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.