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Nurses are a global network of frontline workers in battle against TB

2009; Wiley; Volume: 56; Issue: 4 Linguagem: Inglês

10.1111/j.1466-7657.2009.00777.x

1466-7657

Patrizia Carlevaro,

HIV/AIDS Impact and Responses

Dr Patrizia Carlevaro In western countries, tuberculosis (TB) is often considered a disease of the past. In the developing world, it is a disease of today, afflicting millions of people. Although the number of TB cases per capita is decreasing, the total absolute number of cases continues to rise globally. The World Health Organization (WHO) estimates that there were 9 million new cases of TB in 2007 and some 500 000 cases of multi-drug resistant TB (MDR-TB), which often occurs when treatment with the first line of TB medicines is mismanaged (WHO 2009). Like TB, MDR-TB is treatable and curable. However, the treatment process for this illness is far more arduous than for TB, often lasting for over 18 months and requiring greater involvement from health care workers. To successfully control the MDR-TB epidemic, a more comprehensive approach is needed to ensure that the overall health care system is upgraded to face this challenge. The highly infectious nature of TB makes it crucial for health care workers to diagnose it immediately, place patients on the appropriate treatment, and have the correct measures in place to avoid transmitting the disease among health staff and the community. The diagnosing and care of TB patients usually relies on nurses – the frontline health care workers around the world. In treating MDR-TB, the role of nurses becomes particularly important because of the complex and long treatment process, as well as the potential for a particular TB case to become further drug resistant. As the head of the Lilly International Aid Unit and the Lilly MDR-TB Partnership team leader, I drew heavily on my previous experience working with UNICEF, where I saw first-hand the immense value of the nursing profession in developing countries. Nurses are often the sick person's only contact with the health care system in developing countries. Medicines alone are not enough unless they are effectively transported, stored and administered within a functioning health facility. Nurses play a critical role in making the entire health care system function properly. For this reason, early in the 2000s, I approached the International Council of Nurses (ICN) to explore opportunities to partner in the battle against MDR-TB. Today the Lilly MDR-TB partnership is a public private partnership of 20 global partners working in over 80 countries on five continents. It was initially launched in 2003 to supply WHO with much-needed MDR-TB drugs and later to transfer drug manufacturing technology to the countries hit hardest by TB. Lilly then expanded its role to cover treatment, training, surveillance, awareness, prevention, community support and the elimination of the debilitating stigma surrounding TB. Lilly's partnership with ICN has been essential in informing nurses and other health care practitioners, such as doctors and hospital managers, on the proper management of this disease and in engaging this vital workforce at the global level. Because of its large membership and broad country representation, engaging national nursing associations through ICN, particularly in countries with high HIV/AIDS and TB mortality, is the most sensible and cost-effective way forward. Moreover, ICN member associations are strong in the 22 countries with the highest TB burden that account for over 80 percent of the world's TB cases. The partnership with ICN is gratifying to me because it has ensured that educational materials are distributed to the largest network of health care workers in the world, thus helping us scale up the basic knowledge and skills for TB detection, treatment, awareness, and prevention. With Lilly support, ICN has developed an online Global TB/MDR-TB Resource Center consisting of numerous tools: Guidelines for Nurses in the Care and Control of TB and MDR-TB; fact sheets on TB exposure in the health care setting and on TB and stigma; a TB forum for Health Professionals and Patients; and, learning modules on TB and MDR-TB treatment for nurses. The Training of Trainers (TOT) concept developed by ICN has reached several thousand nurses in nearly 20 countries, with more nurses scheduled to take the course in the future. One of the innovative approaches of this program has been the development of local partnerships whereby nurses, doctors, community health workers, in unison with local health authorities and patient advocate groups, are ensuring that the patients not only receive proper treatment, but also companionship in their journey to conquer the disease. I had the privilege of being updated on the nurses' work during the recent ICN Congress in Durban, South Africa. ICN's commitment and energy in the fight against MDR-TB is impressive. Equally significant is its strategic use of the program in raising the national nursing associations' profiles as key players in the TB policy sphere. When dealing with an illness on a global scale, not only are international and local networks valuable, but equally important is having the proper tools to educate and train individuals within those networks. For this reason, ICN's model could be particularly applicable to other global pandemics. After reading the amazing stories of the ICN TB Award winners, I became especially proud of our collaboration with ICN, particularly of the hardworking nurses who, each and every day, often in difficult environments, battle diseases to bring quality health care to all. Their commitment and passion is invaluable. For more information on the Eli Lilly MDR-TB Partnership, please visit: http://www.lillymdr-tb.com. Dr Patrizia Carlevaro is Head of the International Aid Unit at Eli Lilly and Company, which provides guidance and support for Lilly's corporate policies and initiatives on health-related aid to developing nations. In addition, she is Team Leader for the Lilly MDR-TB Partnership, the company's signature corporate social responsibility initiative, to which it has contributed $135 million. Dr Carlevaro serves on the Board of the Florence Nightingale International Foundation. She obtained her Doctorate in Chemistry and Pharmaceutical Technologies, as well as her License in Pharmacy at Italy's Pavia University.