Life of an inmate with TB Issue 1, July-September 2012 The WHO support staff of the De- tecTB Project was able to interview two prison inmates of Puerto Prince- sa City Jail. For the sake of confiden- tiality, we will call them by the names of Rolly and Eddie. Rolly is 57 years old, was born in Bicol and migrated to Palawan when he was 3 years old. He worked as a carpenter until the day he was convicted of rape and was sentence to serve term at Puerto Princesa City Jail. He experienced on and off cough for several months and took only symp- tomatic medications. He felt loss of appetite and experienced weight loss and had to seek consultation at the jail’s clinic. It was the first week of July 2011 when he was subjected to sputum examination. The specimens are collected at the clinic and sent to the City Health Office for smearing, staining and reading. The result came out negative so he was prescribed with antibiotics for 2 weeks and repeat sputum exam was done. Result after a week again re- vealed negative so he was advised to undergo Chest X-Ray. It took more than a month for Rolly before he was diagnosed of TB and started on DOTS. Eddie on the other hand, was not that lucky as Rolly. Eddie is 28 years old, a native of Ilocos region, and was brought here by his sibling to work as a household helper but unluckily was involved in the murder of their em- ployer. While in jail he experienced cough, loss of appetite and weight in April of 2011. He was subjected to sputum exam in July of same year. Results were negative so he was considered a non-TB case until the condition recurred in October once again, his repeat sputum exam re- vealed negative results. It was only in December when he was subjected to Chest X-Ray that he was treated with anti-TB medica- tions. These are just two cases of prison inmates who have experienced de- lays of TB diagnosis because they are screened late by X-ray examina- tion. DetecTB project gives priority to these people because the project believes they don’t deserve delay in TB diagnosis. One of their jail officers was already trained in sputum smea- ring and once the project starts imple- mentation, the city jail’s more than 400 inmates will be the first benefi- ciaries of the One-Stop DetecTB Ser- vice where TB will be diagnosed with new high-tech diagnostic methods with the same day. D etecTB stands for “Diagnostic Enhanced Tools for Extra Cases of Tuberculosis”. The project is funded by the Korea Foun- dation for International Healthcare (KOFIH) in collaboration with the Department of Health, World Health Organization, Korean Institute of TB and the local government units of Palawan Province and Puerto Princesa City. The project’s main objective is to increase case detection of all forms of TB to 10% or more in target areas. The project will employ mo- dern, fast and reliable diagnostic equipment such as digital Chest Radiography, Light Emitting Diode- Flourescence Microscope (LED-FM) and molecular identification of TB bacilli through the Genexpert. With the use the following technology, the project also aims to improve the turnaround time for TB diagnosis to only within one day. The current NTP protocol takes about a week or more to diagnose TB, depending on the need for Chest X-ray and refer- ral to the TB Diagnostic Committee (TBDC). The mobile clinic Delivery of the DetecTB services is through a mobile clinic equipped with the abovementioned diagnos- tic tools. All the diagnostic equip- ments are available inside the mo- bile clinic including X-Ray Machine connected to a computer for digital imagery. The laboratory, aside from the LED Flourescent Micrscope and Genexpert machine also has a slide warmer, biosafety cabinet and refrig- erator where sputum can be stored temporarily. The Genexpert machine is attached to a UPS to ensure non- wastage of cartridges in case of power interruption which is common in the province. What is DetecTB Project?
Transcript
Life of an inmate with TB
Issue 1, July-September 2012
The WHO support staff of the De-tecTB Project was able to interview two prison inmates of Puerto Prince-sa City Jail. For the sake of confiden-tiality, we will call them by the names of Rolly and Eddie. Rolly is 57 years old, was born in Bicol and migrated to Palawan when he was 3 years old. He worked as a carpenter until the day he was convicted of rape and was sentence to serve term at Puerto Princesa City Jail.
He experienced on and off cough for
several months and took only symp-tomatic medications. He felt loss of appetite and experienced weight loss and had to seek consultation at the jail’s clinic. It was the first week of July 2011 when he was subjected to sputum examination. The specimens are collected at the clinic and sent to the City Health Office for smearing, staining and reading.
The result came out negative so he was prescribed with antibiotics for 2 weeks and repeat sputum exam was done. Result after a week again re-vealed negative so he was advised to undergo Chest X-Ray. It took more than a month for Rolly before he was diagnosed of TB and started on DOTS.
Eddie on the other hand, was not that lucky as Rolly. Eddie is 28 years old, a native of Ilocos region, and was brought here by his sibling to work as a household helper but unluckily was involved in the murder of their em-ployer. While in jail he experienced cough, loss of appetite and weight in April of 2011. He was subjected to
sputum exam in July of same year. Results were negative so he was considered a non-TB case until the condition recurred in October once again, his repeat sputum exam re-vealed negative results.
It was only in December when he was subjected to Chest X-Ray that he was treated with anti-TB medica-tions.
These are just two cases of prison inmates who have experienced de-lays of TB diagnosis because they are screened late by X-ray examina-tion.
DetecTB project gives priority to these people because the project believes they don’t deserve delay in TB diagnosis. One of their jail officers was already trained in sputum smea- ring and once the project starts imple-mentation, the city jail’s more than 400 inmates will be the first benefi-ciaries of the One-Stop DetecTB Ser-vice where TB will be diagnosed with new high-tech diagnostic methods with the same day.
D etecTB stands for
“Diagnostic Enhanced
Tools for Extra Cases
of Tuberculosis”. The
project is funded by the Korea Foun-
dation for International Healthcare
(KOFIH) in collaboration with the
Department of Health, World Health
Organization, Korean Institute of TB
and the local government units of
Palawan Province and Puerto
Princesa City.
The project’s main objective is to
increase case detection of all forms
of TB to 10% or more in target
areas. The project will employ mo-
dern, fast and reliable diagnostic
equipment such as digital Chest
Radiography, Light Emitting Diode-
Flourescence Microscope (LED-FM)
and molecular identification of TB
bacilli through the Genexpert. With
the use the following technology, the
project also aims to improve the
turnaround time for TB diagnosis to
only within one day. The current
NTP protocol takes about a week or
more to diagnose TB, depending on
the need for Chest X-ray and refer-
ral to the TB Diagnostic Committee
(TBDC).
The mobile clinic
Delivery of the DetecTB services is
through a mobile clinic equipped
with the abovementioned diagnos-
tic tools. All the diagnostic equip-
ments are available inside the mo-
bile clinic including X-Ray Machine
connected to a computer for digital
imagery. The laboratory, aside from
the LED Flourescent Micrscope and
Genexpert machine also has a slide
warmer, biosafety cabinet and refrig-
erator where sputum can be stored
temporarily. The Genexpert machine
is attached to a UPS to ensure non-
wastage of cartridges in case of
power interruption which is common
in the province.
What is DetecTB Project?
2
The two teams together with the WHO-KOFIH Project Coordinator, Dr. Francisco Ogsimer, Jr., were sent to Korea for two weeks, May 28 - June 9, 2012 to train on the use of a mobile clinic. First days were spent on the discussion of the Operational Guidelines which was developed by
WHO/WR-PHL staff under the super-vision of Dr. Woojin Lew, STB Medi-cal Officer. In the succeeding days, the team members had separate sessions with experts from Korean Institute of TB (KIT) and Korea Na-tional TB Association (KNTA) de-pending on their professional role in the mobile team. The physicians were acquainted on reading digital Chest X-ray images of TB cases, the medical technologists on how to operate the Genexpert and the radio-logic technologist on the digital X-ray machine.
The team was able to witness opera-tions of a centralized X-Ray reading facility where digital images from
different health care facilities and institutions are received through the internet. The two teams also had the opportunity to observe how the mo-bile clinics of KNTA operated in two institutions, one that cares for the elderly and a school for college stu-dents.
The marginalized sector and people
highly vulnerable to Tuberculosis
more often have poor access to TB
diagnostic services. These include
the indigenous peoples, prison in-
mates, urban and rural poor, and
people living in congested communi-
ties.
The project aims to give priority to
these groups in the conduct of TB
case finding when the DetecTB ope-
rate in the field. Palawan has a high
number of indigenous peoples which
include Palawan, Tagbanua, Batak,
Tau’t Bato, Panimusan, Molbog,
Cuyunin and Agutaynin. The Munici-
pality of Aborlan, which is adjacent to
Puerto Princesa City and an hour
drive from the heart of the city has
the most number of indigenous peo-
ples which accounts for about half of
the population of the town.
With regards to prison inmates, Iwa-
hig Prison and Penal Farm is one of
the institutions managed by the Bu-
reau of Corrections that has a large
population of around two thousand.
Also within Puerto Princesa City are
two prisons where each team can
conduct their active case finding
among inmates. These are the Pala-
wan Provincial jail which has an ave-
rage population of 800 and Puerto
Princesa City Jail with around 400
inmates.
Target Population of DetecTB
Mobile teams’ training in Korea
The Provincial Health Office (PHO) of Palawan and City Health Office (CHO) of Puerto Princesa City each formed
a team which is composed of two Physicians, one Nurse, one Medical Technologist and one Radiologic Technolo-
gist.
Palawan PHO
Dr. Louie Ocampo, Team Leader Dr. Eduardo Cruz Ms. Pamela Garcia, Nurse Mr. Cyrus Caabay, Medical Technologist Mr. Herminio Bitara, Jr , Radiologic Technologist
Puerto Princesa CHO
Dr. Juancho Monserate, City Health Officer Dr. Janeth Reston, Team Leader Dr. Dean Palanca Ms. Mary Joy Tianchon, Nurse
DetecTB: INNOVATION In TB Detection
Dr. Woojin Lew, discussing the DetecTB Diag-
nostic Protocol during discussion of Operational
Guidelines.
Dr. Francisco Ogsimer Jr., presenting the
DetecTB Operational Guidelines.
3
O ne of the criteria for selecting
target areas by the PHO and
CHO is the 2011 case detection rate.
Among the municipalities selected
are mostly from the southern part of
Palawan namely: Aborlan, Narra,
Rizal, Espaňola, Bataraza, Brooke’s
Point and one from the north, Tay-
tay.
Target areas of Puerto Princesa City
include the four Barangays with pe-
nal colonies such as Iwahig, Sta.
Lucia, Montible, and Inagawan and
those with big population of targeted
group namely Tanabag, Concepcion,
Bagong Silang, Langugan, Mabuhay
at Pagkakaisa.
The DetecTB team of Palawan Pro-
vince together with the WHO-KOFIH
Project support staff visited every
municipality from July 16 – 20, 2012
to conduct courtesy call and advoca-
cy meeting with the local officials.
Mayor Jaime Ortega of Aborlan and
Mayor Zenaida Gomez of Espanola
were among the local chief execu-
tives (LCEs) whom the team were
able to talk with during the visit.
Mayor Ortega even encouraged the
Barangay Officials of Aborlan to pro-
vide necessary support during the
implementation of the project.
In other municipalities, the Sanguni-
an Bayan members (municipal coun-
cilors) and Barangay Officials were
present. The WHO-KOFIH Project
Coordinator provided information
regarding the project and solicited
the needed support from their end.
Part of the advocacy meeting is the
signing of the “DetecTB Pledge of
Commitment and Support”.
The City advocacy meeting was held
in Asturias Hotel on September 4,
2012. This was attended by Vice
Mayor Lucilo Bayron and SB Mem-
ber Miguel Cuarderno. Ms. Hyun
Kyong Kim, Manager of Project
Operations of KOFIH was present to
discuss a brief introduction of KOFIH
as the funding agency.
Aborlan Mayor Jaime Ortega addressing his constituents during
one of the advocacy meetings held July 16, 2012 at Magsaysay
Hall.
Dr. Ogsimer, Project Coordinator and Dr. Ed Cruz
having courtesy call with Mayor Zenaida Gomez of
Municipality of Española.
Advocacy Meeting with Local Officials
Ms. Hyun Kyong Kim, presenting the Introduc-
tion of Korea Foundation for International
Health Care (KOFIH) during City Advocacy
Meeting.
In the conduct of field operations, some health workers of target areas will be requested to assist the mo-bile teams. These will include orga- nizing of clients, conduct of inter-view, signing of consent, health edu-cation and others. The WHO-KOFIH project support staff together with the DetecTB teams conducted a one
day orientation / training among se-lected health workers to provide ca-pacity to assist in field operations.
The participants were oriented on the project operations and several forms that will be used. They were also taught on how to perform se-veral procedures and their role when the team visits their area.
For the Provincial team the activity was conducted on July 24, 2012 while the City team was done on
September 5, 2012, both in A&A Hotel, Puerto Princesa City.
Orientation/Training of target areas’ health
workers and field assistants
4
Field Training
Prior to the actual field implementation,
the DetecTB teams were able to expe-
rience actual field implementation under
the supervision of technical experts from
WHO and Korea. The WHO, through Dr.
Woojin Lew and a Korean team observed
the DetecTB teams’ field performance.
The field training was done on August 27
- 31, 2012 at the Provincial Jail and Puer-
to Princesa City Jail. Several inmates
were requested to act as subjects for this
purpose. Both Provincial and City teams
were able to serve 212 inmates within a
period of four days.
The last day, August 31, was utilized to
discuss technical issues and concerns
that need to be addressed. The activity
was conducted at Skylight Hotel in Puer-
to Princesa City.
Dr. Hee Jin Kim, headed the Korean team during
field training.
How will DetecTB operate?
The two teams will use the DetecTB
service bus alternately for one week.
Coordination will be done with local
officials at least one week prior to
the field visit. Initial target for the first
few months of operations will be 50
clients per day. The teams will set-
up a suitable area to accommodate
clients. In case there are no covered
working area (e.g., covered court or
gymnasium), available canopy tents
will be used. The WHO project sup-
port staff will oversee the operations
of the two teams and will report and
coordinate all activities to major
partners.
DetecTB: INNOVATION In TB Detection
5
One of the identified needs for field activities are additional human resources such as smearers who will assist the Medical Technologist in doing smearing of sputum for LED-FM reading. In case of high workload, the Medical Techno-logist might not be able to cope with all the task, thus, the De-tecTB project decided to con-duct a training of smearers who will help the Medical Technologist in the conduct of smear preparation.The Medical Technologist will perform two confirmatory test for TB, spu-tum microscopy and Genex-pert.
The WHO-KOFIH Project sup-port team together Palawan PHO and Puerto Princesa CHO facilitated the conduct of the training of smearers which was attended by 12 Barangay Health Workers from target municipalities (Rizal, Taytay and Aborlan), 3 selected labo-ratory aides from the City Health Office, one nurses each
from Iwahig Prison and Penal Farm and Puerto Princesa City Jail which are two of the priori-ty sites of the project.
The training was conducted at Bulwagang Princesa Tourist Inn and Restaurant on Sep-tember 25-27, 2012. The train-ing provided capacity to the participants in performing qua- lity sputum smearing taking into consideration quality as-surance system standards. Several participants were not able to join the training due to flooding in most parts of Pala-wan cause by heavy rains be-fore the start of the training.
Facilitators of the training were Mr. Cyrus Caabay, Provincial Mobile Team Med. Tech, Ms. Jocelyn Calalin, City Mobile Team Med. Tech, Ms. Jojie Cadiente, Carmona Med. Tech, Ms. Pia Crisolo, Rizal Provincial Med Tech, and Ms. Rio Oriel, Laguna Provincial Med Tech.
The project was officially launched on
September 18, 2012 with two sepa-
rate ceremonies for Palawan Pro-
vince and Puerto Princesa City. The
Provincial launching was held in the
morning at Legend Hotel which was
hosted by the Honorable Governor
Abraham Kahlil V. Mitra who deli-
vered a speech expressing his sup-
port to the project and committing to
utilize whatever resources the Pro-
vince have to ensure the success of
the project. The Puerto Princesa City
launching was held at Asturias Hotel
in the afternoon.
Heads and representatives of partner
agencies graced the two events.
These inlude Dr. Pauline Jean Rosell
Ubial, Assistant Secretary of the
DOH; Dr. Gloria Balboa, Director of
Center for Health Development 4B;
Dr. Lee Soo-Ku, President of KOFIH;
Mr. Ahn Jeong In, Director of KOFIH;
Dr. John Patrick Ehrenberg, Director
of Combating Communicable Di-
sease Division of WHO-WPRO; Dr.
Woojin Lew, Medical Officer of
StopTB and Leprosy Elimination of
WHO/WR-PHL.
Included among the guests are DOH
representatives namely Dr. Rosalind
Vianzon, Manager of the National TB
Program, Dr. Noel Macalalad, Head
of the National TB Reference Labora-
tory and Ms. Jocelyn Sosito, Senior
Health Program Officer of Bureau of
International Health Cooperation.
Included among the Korean contin-
gent are officers of KOFIH and me-
dia reporters who covered the story
and conducted interviews of key per-
sonalities.
The following day after the launching,
the DetecTB teams conducted a
demonstration of the field operation
in the Provicial Jail. This was wit-
nessed by the Dr. Lee Soo-Ku and
other officers of KOFIH.
Training of Smearers
Health Workers practicum on sputum smear preparation.
Ms. Cadiente, facilitated the recapitulation of day 1 training, pre-
pared questions were written in pieces of paper for the participants
to pick and answer.
DetecTB Launching
. For questions, suggestions or concerns, please contact WHO-KOFIH Project through: Address: G/F Building 3, Department of Health Compound, Sta. Cruz Manila
The WHO Philippines– DetecTB: INNOVATION In TB Detection
Dr. Soe Nyunt-U, WHO Representative in the Philippines
Dr. Woojin Lew, Medical Officer, STB – Leprosy Elimination
Madeleine Oriondo, Secretary
Dr. Francisco Ogsimer Jr., Project Coordinator, WHO-KOFIH Project
Dr. Louie Ocampo, OIC-PHO,Team Leader Dr. Eduardo Cruz Pamela Garcia, Nurse Cyrus Cecilio Caabay, Medical Technologist Herminio Bitara Jr., Radiologic Technologist
Puerto Princesa CHO
Dr. Juancho Monserate, City Health Officer Dr. Janeth Reston, Team Leader Dr. Dean Palanca Mary Joy Tianchon, Nurse Jocelyn Calalin, Medical Technologist Walter Gonzales, Radiologic Technologist
The DetecTB project is funded by the Korea Foundation for International Healthcare (KOFIH) in collaboration with the World Health
Organization, Department of Health, Korean Institute of TB and the local government units of Palawan Province and Puerto Princesa City
