30 September 2011- Treating Tuberculosis in Gorgan
“I was so weak it became impossible to work,” sighs Nazar Ghorbani, a 53 yearold metal worker from Zabol living in the north-eastern Iranian city of Gorgan. Nazar has eight children to feed, the youngest of which is only three months old. Nazar’s fatigue and persistent cough led him to visit the local health center in Fazelabad on the outskirts of Gorgan where he lives with his wife and children in a cramped and poorly ventilated house. The health worker who examined Nazar suspected TB infection and collected his sputum sample.
The Global Fund and UNDP have supported the Center for Disease Control to establish two Direct Smear Microscopy (DSM) labs and one culture lab in Golestan province to reduce the time lag between the appearance of TB symptoms, diagnosis and treatment. This has significantly improved access to laboratory services and sped up lead-in times considerably for sputum sample testing, meaning that people presenting TB symptoms such as Nazar can get diagnosed much faster. To date, 46 TB laboratories across Iran were equipped with the help of the Global Fund grant. More labs shorten the time lag between suspicion of disease and diagnosis. Consequently, patients can be treated faster and reduce the number of people they unwittingly contaminate. Nazar was confirmed to have tuberculosis. “I was helpless when I got the news – with all the troubles I already had to support my family, I didn’t know where to turn for help,” he continues. Behvarz, community level health workers, provide a nework of coverage for health services in Iran, facilitating outreach to communities no matter how remote or marginalized. With the information provided by the behvarz active in Nazar’s area, Hossein Dankoub, the doctor examining Nazar was aware that he has several children under the age of six living wityh him. Nazar was asked to bring in his young children for testing straight away.
Small children are especially vulnerable to TB, among other contagious infections.
Two of Nazar’s sons, ages three and four both had caught TB from living in overcrowded and airless conditions. Isa, his three year-old son, caught sputumnegative TB. His four year-old, Moslem, developed TB meningitis - one of the most severe manifestations of TB which if left untreated, could have irreversible consequences on his mental acuity. Moslem was so sick that he temporarily went blind.
Nazar and his two sick children were immediately started on DOTS – directly observed treatment, short course – the internationally recommended strategy for TB response, for which the Iranian Ministry of Health received assistance from the Global Fund and UNDP in reinstating to control the country’s TB epidemics. Another one of Nazar’s young sons, Mousa, was also started on a course of TB prophylaxis to prevent him from getting infected. Hossein Dankoub, the behvarz working in Nazar’s community, now visits his house daily to deliver his and his sons’ daily medication against the disease and to make sure that they are adhering to the treatment correctly. “If patients are not assisted to adhere strictly to the treatment, they can develop a resistance to the medication. It is very important for us behvarz to be able to access our designated patients first thing in the morning. Nazar lives close by, but some of my colleagues have to travel far in the early hours to make sure they administer the medications correctly,” explains Hossein Dankoub. “The Global Fund’s support for DOTS administrators’ travel costs has been enormously helpful,” adds Dr. Kamalinia, TB focal point in the Golestan Provincial Health Center.
Nazar and his sons have responded remarkably well to the medicines and medical attention they are receiving through the dedicated and consistent support of Iran’s national public health system and its international partners. While Nazar and his boys are still under treatment – therapy for TB meningitis can last between nine and twelve months – they are making a swift recovery to good health. Nazar has gradually regained his strength and begun working again to support his large family. Moslem got his sight back and has returned with his bother Isa to play with the children in his neighborhood more than ever before. In just a few years, Nazar’s boys will soon be admitted to school. With the help of Iran’s health system supported by the Global Fund, their life-threatening illness will have become little more than a bad memory.
Written By: Tamara Kummer