A volunteer’s story: Fighting TB among remote mining workers and their families

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Photo credit: Warren Zelman

TB is an ongoing public health problem in Ethiopia, and finding people with TB and getting them treated quickly is critical to ending the epidemic. TB is a particular issue among high-risk groups, such as HIV patients, substance abusers, prisoners, and gold miners.

In Ethiopia, around 1 million traditional gold miners are at high risk of TB because they work in confined spaces and are exposed to respirable crystalline silica that can build-up in their lungs and predisposes them to TB. Despite TB control efforts, traditional mining is an area that has been neglected in the fight to end the disease.

There are no public health services for miners and the remoteness of the mines makes access to health services difficult. Delays in TB case detection and initiation of treatment and a lack of follow-up services are common at the traditional mining sites.

To address this problem, the USAID-funded Challenge TB (CTB) Project began recruiting volunteer TB treatment supporters (TTS) from the mines in the southern part of the Oromia Region (with an estimated miner population of 30,000). The TTS were trained on identifying presumptive TB cases, screening and referral, counseling, and treatment supervision.

Photo credit: Ali Galgalo

When Mustafa Abdi, a 24-year old miner at the Melka Soda Woreda gold mine, started to cough and suffer from a fever, severe chest pain, and weight loss, he visited the nearby health center. He was tested and diagnosed with pulmonary TB (bacteriologically confirmed) and put on first-line anti-TB treatment. He completed the treatment on July 23, 2016, and was declared cured.

Six months later, Mustafa’s father, Abdi, developed similar symptoms. His father visited the same local clinic and was given antibiotics, but his health got worse by the day. Mustafa, who volunteered to be part of the case-finding team, told Mohammed, the woreda CTB Program coordinator, about his own case of TB and that he thought his father might have TB as well. He said that his father should be evaluated, and so should close family members he had come in contact with when he had TB. Mohammed screened Abdi and collected a sputum sample that was sent to the Megado GeneXpert site by motorbike for testing. Abdi had bacteriologically confirmed pulmonary TB; he was referred to a nearby health center, put on anti-TB drugs, and counseled on treatment adherence.

“I now know a lot about TB and I’m teaching my peers in the mine so that our workplace and families remain safe.”

When Abdi began treatment, Mustafa took responsibility for his father as a TTS. Abdi was not strong enough to travel to the health center so he stayed home, taking the TB treatment under the observation of his son. “I feel a lot stronger now,” Abdi says. “Going to the health center for daily observed TB treatment would have been difficult for me because of the distance and the costs of transport.”

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Able to detect TB and its resistance to antibiotics in less than two hours, GeneXpert technology has revolutionized the diagnosis of TB without the need for sophisticated laboratories.

Among eight of Abdi’s family members screened for TB, three were diagnosed with bacteriologically confirmed pulmonary TB by using GeneXpert and put on treatment. Today, rapid diagnosis by GeneXpert, shorter turnaround times, and appropriate anti-TB treatment are improving the chances of early diagnosis and cure and are reducing the further transmission of TB. The Megado Health Center is one of the health centers near the mine that has a GeneXpert machine provided by USAID’s HEAL TB Project, and CTB provided ongoing technical and material support.

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Management Sciences for Health helps leaders, health managers & communities build stronger health systems for greater health impact. More at www.msh.org

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