JP/17/TB

JP/17/TB

Free treatment gives hope for a TB-free country

Tantri Yuliandini, The Jakarta Post, Jakarta

One can imagine that in her youth, Nihaya was very beautiful. At
57 years of age, this petite woman looks like she is in the best
of health. Her eyes twinkle, her skin glows and laugh lines are
barely visible around her rosebud mouth.

Nihaya, however, is one of the hundreds of thousands of people
in the country who have contracted tuberculosis (TB).

According to the World Health Organization (WHO), the rate of
TB in the country in 2002 was 271 per 100,000 people, making it
number three after China and India in terms of the number of
patients.

The way in which Nihaya talks about her illness is down to
earth. She breezes over her experiences in much the same way as
one might relate their grandson's school achievements, or the
pengajian (reading the Koran) gathering at a neighbor's house.

"When I have a relapse -- it usually happens in the morning
you see -- I sweat profusely, my whole body gets all wet, and I
cough a lot -- expectorated coughing -- and my nose runs
horribly. It usually happens in the morning -- by noon it would
have gone away," Nihaya explained.

She has been attending the free tuberculosis clinic on Jl.
Baladewa 34, Tanah Tinggi, Central Jakarta, for five weeks now.
The entire treatment program runs for six months.

"They prepare for you your whole six-month treatment package
immediately after you register, did you know? And you don't have
to pay anything except for the Rp 35,000 (about US$4)
registration fee and first course of Roentgen (X-ray
examination)," Nihaya said.

The tuberculosis clinic on Jl. Baladewa -- officially called
Poliklinik Pemberantasan Penyakit Paru (Polyclinic for the
eradication of lung diseases) -- was established in 1978 by the
Indonesian Tuberculosis Association (PPTI).

Since then, the non-governmental organization has set up
similar clinics on Jl. Sultan Iskandar Muda 66A in South Jakarta
and on Jl. Dermaga I, Kompleks Nelayan in Muara Angke, North
Jakarta, as well as five other clinics in North Sumatra, Jambi,
South Sulawesi, Central Java, and Yogyakarta.

The clinic on Jl. Baladewa treated more than 14,000 patients
between 1978 and 2003, with a cure rate of more than 90 percent,
the clinic's medical supervisor Halim Danusantoso said in a
journalists forum on International Tuberculosis Day last week.

The treatment strategy endorsed by the clinics is the Directly
Observed Treatment Short-course, or DOTS, as recommended by WHO.

According to WHO, DOTS produces cure rates of up to 95 percent
in even the poorest countries, and prevents new infections, at a
cost of as little as US$10 per patient in some parts of the
world.

DOTS is comprised of five key components; political commitment
to sustained TB control activities, case detection by sputum
smear microscopy, a standardized treatment regimen for six to
eight months, the regular and uninterrupted supply of all
essential anti-TB drugs, and a standardized recording and
reporting system that allows for the assessment of treatment
results.

Once patients with infectious TB have been identified using
microscopy services, health and community workers and trained
volunteers observe patients taking the full course of the correct
dosage of anti-TB medicines.

In conforming with this, and to make use of the free
medication, every patient admitted to the Baladewa clinic has to
sign a letter of agreement. This must be acknowledged by the
local administration and a third party, who commits to ensuring
that the medication is taken correctly.

The letter, or contract, states that the patient has
voluntarily promised to take the full course of medicine. They
also agree to bring the empty plastic medicine packets with them
to the clinic once a week, when they come for more medicine.

Should a patient fail to comply with the expressed procedure,
he or she would be bound to repay the cost of the medicine that
had been taken so far.

"This very rarely happens though. We have a compliance rate of
more than 95 percent," Maria Heru Gunadi, vice president of PPTI,
said.

The need for the contract stems from the fact that it is
tempting for patients to stop taking their medication halfway
through the course. Often they feel much better a few weeks into
the treatment and mistakenly believe that they have been cured.
Other times, the reason is simply that the patient is
absent-minded or forgetful.

If the course is interrupted, or the dose of medicine is
incorrect, the TB bacteria could become drug resistant. Treating
a patient with multi-drug resistant TB (MDR-TB) is far more
difficult.

"My son's mother-in-law has agreed to ensure that I take my
medicine properly," Nihaya said.

Similar TB-treatment programs are available in 99 percent of
the 7,240 public health clinics across Indonesia, Minister of
Health Achmad Sujudi said, but this does not mean that the
disease is under control, as people still have a low awareness of
TB.

"DOTS only managed to reach 41.3 percent of all TB patients in
2003," he said, explaining that with the "more aggressive"
dissemination of information the government expected the number
to increase by 70 percent by 2005.

As for Nihaya, she did not always have such confidence in
doctors and used to go to a dukun (shaman) for treatment.

"It didn't always made sense of course. I mean, what does
rubbing a lemon up and down your arm has to do with curing chest
pain, I ask you?" Nihaya said.

But after a variety of traditional treatments failed to bring
about results, Nihaya decided to give the clinic a go.

"I don't really mind, you know, whether I get better or not,
that's up to God, but at least I am doing my part in trying to
get better," she said cheerfully.