A GINA feature by Delicia Haynes
“I USED to smoke drugs. I used to smoke weed, then I start smoking drugs (crack cocaine); and while smoking, I find myself coughing. Next thing I know, when I smoking my joint I see blood on the spliff (small marijuana cigarette), so I wonder where this thing coming from, if I get a buss mouth or something; so I cough, and when I cough I see blood.”
It was the beginning of a 13-year flirtation with death for Rey (not his real name), as his addiction to illicit drugs saw him battling to stick with his treatment regime.
Rey contracted tuberculosis (TB) after coming into close contact with one of his colleagues who was also a drug abuser. This friend, however, died because of the advanced stage of his infection with TB.
“(One) day I lie down and see he bring up this cold…, so I said ‘is my friend, I will help him,’ and I go close to him and lift him up and carry him downstairs and wipe off this cold from him. He cough in my face. Well, I don’t know what it was. He died with this same thing, but I didn’t know this was TB,” Rey explained. He went to the hospital and was diagnosed with TB.
TB is an airborne disease caused by the bacterium Mycobacterium Tuberculosis (mtb). This bacterium can attack any part of the body, but it generally affects the lungs. If a person breathes Mycobacterium Tuberculosis contaminated air, the mtb bacteria reach the lungs and cause a lung infection.
The bacteria can, however, remain dormant for years, without the person showing any symptoms of the disease. This is called latent TB infection. People who have latent TB infection do not get sick and do not spread the bacteria to others. The only manifestation of this infection may be a reaction to the Tuberculin Skin Test (TST) or Interferon – Gamma Release Assay (IGRA).
However, some people with latent TB infection eventually contract the TB disease. The disease has initial signs of coughing for more than three weeks; coughing up blood; chest pains while breathing or coughing; weight loss, fatigue, fever, night sweats and chills.
CONSTANT DEFAULTER
Even after his diagnosis and positive test for TB, Rey never took his condition seriously, and continued a cycle of treatment-drug abuse-treatment-drug abuse. “I started to take the treatment and I still smoke, and then, months after, I start to lose weight. First of all, when I lie down sleeping, I hear like a bubbling — the cold inside of me bubbling up — and I want to know what going inside here, and I tell my mom. I said ‘mom, this thing ain’t going on nice’. She sent me back again (to the chest clinic) and the people them tell me that I default treatment. Then another doctor gave me some injections. She say I am a defaulter, so when I drink the tablet and when I catch myself back, I say ‘well, I alright’. I saying this is how the TB work; so I catch myself back, so I gone back smoking again.
“I find myself sweating and losing weight again. I come back again; they say I am a defaulter again…they say from (stage) one, I gone to stage two. I got to go take more treatment, more tablets again,” Rey explained.
Rey had seen about six of his friends dying after being diagnosed, as a result of not sticking with their TB treatment plan.
LOVE OF A CHILD
Support from family members and friends can mean the difference between life and death for persons suffering with TB or any other contagious disease, with outward symptoms such as blisters or visible weakness of the limbs.
Rey added, “A woman see me, a very good friend of mine see me. Hear her words to me: ‘Is what happened to you? Like you get the truck?’ I say ‘No, I got the bus’. So things start turn out on my skin now, and I said ‘alright, I feel I would have to go through this thing serious’. Some days when I go through it, I feel good, and I stop and went back to the normal thing.
“This cold thing got me, I using a lot of ice water, too, in the night — plenty ice. I start eating ice because inside here (touches throat) was getting thirsty. Well, I get back sick again, my daughter…she didn’t give up on me, but she said, ‘Daddy, you look like you not going to make it’. I say, ‘Well, you keep praying, I strong’. She said, ‘Alright’. Anyway, when I gotta go in the bus, she will hold me up to put me in.”
PUBLIC HEALTH CARE DELIVERY (SUPPORT AND CARE)
Coming back for treatment the third time after defaulting, Rey met TB Field Supervisor Jellien Griffin at the Chest Clinic of the Georgetown Public Hospital Corporation (GPHC).
“I come back and get the treatment, and I meet with her (Jellien Griffin) and she try with me. She try, try; she come home at my house, she used to come and give me treatment, injection and everything… People with this thing (TB) smoke thing and buy this thing (drugs) whole day on the block, and I selling it. While I selling, I still going on with this coughing thing, and I said, ‘You know something, this thing affecting me more than it affecting them’, so I go back home.
“I come back here, meet up with a doctor. She told me, ‘You got to take this thing serious.’ So, I get the injection, she come (at my home) inject me and make sure I drink the tablets,” Rey detailed.
Speaking with Griffin, she said Rey was an excellent listener, but his addiction to illicit drugs was interfering with his treatment. “He feels that whenever he gets the urge to go smoke he should go. I remember a few occasions where I would go and see him when he is down. When he is sick he is one of the patients that would encourage you to keep doing what you’re doing and give of your best, because there are times you would turn up and see water there ready for him to take his pills; that in itself is motivation to want to continue in this profession,” Griffin said.
The TB Field Supervisor explained that Rey’s habit of continually defaulting on treatment caused the disease to become resistant to the prescribed drugs. He became a multi-drug-resistant TB patient. “For us to treat persons who are drug resistant to TB is very expensive. The medication is far more expensive than what we would use to treat the normal TB,” Griffin explained.
In 2002, Guyana, through the National Tuberculosis Programme, implemented the Direct Observed Treatment Short-course (DOTS), which has assisted in combating alarming cases of tuberculosis. There are, across the country currently, 18 TB testing sites that diagnose and treat TB patients.
Dr. Jeetendra Mohanlall is the National Tuberculosis Programme Director. “Over the years, we have built a programme where you have different departments, like TB/HIV, DOTS, M&E which is monitoring and evaluation; and we also do mobile outreaches. We have the DOTS programme where outreach workers are trained to observe patients taking their medication,” Dr. Mohanlall detailed.
There were 564 new cases recorded in 2015, twenty per cent of which were co-infected with HIV. The unit has recorded a success rate of 81% treatment, with a 14% default rate. In 2016, the unit identified 265 new cases, 72% of which are smear positive. The co-infection rate for 2016 remains at 20%.
“…we implemented DOTS just over 12 years ago, the treatment success rate at that time was 38%; now we’ve actually reached 81% success rate, which is a commendable achievement for us in a developing country,” Dr. Mohanlall told GINA.
The growing prevalence of TB has been getting the attention of health officials worldwide. Statistics show that TB is the second leading cause of death by infectious diseases. TB is among the top five causes of death in persons between the ages of 15 and 45 years, with over 95% of those individuals living in low to middle income countries.
The World Health Organisation (WHO) in 2014 recorded a total of 1.5 million deaths as a result of TB infections. One-third of those recorded were co-infected with HIV.
In Guyana, it is recommended that persons with the TB disease seek medical treatment by way of submitting to DOTS, which would usually take six months of constant managing.
It took more than 13 years for Rey to be TB free, when the actual treatment-to-cure process takes a maximum of two years. This is because he had been a defaulter to his TB treatment.
IN PRISON
While Rey had not tested positive for HIV/AIDS, his addiction to crack cocaine was keeping him off-course with the treatment; that is, until it caused him to end up in prison.
Involved in selling illicit drugs, Rey was apprehended and sentenced to three years’ imprisonment. While in prison he was shunned, because the health condition from which he suffered was easily spread, although he was, to some extent, separated from the other prisoners.
“I end up getting in trouble with this thing (drugs) selling, and I end up in prison for three years. The driver that used to bring her (Jellien), he see me on court round-up (television programme) and that’s how they know,” Rey declared.
Griffin continued to provide moral support to Rey while he was in prison. “My word to him was, ‘use this opportunity to get the best out of it. You would have defaulted so many times before, but let this time be different’; and I was happy that he was in prison, not in that negative way, but to know that now that he is there, certain privileges will not be given, and adherence will be easier.”
But Griffin was not working only with Rey, to combat his addiction and stick with his TB treatment plan; she was also working with his family. There were times when Rey lost the support of his direct family members because of the complexity of his illness. However, after they had been educated on the facts of TB, family members were the key persons in his life for encouragement towards his recovery.
“We had quite a lot of work to do with him, so we recognized — because of his behaviour pattern — we had a lot of counselling to do, and he needed family support. So one of the things that we did was not only to encourage him, but work with the family,” the field supervisor said.
ROAD TO RECOVERY
Rey found his road to recovery while in prison. “They put me in a place where TB people be, and I take my treatment two years flat. With this treatment, it’s every day from Monday to Monday; no day I skipped. They had other people with TB where they get tablets five days a week, Monday to Friday; but I getting Monday (to) Sunday, every day I getting this treatment and taking this treatment now, tablets plus injections.
“I started feeling better, but we weren’t getting the sunlight, so I start to get weak. I find that the coughing easing, and when I bathe I would wet my head. Then some things come out on my skin, and I thought it was from the mattress in jail, but the doctor at the prison said it’s because I backslide so much from treatment and because of the drugs I was using at that time…”
Rey said he abandoned smoking because “they said that this thing is what is causing me to not recover; so I stopped smoking cigarette and weed, and stopped smoking drugs. And I decided to take the treatment in prison for two years, and this is where I am today.”
Having worked with Rey for more than three years, Griffin has expressed joy at working with patients like him. “I am really happy to be here with Rey and share his success story. Rey is one of the clients that I admire, because as much as he was difficult in the early stage, he is one that is very respectful, very humble, and appreciates the service that the National TB Programme offers. I remember him saying when I go to visit that this is something he wouldn’t want to do, but I could not understand because I was not in his shoes. So I realised that as long as I continue to do my part as a health worker in the line of continuous counselling, he would be able to understand the benefit of using his pills.
“Despite the challenges, I was hoping that someday he would see the bright side of life; so now I am happy to see him here today, because today you are actually seeing the true ‘Rey’ he was meant to be,” Griffin exulted.
The Pan American Health Organization/ World Health Organization PAHO/WHO, along with the Global Fund, has been partnering with the Government of Guyana on tackling TB.
SECOND CHANCE
Rey considers his TB-free status as a second chance at life, and encourages other TB-infected patients to adhere to treatment. He also hopes to start over by meeting a partner to spend the rest of his newfound life with.
Rey is testimony that TB is treatable and curable!
