We have done more damage than good

ON March 24, PNG joined the glo­bal community to commemorate World TB Day.
This important day is celebrated annually to raise awareness about the threat of TB, its related problems and to support worldwide efforts.
This year is also the second year of the two-year “Stop TB in my life time” World TB Day campaign.
If the recent media reports of TB in PNG are any indication of our efforts towards the control and eradication of the epidemic, only minimal impact is seen.
The recent death of a 20-year-old girl with extensively drug-resistant TB (XDR-TB) in Cairns Base Hospital should remind us, all partners and stakeholders in the TB fight, to realign all our TB control and eradication strategies.
Obviously, our current strategies are not working and our national targets to achieve at least 70% case detection rate, 85% cure rate and 80% DOTS coverage rate by 2010 did not materialise.
Clearly, our control efforts have been poorly planned and coordinated at all levels of our health system.
We are reminded time and again that locally-controlled programmes are the most effective ways of combating TB.
That is true because we know exactly what the problems are, how they occur and/or are created and obviously we have some fair know­ledge on how to address them.
I am sure most of these locally-oriented ideas are captured in our national programmes and plans to control TB in the country.
Unfortunately, the programme continues to encounter the same old issues of health delivery and the following three remain outstanding – inconsistent supply of TB drugs, lack of regular supervision and the lack of proper monitoring and evaluation (M&E) at health facilities.
The question of appropriate training for TB personnel is a non-issue, more people are actually being trained but yet cannot implement.
This is the biggest issue in the majority of our different health programmes in the country.
While serving at the Kiunga district hospital last year, I cannot recall a single visit by the health department’s TB section to the hospital despite Western reporting cases of XDR-TB.
However, I do recall three visits by an M&E officer from the malaria branch.
We could see progress locally if quality control measures were undertaken, supply of anti-malarial drugs were monitored, statistical progress was updated, clinical and technical staff were supervised and treated bed nets were distributed.
It is, therefore, illogical to blame it all on inadequate financial re­sources allocation, especially when these two programmes are also supported by the same external donor, Global Fund.
Even when money is available, we still have drug shortage pro­blems, no one bothers to monitor progress and the list goes on.
I urge the health department’s TB team to be more proactive in its approach.
The emergence of drug-resistant TB in PNG is created by man as a result of inconsistent and inadequate treatment.
In an environment where completion of TB therapy by patients is no guarantee, I believe we have in fact done more damage than good by treating them.
If we are really serious, we need to get the basics right; ensure early diagnosis and treatment, drug supply must be consistent and uninterrupted, ensure full treatment compliance and provide for regular monitoring and evaluation.
In order to make an impact beyond March 2013, I suggest the health department and its partners should invest more of their resources in providing regular supervision to health facilities around the country.
It is a simple strategy, yet it is cri­tically important and vastly rewar-ding.

Dr Francis Wandi
Goroka Hospital