Case Study - 2

Roles of Community in Counseling Clients to Access to Health Facility and Retaining in the Treatment of Tuberculosis

Solukhumbu is the district where Mount Everest, the highest peak of the world exists and is full of hardship due to the mountainous terrene and limited access by road and air transports. There lives a 66 year old person named Chonga Sherpa who was a defaulter client of tuberculosis since last 2 years. He could not continue his treatment of tuberculosis due to his old age, poverty and living alone at home and dropped out from the treatment after 40 days of medication. The health facility was 6 hours away from his home and it took 2-3 days for him to reach walking through the mountain trails with his poor health. After two years of interval, the man again started coughing, vomiting with blood and complaining severe chest pain and weaknesses but always denied going for treatment at the health facility.

There also lives a lady named Chokki Sherpa who is 55 years old but active and energetic. She also works as a community health worker in her community. She participated in one of the orientations organized by Volunteers for Development Nepal (VFDN) under CFCS Grant. With the information shared during the orientation about roles and responsibilities of community people in combating tuberculosis from the community, she recalled the situation of Mr. Chonga Sherpa, the defaulter TB patient. After going back to her community from the orientation program, Chokki visited the client and gave a proper counselling to him about the consequences of defaulting treatment of tuberculosis. She herself donated as well as raised some funds from the community to support Mr. Chonga to go to the health facility by riding on a horse back as horses are used as reliable means of local transport in high mountains. As being a community health worker, she also accompanied him to the health facility and endorsed him as a default case of TB and started new course of treatment. Talking to the authority at the health facility about the condition of Mr. Chonga, she was able to get regular supply of medicines for him under her supervision at her own community. During our follow up with Chokki, she informed us about the improvement in treatment and health of the patient. During communication with us, Chokki expressed her belief that family as well as community need to support TB patient for accessing and continuation of treatment of tuberculosis. Otherwise, there will always remain a high number of undiagnosed tuberculosis cases transmitting bacteria silently to other members of family and the community. Likewise, there will be a high number of default cases which may develop DR-TB and transmit to others unconsciously. Poverty, discrimination and stigma from community and family, distance of health facilities, unavailability of health service providers always encourage not seeking for treatment of tuberculosis as the treatment is a long course for six to eight months which requires continuous psycho-social counselling and full support of family, community and health facility to the clients for retention in treatment and fully cure.

If Chokki had not taken initiation in counselling, the default case would not have come up to the health facility for endorsement of treatment. So, not only the health workers but also the community people play important role in identifying TB patients and motivating them to take medicines regularly. Family support plays vital role in health seeking behaviour of a person. Good counselling of service providers is equally essential and vital in retaining TB patients to be in regular medication.