CAREERS STUDENT LIFE
African learning experience Holly Howe Watson describes how she witnessed good TB care in poor circumstances while on placement in Ghana Archbishop Desmond Tutu once claimed that TB was the child of poverty, as well as its parent and provider. My first insight into the truth of this came while I was on a placement with Find & Treat, a pan-London tuberculosis (TB) service for vulnerable communities. When I was offered an opportunity to undertake an international elective, I was determined to gain more experience and knowledge of TB. The disease was declared an African emergency in 2005 and is a major health concern in Ghana where the government has an ambitious goal of universal access to health care for all TB patients and 100 per cent case detection, a strategy based on the World Health Organization (WHO) TB programme (see resources). The Ghana Health Service insurance scheme entitles people to services such as treatment for HIV, TB and malaria. Other services must be paid for separately. Food and personal care are the responsibility of the patient’s family and those without
Global strategies
In Ghana, the disease is often critical before the patient seeks medical attention. This is mainly because people follow their pastor’s advice to stop taking
Holly Howe Watson witnessed the stigmatising effect of TB on patients in Ghana
MISUNDERSTANDINGS PREVENT PEOPLE FROM ACCESSING CARE AND DISCLOSING A DIAGNOSIS family or money often go without these necessities. My placement was at Effia-Nkwanta Regional Hospital, a government hospital in Takoradi-Sekondi, the capital of Ghana’s western region. I spent most of my time on the medical wards where there were many patients with late-stage TB. In London, I rarely saw patients so ill, as detection was usually earlier.
Misunderstandings about the disease and its transmission are preventing people from accessing care and from disclosing their diagnosis to relatives, which means that close contacts are not being screened. I reflected on the TB patients in London, many of whom are born outside the UK. We ask them to inform their close contacts so they can be tested and I wondered how many patients experience ostracisation when they do this.
medication and to pray or attend prayer camps instead of consulting a doctor – a source of deep frustration for the nurses and doctors at the hospital. TB is also a hugely stigmatising disease. Many patients spoke about how they could not tell their family for fear of being ostracised. One woman, for example, said her family made her sleep outside the house and use different cutlery.
I was impressed by how health professionals in Ghana had adapted global TB strategies in the face of shortages of money and resources. The directly observed treatment (DOT) scheme recommended by WHO involves the observation and recording of every dose of TB medication taken by the patient to ensure adherence. In the UK, these observations and recordings are undertaken by clinic support workers or community DOT workers. In Ghana, volunteer DOT workers have been recruited and trained. Often these are religious leaders who can have a positive influence on a patient’s adherence to medication. My elective placement in Ghana was a fruitful learning experience that furthered my knowledge and understanding of TB at a clinical level and also as a global health problem. The nurses taught me that by being open-minded and resourceful, lack of funding can be overcome and good care is possible in poor circumstances NS Holly Howe Watson is a second-year nursing student at King’s College London
RESOURCES WHO Stop TB strategy www.who.int/tb/strategy/en TB in Ghana who.int/tb/Ghanafactsheet_Oct12.pdf TB in the UK tinyurl.com/TBUKHPA Student Life online rcnpublishing.com/page/ns/students/student-life
66 august 13 :: vol 28RCNi.com no 50 :: 2014 STANDARD Downloaded from by ${individualUser.displayName} on Oct 18, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
African learning experience Holly Howe Watson describes how she witnessed good TB care in poor circumstances while on placement in Ghana Archbishop Desmond Tutu once claimed that TB was the child of poverty, as well as its parent and provider. My first insight into the truth of this came while I was on a placement with Find & Treat, a pan-London tuberculosis (TB) service for vulnerable communities. When I was offered an opportunity to undertake an international elective, I was determined to gain more experience and knowledge of TB. The disease was declared an African emergency in 2005 and is a major health concern in Ghana where the government has an ambitious goal of universal access to health care for all TB patients and 100 per cent case detection, a strategy based on the World Health Organization (WHO) TB programme (see resources). The Ghana Health Service insurance scheme entitles people to services such as treatment for HIV, TB and malaria. Other services must be paid for separately. Food and personal care are the responsibility of the patient’s family and those without
Global strategies
In Ghana, the disease is often critical before the patient seeks medical attention. This is mainly because people follow their pastor’s advice to stop taking
Holly Howe Watson witnessed the stigmatising effect of TB on patients in Ghana
MISUNDERSTANDINGS PREVENT PEOPLE FROM ACCESSING CARE AND DISCLOSING A DIAGNOSIS family or money often go without these necessities. My placement was at Effia-Nkwanta Regional Hospital, a government hospital in Takoradi-Sekondi, the capital of Ghana’s western region. I spent most of my time on the medical wards where there were many patients with late-stage TB. In London, I rarely saw patients so ill, as detection was usually earlier.
Misunderstandings about the disease and its transmission are preventing people from accessing care and from disclosing their diagnosis to relatives, which means that close contacts are not being screened. I reflected on the TB patients in London, many of whom are born outside the UK. We ask them to inform their close contacts so they can be tested and I wondered how many patients experience ostracisation when they do this.
medication and to pray or attend prayer camps instead of consulting a doctor – a source of deep frustration for the nurses and doctors at the hospital. TB is also a hugely stigmatising disease. Many patients spoke about how they could not tell their family for fear of being ostracised. One woman, for example, said her family made her sleep outside the house and use different cutlery.
I was impressed by how health professionals in Ghana had adapted global TB strategies in the face of shortages of money and resources. The directly observed treatment (DOT) scheme recommended by WHO involves the observation and recording of every dose of TB medication taken by the patient to ensure adherence. In the UK, these observations and recordings are undertaken by clinic support workers or community DOT workers. In Ghana, volunteer DOT workers have been recruited and trained. Often these are religious leaders who can have a positive influence on a patient’s adherence to medication. My elective placement in Ghana was a fruitful learning experience that furthered my knowledge and understanding of TB at a clinical level and also as a global health problem. The nurses taught me that by being open-minded and resourceful, lack of funding can be overcome and good care is possible in poor circumstances NS Holly Howe Watson is a second-year nursing student at King’s College London
RESOURCES WHO Stop TB strategy www.who.int/tb/strategy/en TB in Ghana who.int/tb/Ghanafactsheet_Oct12.pdf TB in the UK tinyurl.com/TBUKHPA Student Life online rcnpublishing.com/page/ns/students/student-life
66 august 13 :: vol 28RCNi.com no 50 :: 2014 STANDARD Downloaded from by ${individualUser.displayName} on Oct 18, 2015. For personal use only. NoNURSING other uses without permission. Copyright © 2015 RCNi Ltd. All rights reserved.
