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)