Operation Food Basket: Part II

This morning, Briana, Cindy, and I headed back out to Callao to continue our work on Operation Food Basket.  Judy planned to take us with her while she evaluated patients who might qualify for ASPAT´s assistance.  To receive food baskets, patients generally have to be living in extreme poverty (I believe in Peru, you qualify as extremely poor if you live off of less than $2 a day) and have MDR-TB.  ASPAT provides food and nutritional supplements for the first six months of a patient´s recovery period, which are generally the hardest on them for reasons which I will explain later.  Receipt of these baskets hinges upon the patient´s compliance with their treatment regimen: once Judy decides that ASPAT will support a patient, she calls their local health clinic every day to ensure that they really are going to treatment.  If they fail to comply, they lose the food.

We got up far too early to meet up with Judy and travel to Ventanilla, one of the three zones that makes up Callao (see the blog post Callao, Here We Come! for a more thorough explanation of the different zones).  There is nothing nice to say about Ventanilla.  It really is devastatingly poor, and makes the part of Callao in which ASPAT is located look decent in comparison.

When we arrived in Ventanilla, we were met by Norma, a nurse who works at the local clinic.  She took the four of us around to meet up with three patients so that Judy could evaluate their situations.  We too had come prepared with interview questions for the patients.  Below is a transcript of the interviews conducted by the GROW team and Judy (but mostly by Judy, who clearly made the patients feel more comfortable than we did).

Judy is on the left and Norma is on the right.

MARTHA

(This photo is actually of Martha’s daughter and dog – we forgot to take a photo of Martha herself while there. Judy should have a photo of her though, so we’ll ask her for it tomorrow.)

Age: 41 years old

Type of TB: MDR-TB

Do you have children?

Yes, 3 children (the oldest is 10).

Do you currently have a job?

Yes, I run my own little grocery store.

Have you stayed on treatment since you were diagnosed?

Yes.  I was just diagnosed recently, and I´ve been on the treatment plan for 2 months (for MDR-TB, a full course of treatment takes 18 months).  

Do you know how you contracted TB?

I´m diabetic (TB is an opportunistic infection that is often contracted in conjunction with other diseases, like diabetes, that weaken the immune system).


RAUL

Age: 29 years old

Type of TB: MDR-TB

Do you have children?

Yes, 3 children, but they don´t live with me right now.  They´re living with my mother while I´m sick.

Do you currently have a job?

No, I´ve been too sick to work.

Did you have a job before you were diagnosed with TB?

Yes, I did vigilance (police) work, but it was never a particularly stable position.

Have you stayed on treatment since you were diagnosed?

No.  I´ve been on the treatment plan for about 1 month now, but I´ve failed to complete the plan once before.

Why did you stop the treatment?

The side effects of the medicine were really bad.  They made my arms swell up, so I wasn´t able to work.  If I don´t work, then my children don´t eat.  I stopped taking the medicine so I could go back to supporting my family.

(Judy): You need to get well first, then you can go back to work.

I understand that, but my family doesn´t.  

Do you know how you contracted TB?

No, I have no idea.  I´m not diabetic, and I don´t have HIV.  

(Judy):  He probably got it from taking the public bus to work.  There´s ventilation on the bus, but sometimes, when it gets very crowded, people can´t get very close to the windows and doors to receive the benefits of the ventilation.  Then, when people who do not know they´re contagious get on the bus in these overcrowded conditions, they pass the infection on to people like Raul.

(Norma, the nurse):  He´s really had a rough time recently.  His wife left him and their kids when he was diagnosed with TB.  It´s a fairly common response, once the spouse is no longer able to work.  She wasn´t the first person to walk out, and she won´t be the last.

ANGELA

Age: 29 years old

Type of TB: MDR-TB

Do you have children?

Yes, 1 child.  He´s 10 years old.

Do you currently have a job?

No, I´ve been too sick to work.

Did you have a job before you were diagnosed with TB?

Yes, I worked the night shift at a botica (a type of small pharmacy).  I had to stop working once I started coughing and it was obvious that I was sick.  

Have you stayed on treatment since you were diagnosed?

Yes.  I´ve been on the treatment for six months now.  I have a lot of side effects, though, and it´s been very painful.

(Judy):  You´ve got to keep at it.  You´ve made it six months, that´s the turning point for a lot of people.  Once they make it through the first six months, they can make it through the next year.

I know.  

Do you know how you contracted TB?

Yes.  I developed anorexia, and became obsessed with losing weight.  I starved myself, and became dangerously skinny, which weakened my immune system.  That´s probably why I got infected.  

(Judy):  Angela´s had TB already.  In 2003, she was diagnosed with regular TB, and she completed the full six month regimen.  The anorexia caused her to contract it again (7 years after the initial infection), MDR-TB this time.  She´s really got to be careful, she can´t afford to contract anything more drug resistant.

Watching Judy interact with the patients was very interesting.  As a former TB patient herself, Judy had sympathy for what they were going through, but also tended to take a hard line with anyone who seemed like they were hestitating to commit to treatment (in this case, mostly Raul and Angela).  In both cases, she tried to remind the patient of all they stood to lose if they failed to become healthy, and highlighted the potential consequences the decision to stop treatment could have for their loved ones.  Below is an example of a Judy guilt-trip:

You´ve got to think of your children.  When you go off the drugs, you became contagious again, and you risk spreading TB to your children.  It´s a lot harder to diagnose TB in children than in adults, and children have to be on the medicine for a longer period of time (2 years vs. 18 months).  You know how hard it is to take these treatments.  You know how much pain you´ve experienced as a result of the side effects.  Do you really think it´s fair to expose your children to that?  To know that they´re suffering, and it´s your fault?  You´ve already got MDR-TB.  That´s curable, but if you stop with the medicine and your disease gets more drug resistant, it won´t be.  What if you die?  Who will take care of your children when you´re dead?  That´s why you´ve got to stick with the regimen – not for me or the doctors who tell you to, but for yourselves, your communities, and most importantly, your children.  

It might seem a little harsh,  but it´s an honest evaluation of their situations, and Judy was not afraid to confront anyone with reality.  Hopefully, she got through to patients who were thinking of quitting.

Judy is a force of nature.

After meeting the patients, we returned with Norma to the health clinic, where Judy picked up copies of the patients´paperwork for further analysis, so she and the other members of ASPAT could decide whether they would be supporting anyone.  While she did this, the three of us talked with Norma, who showed us the drug regimen that a multi-drug resistant patient would be expected to take.  As it turns out, for the first two months of treatment, MDR patients are put on 11 different drugs to help them, which drops to 4 different drugs in the third month.  By six months, it drops down to 2 different drugs – which helps explain why those initial months of treatment are so painful for the patients, and why making it through six months is considered a virtual guarantee that the patients will finish up their treatments.  By this point, Judy had finished her paperwork so the four of us said goodbye to Norma and headed back to Callao (or Miraflores, in our case).

The amount of medicine that a patient has to take EVERY DAY for the first two months.

Bins containing each patient’s treatment regimen. The drugs are stored in the clinic because the patients come into the clinic everyday to take their medicine, monitored by Norma.

A map of the TB cases in the neighborhood around the clinic.

Tomorrow, we will be returning to Ventanilla to meet with another series of patients that ASPAT is considering supporting.  Stay tuned!

To be continued…

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Posted on June 20, 2012, in GROW Trip 2012 Blog. Bookmark the permalink. Leave a comment.

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