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Indonesia Fights Drug-resistant Tuberculosis Strains
FrontLines - March 2010
By Roman Woronowycz
JAKARTA —Rohmin*, 41,
drives a taxi in Jakarta, a bustling,
overcrowded megapolis.
Tuberculosis is common and a
cab is an easy place to pick it up.
So when Rohmin began
coughing up blood more than a
year ago, he sought medical help
and was told that he had TB.
With a wife and four children to
support, Rohmin had little time
for treatment.
|
Dr. Lia Gardenia Partakusuma (left), Persahabatan Hospital’s director of general affairs, human resources,
and education; and Dr. Erlina Burhan, chief pulmonologist, discuss the hospital’s MDR -TB program.
|
Twice he took medication and
twice he quit after he felt better.
The third time the disease
returned with a vengeance as
multi-drug resistant TB (MDRTB):
difficult to detect and difficult
to cure.
Today Rohmin swallows 28
tablets daily, including vitamins.
He will take them for the next
two years with little choice. This
time he either completes treatment
or faces death.
Dr. Erlina Burhan, chief pulmonologist
at Persahabatan Hospital
in Jakarta where Rohmin is
an inpatient, believes that he will
complete treatment. “He’s committed,”
she said.
She said that Rohmin is monitored
to ensure he adheres to an
internationally recognized system
for treating tuberculosis
known as Programmatic Management
of Drug Resistant TB
(PMDT). The treatment is more
intensive than the treatment for
standard TB, known as Directly
Observed Treatment, Short
course (DOTS).
“Most MDR patients have a
previous history of TB and have
either taken medication and
stopped, or received inadequate
doses or counseling,” Burhan said.
Indonesia is reducing its rate
of TB, which has fallen from
115 cases per 100,000 people in
2002, when USAID began supporting
the fight against TB, to
100 cases per 100,000 in 2008.
Currently, 91 percent of those in
treatment have a successful
outcome.
Yet, even as TB rates begin to
slow, the resistant TB is becoming
more prevalent. | Each year, World
Tuberculosis Day,
a worldwide call to
combat the disease,
is observed on
March 24. USAID
is working among
global efforts to
halve TB rates and
deaths by 2015.
|
USAID has provided $18
million since 2002 to Indonesia’s
Ministry of Health for programs
through 2010 and is now
increasing its focus on drug
resistant TB. A new pilot project
will identify and treat 100
MDR-TB patients in Jakarta and
Surabaya.
Rohmin is among the first 10
patients in treatment.
Dr. Sri Prihatini, a World
Health Organization TB consultant,
said that the key to success
is a referral and monitoring system
that connects local doctors
and health centers with hospitals
in a communication network that
ensures patients remain in
treatment.
A good program will reduce
default cases, preventing new
drug resistant TB cases. “TB
treatments work better at the local
health centers because the doctors
and nurses know and track their
patients,” said Prihatini. “We need
for hospitals to notify local officials
when one of their patients
becomes a no show.”
The pilot projects in Surabaya
and Jakarta ensure that local
government health centers and
hospitals understand PMDT and
how to implement it. Prihatini
said that before the pilot projects
are rolled out, it will be crucial
to train medical professionals in
the surrounding areas in the new
system. It will be equally important
to have enough labs certified
in MDR-TB testing.
She believes that adequate
preparation is the key to success in
fighting MDR-TB. “But it is also
dependent on commitment by the
local clinics, the hospitals, and the
government,” she said. And by the
patient, too, she added.
*Many Indonesians do not
use a surname.
★
FrontLines is published
by the Bureau for Legislative and Public Affairs
U.S. Agency for International Development
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Material should be submitted
by mail to Editor, FrontLines, USAID,
RRB, Suite 6.10, Washington, DC 20523-6100;
by FAX to 202-216-3035; or by e-mail to frontlines@usaid.gov
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