Free medication boosts tuberculosis recovery rate

Free medication boosts tuberculosis recovery rate

Rodiyah nods and smiles when asked if she will finish the entire
six-month course of tuberculosis (TB) medicine that the Setiabudi
district community health center (Puskesmas) is providing her
free of charge.

"I want to get well this time around," the 50-year-old woman
says.

When she was first diagnosed with tuberculosis two years ago,
she stopped taking the medicine after two months and the TB
eventually came back.

Rodiyah returned to the Puskesmas last month and has been
coming in every week to pick up her free medicine.

"I thought I was cured until the symptoms reappeared," she
said.

The fact that she is raising six children, with the youngest
in the fourth grade, makes it that much more important that she
beat the disease once and for all this time.

"I need to get better," she says.

Rodiyah is an example of the main problem facing the country
in eradicating TB. The World Health Organization has estimated
that about 400 people in Indonesia die each day from
tuberculosis, making it the number one killer among infectious
diseases.

Indonesia had the largest number of registered TB patients in
the world after India and China with 207,000 in 2004, a sharp
increase from 178,000 the previous year.

"This increase is the result of more people going to Puskesmas
because they have heard about the free medication provided by the
government," said Setiabudi Puskesmas manager Kenny Zulfa Amir.

Rosmi Day, the acting director of directly transmitted disease
control at the Ministry of Health, said recently the recovery
rate for TB patients increased from 69 percent in 2003 to 76
percent in 2004. Rosmi credited this improvement to Puskesmas
applying the WHO's Directly Observed Therapy Short-Course (DOTS)
method of treatment.

The DOTS strategy focuses on the government's commitment to
fighting tuberculosis, the detection of cases, regular supervised
treatment (including close observation of patients), ensuring a
regular supply of anti-TB drugs and the effective reporting and
monitoring of patients. The WHO has said that DOTS can improve
cure rates to up to 95 percent, even in the poorest countries.

Jan Voskens, a senior consultant at the Royal Netherlands
Tuberculosis Foundation, said DOTS was important because for TB
to be cured patients had to finish their entire course of
medicine, uninterrupted.

On-and-off treatment will result in multidrug resistant TB.

"Resistance is not only expensive, costing about $20,000 to
$40,000 for a two-year treatment, but the medicine given can
actually harm the patients," he said.

At a Puskesmas in Mampang Prapatan, South Jakarta, Herawati, a
nurse in the Puskesmas' TB unit, said the work done by people
monitoring the patients (PMOs) played a big role in the high cure
rate at the health center.

"PMOs, usually the patients' relatives or friends, play a
pivotal role in ensuring that medication is taken regularly," she
said.

Puskesmas, she said, only play a passive role in this work,
meaning that they educate patients and PMOs about TB, its dangers
and how to cure the disease.

"With our limited human resources, it is impossible for us to
take the campaign to the streets. We can only visit patients
every four weeks to check if they are taking their medication,"
she said.

At both the Setiabudi and Mampang Prapatan health centers,
boxes containing six-month courses of medicine are labeled with
the patients' names to help monitor their compliance with the
program.

Whenever the medicine runs out, the Puskesmas go to municipal
health agencies for new supplies.

Herawati said there needed to be more of an effort to educate
people about tuberculosis.

"People need to know the symptoms, which include continuous
coughing over a three-week period, fever during the night,
difficulty breathing and weight loss," she said.

Since the disease is transmitted through airborne particles,
it is important for medical workers dealing with TB patients to
wear masks to protect themselves from infection.

"We have work to do, and to do that work we need to stay
healthy," Herawati said. (005)