ago, with his wife as he had been unwell for a while. After being refereed to the TB clinic, sputum samples and X-rays where ordered and a month and a half later, here we are sitting, explaining his medications, what TB is and what it means. This gentleman was going home with his months worth of medications, so a referral was made to Thembacre- the community palliative care team. They will visit him regularly to ensure he is taking his medications, and help him get to his next appointment. Nearing the end of his consultation, the nurse turns to me and say she is now going to do a HIV test. I’m a little taken back by this, wondering how they actually do it, thinking it would be complicated. She opens a box filled with things, and a device that i can only explain looks like a cross between a blood glucose and pregnancy test. Sure enough the HIV reader works in a very similar way. I’m watching intensely as the strip turns colour, praying for a negative result. Breathing a sigh of relieve shortly after, as 1 not 2 stripes show...
I heard a lot of stories yesterday, all different but with the common threat that TB sewed them all together.
Yesterday, stepping in for a local church who usually works with the Community Police Forum (CPF), to provide food at the TB clinic. we where able to offer a meal to each person who attended the clinic as the village supplied the meal. Along with the meal, and safety information from CPF, we where able to pray for their health.
The provision of a meal is important from many reasons here, where food is not always available to those in need, food is also thought to increase medication compliance. As research has shown that the nasty side effects can be exacerbated on an empty stomach, TB medication is better absorbed, when taken with food.
When we had given a meal to the TB patients, we where able to hand out meals at the ARV clinic to people with HIV before heading up into one of the townships, Iraq.
When driving up to the back of the township, we stopped to hand out meals to some children. They ran towards us, thanking s for the food before running way to eat. We continued to drive, further into the township to a small creche. There are no words to describe what it was like, no words will explain it in the way that it makes your heart cry. The distinctive smell, the wonky walls lined with news paper and bottle caps in the place of washers, the cracked and subsiding wooden floor, the children.
The home of community members, who have adapted a part of there property to double as a place of worship on sundays. Whilst opening as a creche during the week, to provide parents with somewhere for their children whilst they work.
The children, excited to see new faces, to be hugged and played with. A baby sleeping in the corner, young ones playing on the floor, and older children playing together.
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