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Joan, Vidi, workplace change and Drug Resistant TB

Picture above: Joan Kundiri, Brian Bell TB warden learns about the role of microscopy in TB treatment and case management at Businesses for Health: TB warden training.

This is a story about a complex workplace issue - drug resistant TB and the time it takes to make a difference to change health behaviours. Most importantly it is a story about, Vidi, a TB patient and Brian Bell employee and Joan a TB warden at Brian Bell.

Vidi is a 28-year-old man from Central and New Ireland who has worked with Brian Bell since 2016. Joan has worked for 17 years with Brian Bell and is from Kagua in Southern Highlands Province. Together they have a success stoy to tell about the role of the workplace in ending TB in PNG.

In 2018 Vidi suddenly lost a lot of weight and was having night sweats. At the time Vidi didn’t think he was sick, but as he lost more and more weight, he decided to look for help. He went to several private clinics, but not one offered a solution to his sudden loss of health.

On his fourth try for help, he went to the 6-mile clinic, where, because he had signs of extra-pulmonary TB he was referred to Port Moresby General Hospital. At PoM Gen, he was started on a regime of 6 months of TB treatment. Brian Bell gave him leave for 6 months.

For a while, it was going well, but Vidi returned to the hospital when a lymph node on his neck started to swell 3 months into his 6-month treatment regime. Using the latest diagnostic tool called the “Genexpert” a sample taken from Vidi’s swollen lymph glands revealed he had drug-resistant extra-pulmonary TB.

Meanwhile, back at work Joan Kundiri, Vidi’s line manager at Brian Bell, had attended Businesses for Health’s TB Warden training. Joan re-considered her colleague Vidi’s situation. She had learned to ask about Vidi’s diagnosis and case management. She considered, “had Vidi been tested with Genexpert at first test, why did he have to be away from work, and why was he not responding to treatment?”

At TB wardens’ training Joan, learned extra pulmonary TB is not infectious. She considered Vidi’s situation and wondered if Vidi may be able to return to work without fear of him spreading it to others in the workplace. Indeed, Joan followed up with Vidi and he was deemed the doctors to be non-infectious and that Vidi had now been diagnosed using the latest in accurate diagnosis of DR or drug resistant TB.

Joan is one of the first TB wardens to know PNG is working to replace microscopy with the rapid molecular GeneXpert test as the initial diagnostic tool for TB. This ensures that every patient at the time of diagnosis knows their drug resistance TB status and accordingly gets the correct treatment regimen from day one!

Joan had to create a change in the knowledge and processes at work that would allow Vidi to return to his job. Whilst medically safe to return to work, Joan had to help HR understand the new methods for helping employees with TB about safe return to work. Several meetings at work lots of conversation with Nerrie and Catherine in the B4H office and even more encouragement for Vidi, Joan paved the way with Brian Bell’s HR for Vidi to return to work.

After DRTB diagnosis, Vidi’s TB was still “extra-pulmonary”, but now his 6-month of treatment course was extended to 20 months, more TB drugs and for the first six months daily injections of the ‘second line’ DRTB drugs. Despite his major setback to getting better Vidi kept a positive attitude, but he was uncertain if he would be allowed to return to work, or be ordered to stay away from work for the whole duration of his new 20-month treatment regime.

Re-enter Joan – Brian Bell TB warden! Three months later, Joan had Vidi back to work. With her now trained mind and new knowledge of TB Joan made sure that Vidi, who was still on medication and daily injectables, was in a supportive workplace environment. Joan met with HR and her management teams. She hosted toolbox sessions with her staff, B4H and ensured they understood TB better. Her work reduced the stigma around TB amongst her staff and created a better environment for supporting treatment completion. Joan made sure that Vidi had transport to go to 6-mile clinic to have his daily injections of the special drugs for drug resistant TB. Joan checked on Vidi daily and to see if he was showing improvement.

Vidi’s recovery was remarkable, still taking medication Vidi was able to return to work with the support of Joan and the team at Brian Bell.

At Businesses for Health, as far as we know, Brian Bell is be the first business to return a person with DR TB to work whist on treatment. It is a vital step in reducing fear and stigma that still surrounds TB at work. Vidi still has a job and Brian Bell still has Vidi.

Vidi remains at work having endured the worst of the DR treatment regimens and will continue his tablets into 2020. Although Joan admits that they are still improvements to be made in the policy surrounding TB at her workplace she also knows that fear, stigma and knowledge of TB management are complex issues that take time to change. Importantly her colleague is on the path to full recovery and Vidi continues to support his family while on treatment. For Joan the more she contributes to helping people like Vidi get diagnosed, the better it is for her employer.

In PNG in 2018, there were 37,000 new cases of TB. Five percent of those new cases were found to be drug resistant (DR). In people previously treated for TB, the rate of drug resistance is 25%.

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