Helping End TB in the Philippines: Recognizing the Front Line

Region VI in the island of Visayas has the largest percentage (25%; 105 of 509) of patients enrolled in the standard short treatment regimen (SSTR) for multidrug-resistant tuberculosis (MDR-TB) in the country since its introduction in January. The region has a total of 14 treatment facilities that care for these patients every single day during their 9-month regimen.

Western Visayas Medical Center (WVMC), in the heart of Iloilo province, is the pioneer treatment center in the region with its participation as one of 10 operational research (OR) sites for the short treatment regimen (STR – OR) in 2015. In July 2017, the TREAT TB team had the opportunity to visit, learn from, and provide technical assistance to WVMC staff.

Ms. Elena Nono has been a nurse in this facility since July 2015 when she was hired for the OR study. Through this experience with the regimen, she found the value of the short treatment regimen for patients. As she shared, “Nowadays, we have patients of varying ages and backgrounds. We have students and workers, so with the 9 months of treatment that we introduced, they could take leave from work or school for 1 semester unlike the 2-year conventional treatment regimen. This shortened regimen encourages patients to undergo treatment.”

Nurse Elena and a fellow nurse at WVMC provide medications to SSTR patients every day.

Nurse Elena and a fellow nurse at WVMC provide medications to SSTR patients every day.

She administers drugs to more than 20 patients everyday and this shows her commitment to help patients be cured of MDR-TB. Her motivation came from her positive experience during the STR-OR phase, “With the OR phase of the STR, it was fulfilling to see the patients finish their 9-month treatment regimen. To date, four patients are still undergoing treatment because they were enrolled in December 2016.”

Nurse Elena was able to attend the TREAT TB Clinical Management training in April 2017. She shared how this training helped her in managing adverse drug reactions (ADR) that her patients experience especially during their first few weeks of treatment, “It has helped me address ADRs and better explain why the patients need to take their medications everyday. We learned to explain in layman’s terms that the bacteria have a sleep-wake cycle so the patients need to take medication every day.”

In the region, managing 14 treatment facilities with varying capacities is no easy task. Mr. Adrian Ramos, the region’s technical staff, is part of the team that monitors and oversees these facilities and their patients. He shared with us, “As the regional technical staff, I provide both technical and clinical advice to the facilities.”  

Mr. Adrian Hort Ramos, Region VI technical staff, talks to a TB patient during a home monitoring visit.

Mr. Adrian Hort Ramos, Region VI technical staff, talks to a TB patient during a home monitoring visit.

He shared that aside from monitoring, he also conducts directly observed therapy and default tracing. Home and facility visits provide him an opportunity to be hands-on and listen to the patients. As he shared, “What motivates me aside from learning and experience is the power of empathy. I listen to the patients. With listening, you can discover what you do not know. With relationship building and counseling, we will know the underlying causes of why the patient interrupted [treatment] or why they are successful in their treatment. Empathy is part of the job.”

Elena and Adrian are just two of the hundreds of TB frontline staff in the region, but they mirror the dedication and commitment of the region to help fight and eradicate TB by finding and treating patients with MDR-TB one day at a time.