VIDEO: Nurses on the front lines of TB

By David Bryden, Stop TB Officer, RESULTS

This post originally appeared in the ACTION Global Health Advocacy Partnership Blog

For many people, tuberculosis is a dirty word associated with poverty and poor living conditions.  And when a patient is contagious, there is a risk to others.  All of this can lead to TB patients being treated with less than the love and concern they need to stick with the long, difficult course of treatment and get better.

What can be done about it?  Frontline health workers, especially the nurses who confront serious personal health risks by working in a TB unit, can tell us a lot about what leads to stigma about TB and what solutions there may be.

While attending the Union World Conference on Lung Health I had the privilege of interviewing a very impressive TB nurse, Tania Monteiro.

Tania is a nurse and trainer of nurses from Portugal who recently contracted tuberculosis and, after a difficult fourteen months of treatment, was cured. In this interview she talks about why she found her diagnosis hard to accept and what it was like to suddenly find herself a patient. She speaks movingly about why patients need not only medication but also care, support and information.

Top 5 highlights of Coalition’s inaugural year

Mary Beth Powers, Chair, Frontline Health Workers Coalition

Nearly one year ago, Eric Goosby – the United States Global AIDS Ambassador and new Ambassador for Global Health Diplomacy – made a simple yet powerful statement that exemplifies why we founded the Frontline Health Workers Coalition: without health workers, there is no access to care.

From the thousands of women like Almaz Dalsha being trained in Ethiopia to provide health services to mothers and babies in their communities, to trained pharmacists like Brenda Picho putting her life on the line to help quell an Ebola outbreak in Uganda, to the courage displayed by physicians like Dr. Shamail Azimi to improve the lives of refugees in Afghanistan and Pakistan – the 27 member organizations in our Coalition have the privilege of witnessing the extraordinary impact of frontline health workers around the world on a daily basis. We banded together in January to tell their story to the American people and urge greater and more strategic U.S. investment in them.

Mali, May 2009. Gao Nursing School in-service training. Courtesy IntraHealth International.

Unfortunately, the world is short at least 1 million Almaz Dalshas, Brenda Pichos and Shamail Azimis to provide care for a population that we learned last week is living longer lives with more years of disability and illness. As the statement by Dr. Goosby underscores, the U.S. government recognizes the need for its leadership, in partnership with other countries, to address this global health workforce crisis.

In our first year as a Coalition, we have worked with members of the U.S. Congress and the Obama administration on elevating the need to support frontline health workers. Here are our top 5 highlights of 2012 in chronological order:

1. Coalition launches. With participation of U.S. government agencies and private sector supporters, the Frontline Health Workers Coalition formally launches in January 2012.

2. Congressional support builds with introduction of resolution to support frontline health workers. On July 12, U.S. Rep. Nita Lowey (N.Y.) introduced a resolution with bipartisan support that “reaffirms the important role of frontline health workers in saving lives and fostering a healthier, more secure, and more prosperous world,” and calls on federal agencies to “develop a coordinated and comprehensive health workforce strengthening strategy for increasing equitable access to qualified health workers in developing countries, particularly in underserved areas, with a strategic focus on frontline health workers.”

3. Events during United Nations General Assembly raise need for increased support to frontline health workers. Several events during the U.N. General Assembly in September illuminated the critical role of frontline health workers in advancing progress on the health Millennium Development Goals. The events were planned by FWHC members and supporters JHPIEGO, Johnson & Johnson, Save the Children, and Merck. In December, the Assembly passed a resolution recognizing that “effective and financially sustainable implementation of universal health coverage” will require “an adequate skilled, well-trained and motivated workforce.”

4. Frontline health workers recognized with launch of the REAL Awards. Also in September, Save the Children and the Coalition announced the creation of the REAL Awards—a first-of-its kind awards platform designed to develop greater respect for and appreciation of the life-saving care provided by health workers, and to demonstrate the universal and urgent need for more trained, caring health workers around the world. In mid-January 2013, eight U.S.-based honorees will be announced, joining their 10 global counterparts as the inaugural REAL Awards class. Visit www.theREALawards.com to find out more and show your support for health workers everywhere.

5. Coalition secretariat established. In October, the Coalition announced the creation of a secretariat, housed at member organization IntraHealth. Supported by the Bill & Melinda Gates Foundation, the secretariat manages the collective work of the Coalition to urge greater and more strategic U.S. investment in frontline health workers in developing countries.

As we enter 2013, we look forward to carrying forward the momentum created by our Coalition and our partners in our inaugural year. We hope you will stay connected with our work through our website, blog and social media outlets, and that you will tell your government officials about your support for frontline health workers worldwide.

Enhancing training of community health workers in DRC through effective management

By Mary O’Neil, EdD, principal program associate, Human Resources for Health, Management Sciences for Health

Evidence of the need to scale up the number of frontline health workers in developing countries abounds throughout sub-Saharan Africa, as described in the recent post in this blog by Avril Ogrodnick of Abt Associates. Yet training new health workers is not sufficient, in itself, to sustainably address the crisis – governments must also invest in providing management support to harvest the full value of these trainings.

In the Democratic Republic of Congo (DRC) – where almost half of the total deaths among children under age 5 are caused by malaria, diarrhea and pneumonia – the Ministry of Health and its partners are addressing this situation systematically to reduce the child mortality rate. To do so, they must face the reality that there are only 0.09 doctors and one nurse per every 1,000 people in the country. The ministry is working with partners to train community health workers (CHWs) to provide access to basic health services that have the potential to save lives.

To provide such access, the training program needs effective management support. Management Sciences for Health (MSH), the International Rescue Committee and Overseas Strategic Consulting, LTD are supporting the DRC’s Integrated Health Project, supported by the United States Agency for International Development (USAID).  Among other objectives, this project works to increase access to and availability of the government’s Minimum Package of Activities, which are designed so people across the country will take more charge of their own health needs by having greater access to quality, comprehensive care.

Courtesy MSH

The program must address several challenges. There is low ownership of the approach at the intermediate level resulting in weak linkages between the community and the greater health system. Retention of trained CHWs is difficult due to a lack of incentives.  Drugs are often not available, and supervision is irregular and inadequate.

To address these challenges, the project is utilizing a method called the “Integrated Case Management of Childhood Illnesses (iCCM)” approach. The iCCM goal is to ensure increased access to effective care services of children under age 5 living in the most underserved rural areas who suffering from the three main causes of child mortality: malaria, diarrhea and pneumonia. The program includes training and supportive supervision of CHWs chosen by each community, as well as provision and collection of essential drugs, job aids and reporting tools.

The CHWs are volunteers trained in iCCM, including training in behavior change communication. Head nurses from health centers in the DRC transfer some of their lengthy list of tasks to the CHWs by training with the volunteers at the ICCM sites and providing monthly supportive supervision. The CHWs are tasked to perform basic diagnosis and follow standard treatment protocol for uncomplicated malaria, diarrhea and pneumonia, and refer severe cases to health centers. They also provide counseling to mothers of sick children so that they understand key messages including medicines prescribed and dosage instructions.

Although a full evaluation of this program has not yet taken place, we know that community health workers, as a vital part of the health workforce, will improve their performance with basic management support in place.

Placing their lives on the line to quell an Ebola outbreak

By Kelly Willis, Accordia Global Health Foundation

Outbreaks of the dreaded Ebola virus in the Africa’s Great Lakes region have claimed hundreds of lives in the last 20 years, but thanks to the courageous efforts of United States government-supported frontline health workers like Brenda Picho, an outbreak in Uganda’s Kibaale District in July was quickly contained.

Ebola hemorrhagic fever is a highly contagious disease that causes severe fever, muscle pain, vomiting, diarrhea and bleeding; the disease kills more than half of those infected. There is no vaccine and no known treatment. A rapid and coordinated response is essential in containing these outbreaks – and the outcome is largely determined by actions of the “first responders.”

Among the first responders in Uganda were the frontline health workers of Accordia’s flagship institution based in Kampala—the Infectious Diseases Institute (IDI), Makerere University. IDI staff has been working hand in hand with rural health professionals in Kibaale for years, building their confidence through training and mentorship opportunities, as well as strengthening existing clinical and laboratory systems.

Field staff at the Infectious Diseases Institute (IDI), Makerere University, hand out protective clothing to frontline health workers in Uganda’s Kibaale District during an Ebola outbreak in the area in July 2012. Courtesy: IDI

Upon discovering the outbreak, IDI staff immediately began working with local health leaders to organize efforts to contain the disease and protect those most vulnerable to exposure. In no time, emergency supplies had been procured, including protective clothing for frontline health workers most at risk. Prevention measures were demonstrated and isolation facilities were established. IDI staff led efforts to maintain safety standards, provided meals to the hospitalized and quarantined, maintained morale among other health workers, and minimized panic in the community.

At the center of IDI’s efforts was Brenda Picho. A pharmacist by training, Brenda works in Kibaale as part of the U.S. Centers for Disease Control and Prevention (CDC)-supported Saving Mothers, Giving Life project. Her efforts in the community had been focused on reducing maternal mortality by helping mothers during labor, delivery and responding to postpartum complications.

Brenda had heard of a pregnant woman in the community who had died in one of the health facilities and whose family kept getting sick and not responding to treatment. When the clinical officer who provided the family’s care fell ill, Brenda said she became “very alert and concerned.” When the cases were confirmed as Ebola, Brenda said she was “speechless,” adding, “I did not want to believe what I was hearing.”

Her natural fear of this dangerous disease did not stop her and other health workers from putting their own lives on the line to protect the health and wellbeing of others. Brenda’s actions and those of her colleagues are a telling example of how frontline health workers benefit the communities in which they live and work, and ultimately play one of the most essential roles in emergency response.

The U.S. government has a tremendous opportunity to highlight its support of inspiring health workers like Brenda, as well as strategically invest in supporting frontline health workers in the countries with the greatest need.

To read more about Brenda’s personal account of the Ebola outbreak Kibaale and to learn more about how IDI combines expertise in training, clinical care, prevention services, and research to provide fast, effective and comprehensive responses to health emergencies like this, please visit Accordia Global Health Foundation’s website http://www.accordiafoundation.org.

On the Frontline of Achieving an AIDS-free Generation

By: Lisa Bos, World Vision

Photo Credit: Abby Metty/World Vision

Just a few months after starting to work for World Vision, I was able to make my first trip to see our programs in action. My country of choice was Zambia, for several reasons: it’s an English-speaking country (important when the purpose of your trip is to learn from your international colleagues), it was not too far to travel (only 22 hours!), and it was the home of some of the most exciting work World Vision is doing on HIV/AIDS.

During my time in Zambia, I spent two days visiting with volunteer caregivers working in a rural community near Mazabuka, southwest of the capitol of Lusaka. These volunteers take their own time, without compensation, to care for their communities. They clean sores of those suffering from AIDS, they educate and facilitate support groups for community members who are HIV positive, they ensure that pregnant mothers are taking their medication so they don’t pass on HIV to their babies, and they visit with children orphaned by AIDS and provide counseling. The program in Zambia is part of a partnership between World Vision and USAID, through the PEPFAR program, called Sustainability Through Economic Strengthening, Prevention, and Support for Orphans and Vulnerable Children (STEPS OVC).

Community caregivers are a part of a much larger cadre worldwide of frontline health workers who are the first person (and sometimes only person) an individual will see for their health care needs. These health workers are vital in the fight against HIV and AIDS not only for the diagnosis, treatment and support they can provide in a direct way, but also because they can help diagnose tuberculosis, which kills one in five HIV-positive individuals. They can ensure that a family has a mosquito net to sleep under because the viral load of a HIV-infected person increases ten-fold during an attack of malaria.

Last year on World AIDS Day, the Obama Administration announced a bold vision for an AIDS-free generation. The blueprint for how this can be achieved was just released on November 29th. While the blueprint includes many of the necessary steps needed to achieve an AIDS-free generation, including strengthening country health systems and the health workforce, this goal will not be met without people on the frontline like Nomsa Mdluli.

Nomsa Mdluli, 46, is a caregiver for 124 ill people in her community. Most are HIV positive, some have tuberculosis, and some are suffering from mental illness. World Vision has provided Nomsa with training and supplies, and her initiative has launched her to the head of the caregiver program in her area. Now she oversees many other caregivers, which often includes taking care of their patients when they are unable to do so.

Part of Nomsa’s great skill as a caregiver is gently persuading her patients to find out their HIV status so they can treat the disease in its early stages, avoid infecting others, and prevent more severe symptoms or even death.

“I’ve had a number of patients who have gotten well, who have gotten out of bed, regained their standard of life,” Nomsa says. “I get very motivated and encouraged when someone that I’ve taken care of regains their standard of life.”

I believe that an AIDS free generation is possible, but it will take funding, dedication and a lot of hard work. It will also take Nomsa and thousands more like her.