Panel T1: Engaging the Christian Community in Tuberculosis Control
Community-based Approaches to TB Control, the Jamkhed Experience [Shobha
Arole, Jamkhed Institute for Training and Research in Community-based Primary
Health Care]
Dr. Arole presented on the nature of TB and the approach utilized and promoted
by the Comprehensive Rural Development Project in Jamkhed, India. TB is not
simply a scientific or medical condition, it is a social one for which people
are ostracized within a community.
In Jamkhed, the community takes responsibility through love and a non-judging
approach. People work within the community to reduce stigma. Medical teams
go out and identify new cases and follow-up with old cases. The project is
holistic in that a series of prevention and treatment issues are addresses,
including root causes such as poverty.
Community Based DOTS for TB Control in Zambia [Godfrey Biemba, Churches
Medical Association of Zambia for Dr. Rossi Maria Mercedes, Ndola Catholic
Diocese, Zambia]
This presentation on the AIDS Integrated Programme of the Catholic Diocese
of Ndola highlighted the history of the program in addition to the benefits
of moving from a facility-based program to one in which the follow up is done
at the household level.
Planning for the program began in 1991 and has grown to cover 450,000 with
the assistance of 750 community volunteers and 34 nurses. This project can
now be seen as a video documentary, "Under the Mupundu Tree," produced by
ActionAid.
The Role of the Church Hospital in TB Control, The Malawi Experience [Frank
Dimmock, Presbyterian Church, USA/ Malawi]
This pilot project is modeled after the Zambia project and is being tested
in 5 out of 26 districts in Malawi. The role of the hospital is to support
community-based activities and provide a platform for leveraging resources.
There is increased stigma attached to TB as an association is being acknowledged
between TB and HIV. Some
challenges include irregular drug supplies, but that is currently being addressed
with assistance from DFID. There is also a need to strengthen ties between
church hospitals and government. The movement to a multi-sector approach is
threatening to detract from achievements in the integrated vertical program.
Getting Drawn into TB Diagnosis and Treatment Through AIDS Programs [Ivy
Appolis, St. Francis Hospice, Port Elizabeth, South Africa]
One third of AIDS Hospice patients have TB. The great challenge with treatment
is non-compliance. People do not have access to proper nutrition to be treated
properly and there is a lack of care and supervision at home.
The program is meeting these challenges through care workers who implement
community-based DOTS, distribute food parcels, and teach families how to start
and maintain home gardens. The workers also educate on disease prevention.
The program has established partnerships with local churches to devise feeding
schemes.
Discussion Points:
Volunteers are difficult to sustain. There needs to be a way to continue
to motivate people to give their time to community development. This has been
a challenge for all programs in addition to erratic drug supplies.
Programs were criticized for neglecting the roots of disease in poverty
and the challenge was posed, "How do we address poverty?" Treating disease
will be meaningless when the individual may go hungry tomorrow.
Highlights and Discussion of Christian Role and Future Directions in the
Fight against Tuberculosis
-
There is still a stigma associated with TB. The Christian response must
be directed at overcoming this barrier through the love of Christ.
- Community-based
and Church-based DOTS programs have several unique qualities that make them
more effective than institutionally based DOTS programs:
a) less vertical and more comprehensive
b) opportunity
to provide nutrition
c) provides
a personal touch and continuity through use of volunteers in the community.
d) volunteer
burn-out is one factor to watch out for. The Church must seek ways to support
volunteers.
e) personal
relationships between volunteers and patients during the six months of supervised
treatment provide an opportunity for evangelization.
- The Church
based DOTS system could become a model or concurrent system for the administration
of AIDS antiretroviral therapy.
- Western
Churches need to become more aware of the problem of resurgent TB and should
be partnering with third world church programs against TB.
- Churches
need to advocate with governments to insure a constant supply of affordable
drugs.
- An organization
like CCIH should serve as a clearinghouse to disseminate examples of Christian
response and information links as to how DOTS programs can be initiated.
