Tackling TB scourge with well-equipped chest clinics

AS part of its support in the fight against Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS), tuberculosis (TB), and diabetes, which is closely related to high blood pressure, the Chevron Nigeria Limited (CNL) and the Agbami co-ventures, as at the end of the March 2015, have donated over 20 fully equipped chest clinics and TB referral centers to health institutions across the country.

The parties to the Agbami unit operations are Star Deep Water Petroleum Limited (A Chevron Company); Famfa Oil Limited, Statoil Nigeria Limited; Petroleum Brasileiro Nigeria Limited and the Nigerian National Petroleum Corporation (NNPC).

Some of the health institutions are in Eku, Delta State; Oshogbo, Osun State; Akure, Ondo State; University of Benue Teaching Hospital, Makurdi, Benue State; Umuahia, Abia State; Ilorin, Kwara State; Igbogene, Bayelsa State; Akwanga, Nassawara State, Ekiti, Ekiti State, Alimosho, Lagos State Hansen’s Disease Center, Ogun State; SMOH, General Hospital, Kaduna State; TB and Leprosy Referral Centre, Niger State and Auchi, Edo State.

TB is caused by the bacterium, Mycobacterium tuberculosis, that most often affect the lungs. According to the World Health Organisation (WHO), TB is second only to HIV/ AIDS as the greatest killer worldwide due to a single infectious agent, but is curable and preventable.

A WHO Fact Sheet on TB reads: “TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air.

A person needs to inhale only a few of these germs to become infected. “About one-third of the world’s population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with the disease and cannot transmit the disease.

People infected with TB bacteria have a lifetime risk of falling ill with TB of 10 per cent. However persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill.

“When a person develops active TB (disease), the symptoms (cough, fever, night sweats, weight loss among others) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others.

People ill with TB can infect up to 10 to 15 other people through close contact over the course of a year. Without proper treatment up to two thirds of people ill with TB will die.”

Chevron Nigeria joined the rest of the world on March 24, 2015, to celebrate the World TB Day, which was an opportunity to raise awareness about the burden of the disease worldwide and the status of TB prevention and control efforts.

Chevron Nigeria in a statement said the chest clinics were executed with the strong support of the government and the people. They are the dividends of collaborative partnerships with governments, communities and institutions to assess and understand the needs of the people.

The Chest Clinic comes fully equipped with a standard X- Ray machine, male and female wards, treatment rooms, laboratories and GeneXpert Machine.

The Xpert MTB/RIF is a cartridge-based, automated diagnostic test that can identify Mycobacterium tuberculosis (MTB) DNA and resistance to rifampicin (RIF) by nucleic acid amplification technique (NAAT).

The WHO in December 2010 endorsed the Xpert MTB/RIF for use in TB endemic countries and declared it a major milestone for global TB diagnosis.

This followed 18 months of rigorous assessment of its field effectiveness in TB, Multiple Drug Resistant (MDR)-TB and TB/HIV co-infection. This test, and others that are likely to follow, have the potential to revolutionize the diagnosis of TB.

The statement reads: “It involves construction, equipping and furnishing of chest clinics in existing hospitals across Nigeria and capacity building for health personnel who are trained to handle new equipment supplied, lead HIV/AIDS campaigns to promote awareness, distribute drugs and offer free treatment/testing in Nigeria.”

Chairman/Managing Director of Chevron Nigeria Limited (CNL), Mr. Clay Neff, has reiterated the unwavering commitment of the company of being a partner of choice.

Neff said: “Apart from the Chest Clinic we are handing over today, several projects by the Co-ventures, are either on-going or completed across the country.

The projects, mainly Chest Clinics, libraries and science laboratories constitute an aspect of the strategic interventions by the Agbami Co-ventures. It would interest you to know that we have donated 23 Chest Clinics to different states of the Federation including the Federal Capital Territory, Abuja.”

In addition to the Chest Clinics, he said “We have implemented awareness programmes on HIV/AIDS, Malaria and other diseases in several communities across the six geo-political zones in the country.

Medications were also made available to the people of such communities.” Also, in recognition of its contribution and support to TB control and management, the Federal Government through the Ministry of Health recently honoured Star Deep Water Petroleum Limited and its partners in the Agbami Field at the launch of the National Tuberculosis Prevalence Survey Report and the National Strategic Plan for TB Control 2015-2020.

The award was presented by the Supervising Minister of Health, Dr. Khaliru Alhassan, who said he was impressed by the interventions of the Agbami Partners as demonstrated by the many Chest Clinics built in different parts of the country.

“I am sincerely touched and pleased by your donation in different parts of the country including Sokoto State. That was some remarkable support. It is currently in use and we appreciate your efforts and support in the health sector,” he said.

Receiving the award on behalf of the Agbami Partners, Mr. Sam Otuonye, Manager, PGPA Lagos congratulated the Federal Government and all stakeholders in the health sector on the launch of the country’s first ever TB Prevalence Survey Plan and the National Strategic Plan.

He used the occasion to highlight some of the contributions to the fight against the spread of tuberculosis in the country. Otuonye said: “Our contribution to TB till date has seen us build and donate over 23 fully equipped Chest Clinics across the Federation. Our vision is to extend our reach to the 36 states of the country and to areas where TB is prevalent.

We are particularly proud that we were able to provide assistance and we remain committed to partnering with and supporting the Federal Government in its efforts to control tuberculosis and other infectious diseases in Nigeria.”

The Guardian visited two of the benefitting chest clinics in Lagos and Ogun states. The beneficiaries at Alimosho General Hospital Igando, Lagos, and Hansen’s Disease Centre, Ogun State.

The Chest Clinic at Alimosho General Hospital needs more medical personnel Medical Director, of the Hospital, Dr. Bolaji Adebiyi, told The Guardian: “There are many challenges we face in managing tuberculosis cases, Nigerians do not come to hospital on time for general check up until they are at the point of death.

Again some people have tuberculosis infection don’t comply to finish drugs prescribed for them. People who have tuberculosis are always been stigmatized in their family because they feel that tuberculosis can affect other member of the family, which is consistently true but that doesn’t mean that they should be stigmatized. “We always have large number of patients who come down here for tuberculosis treatment.

Everyday we run the clinic volume of patients with tuberculosis become higher we have seen cases of younger children, old adult, men and women some time one would be wondering if he would not contract the disease.

“When you talk about management of tuberculosis you start with diagnosis when a patient is diagnosed with tuberculosis there are procedures we go through during treatment. Luckily it is curable and if a patient is based on a medication and the patient continue taking this combination therapy on regular basis time would come when the infection would totally clear in the system.

We do mantel test, and chest x-ray to go through the lumps and once the diagnosis is made the treatments would start. “We also tell patients the kind of food they would eat, the kind of diet they would take.

The kind of exercise they would engage into the kind of environment to live how to relate with people among others. How do you manage the cough? You need to be with handkerchief all the time and of curse keeping appointment is very important in managing tuberculosis.

Patient who has been diagnosed or who is on medication should keep appointment. Drugs are given for complete three months free of charge and before those drugs would finish the patient would come back to refill for the treatment to continue. It takes a while for the treatment to be completed.

For patient to be declared tuberculosis free the patient must be regularly keeping the appointment because non compliance is the major challenge in treating tuberculosis.”

Is tuberculosis hereditary? Adebiyi said: “It is not hereditary but it is transmittable it can be transferred from an infected mother to a child but it is not in the gene of the mother.

It cannot be transferred through gene but through droplets. If a person that is affected coughs and a person who is tuberculosis free get this cough through droplet he or she can be infected. Person can be affected of tuberculosis through contact.”

On the levels of Chevron support to the hospital, he said: “Chevron has done wonderfully well they have set up standard chest clinic. One of recent equipment meant to manage tuberculosis is already provided in this hospital.

The chest clinic has solid structures and quality treatment facilities.” Is the treatment free of charge? Adebiyi said: “The treatment for tuberculosis here is 100 per cent free all the drugs have been given free injectable and oral drugs have been given free.

No body collect money from any tuberculosis patient all the processes are procedures are free. “When a patient comes with complain suggestive of tuberculosis we run general blood test.

We want to know the blood volume, blood group, genotype of the patient then we go ahead to see whether the person has tuberculosis by doing chest x-ray.

Adebiyi

After chest x-ray we go ahead to do mantel test where the injection is given in the arms and then we see the reaction of the injection. When all these are combine together we achieve a diagnosis whether it is in the case of tuberculosis or not.

It is combination of radiology and dermatology to be able to diagnose tuberculosis. “There is also a new machine called GeneXpert that perfectly help us in the diagnosis of tuberculosis.”

On the needs and gaps in the clinic, the Medical Director said: “The only gap we see in the clinic presently, is high number of patients in relation with personnel available. Lagos State is over populated and of course the number of patients that we see is so high.

Alimosho general hospital is the busiest general hospital in Lagos and I can also said it is busiest general hospital in the country as well. So what we see as major gap is ratio of patients to staff members of the hospital.

We do not have enough personnel to cope with the high volume of patients we have on daily basis. Equipment is here structures are on ground the staff members also doing their best but pressure is so much on them.

I wish if government can employ more staff members in order for us to have enough personnel to manage the patients we have.” How is tuberculosis disease been contracted? Adebiyi said: “It is contracted through droplet contact from the affected persons tuberculosis patient is unmerciful to breathe adequately so, he or she coughs on the regular basis.

If that happens saliva would be coming out from the mouth and the air be saturated with the bacterial that are involve in the infection. Anybody that is enclosed in that area will be infected because he breathe in part of the bacterial that are been released from an infected person.”

On the kind of food and environment TB patients are expected to have, he said: “For environment, tuberculosis patient is expected to stay in an airing environment and not enclosed environment so, that there would be cross ventilation and free flow of air. Especially when they come to the hospital for treatment we do not treat them in a consulting room.

We do not allow them to sit in an enclosed environment when they are waiting for doctors but we prove an open place where there is free flow of air. When they are at home we encourage them to leave with window left open and leave under mosquito treated nets. We ask them if possible leave alone and they need to always have a handkerchief with them incase if they want to cough.

They are not expected to cough and leave the cough open like that but these are expected to cough and use handkerchief to cover their mouths. “For food we ask them to eat balance diet eat enough fruits and vegetables and avoid only eating carbohydrate.

“My advice to Nigerians, they should learn to visit hospitals even when there is no complain for medical check up Nigerians, do not visit hospital until there is pain. The pains must be severe in such a way that paracetamol tablet cannot eliminate it. We have habit of continue to manage an ailment we have on our own but in developed countries they create time to go for medical check up.

Let us cultivate the habit of going for medical check up at least once in a year. We need to check our blood sugar and blood pressure level; women need to check their breasts on regular basis.

“Women over 40 years need to check their private parts to prevent cancer infection. Especially for tuberculosis If you have anybody who cough in your area you advise the person to go for medical check up and you who are close to a person who coughs you need to go for medical check up. It dose not cost much to have a medical check up so, we need to be educated in what causes some of these ailments that we are talking about. Nothing would stop us from going to online to read prevention and treatment of tuberculosis.”

In what aspect do you think government can support to improve quality healthcare delivery especially in tuberculosis cases? Adebiyi said: “Education is the major aspect of health promotion which Lagos state government is at the fore front. On regular basis we hear Jingles advising us on what to do about our health we see many programmes.

In Lagos we have blood sugar and blood pressure test in all the local governments. In these programmes a lot conditions have been identified so, government has already doing it although we can say that government should do more. Government should promote health through school health education.

“We need to have our school health promotion from primary school level when these young ones understand the importance for us to monitor our health.

Then we run these programme through secondary school when these kids would be graduated and become men and women in future they are already know what it takes to maintain one’s health. Health promotion should also start from market women, artisans, taxi drivers, motor parks, and main markets.”

Does tuberculosis disease infection has age limits? Adebiyi said: “No, anybody can be affected we have seen children and older ones been affected but generally, we can say that it is more with the older ones.

In our days we have vaccine that is given to the children even before they leave the hospital after birth to prevent tuberculosis. With some reasons a lot people don’t just bother to get this vaccine and so, those children come back with tuberculosis.”