In this guest blog post, Sue Dart, the lead TB nurse for the London Borough of Newham, discusses the importance of active case finding and shares the stories of the patients she met during a visit to Kampong Cham hospital.
It's another hot day in Cambodia. Blue sky awaits as we leave the hotel to travel a short distance to the hospital in Kampong Cham about two and a half hours north east of Phnom Penh. Amongst the grounds sits the TB hospital which has inpatient facilities, including dedicated rooms to treat multi-drug resistant TB (MDR-TB), two rooms for prisoners with TB, an outpatient facility and a laboratory.
We are met by Dr Chhim Channa who has worked in the hospital for thirteen years. The grounds and buildings are well set out. Used to working in a clinic where space is precious and fought over it feels spacious and bright. The inpatient areas are basic; they are not full but we meet a couple of patients. One man with TB meningitis (TB of the brain) who had been admitted to the general hospital with headaches and confusion. Now on TB treatment his wife, sitting on the bed next to him reports that he is slowly improving. Another young 23-year-old lady called Tram Saram, was sitting in her bed alone. She had a three-hour journey to the hospital and her family were unable to be with her. She had suffered with a cough for three months, she also had a hoarse voice, possibly indicating laryngeal TB (TB of the voice box) as well as pulmonary TB, so likely to have been highly infectious. Speaking to her she revealed that her father was diagnosed with TB and had started treatment a few months previously. Unable to afford to travel to the hospital to get his treatment on a regular basis he stopped his treatment. A not dissimilar story to some of the patients that I have managed in the UK. However perhaps the implications are more immediate as funding for community outreach projects that the Cambodian TB staff speak so highly off are no longer so prevalent.
Having visited a small rural village the previous day I had seen the difficulties that individuals with TB would face if they had to travel on a daily, weekly or even a monthly visit when roads are potholed and in the rainy season difficult to navigate and meaning that a few kilometres can mean a long journey. The importance of community health teams that can provide mobile clinics and collect sputum samples and support patients to keep taking their medication, should not be underestimated.
The TB hospital is facing challenges as its major support from an NGO has wound down and will be completely withdrawn by next year. This means that they can no longer provide active case finding. Consequently, the number of patients being seen in the clinic for screening have dropped which perhaps explains why it wasn’t as busy as I had expected. It also means that incentives for patients including travel costs or community outreach has been withdrawn, not only impacting on screening but also on treatment outcomes.
For me this really brought home the importance and advantage of The Global Fund where money goes directly to Cambodia’s National TB Programme where sustainable initiatives can be developed.
So many sights and sounds to digest from the past couple of days, in the end though it comes back to the person with TB whether in Cambodia or the UK whose treatment success depends so much on individual support and care.