 Interview with Judith Oulton, CEO, International Council of Nurses
Unlike HIV/AIDS, which receives a great deal of attention, tuberculosis efforts are often inhibited by lack of visibility and not enough political leadership. How does this problem manifest itself and what are the implications? HIV/AIDS is a much newer disease about which less is known. TB, having been around for centuries, and known to be preventable and curable, is less frightening for societies, despite the fact that every year, about two million people die from TB, and another 9 million are infected. In 1993, the World Health Organization, (WHO) declared TB a global emergency, and today it is an important focus of the Global Fund to Fight AIDS, Tuberculosis and Malaria. We are fortunate to have accessible, inexpensive treatments that are effective in up to 95% of cases. At the same time there is increasing global concern about drug resistance. There are an estimated 400,000 new cases of MDR-TB every year. Clearly, this pandemic requires a massive mobilization of people and resources. Governments’ role was outlined in the TB resolution endorsed by the World Health Assembly in May this year. Agreed activities aim to accelerate progress towards halving TB deaths and prevalence by 2015 through full implementation of the Global Plan to Stop TB 2006-2015. As well, WHO Member States are urged to develop and implement long-term plans for TB prevention and control, in line with the WHO Stop TB Strategy. Many organisations are supporting prevention, treatment and research into TB at a national and international level and are now working together (e.g. CDC, WHO, IFRC, PIH, etc.) None is more important than the Lilly MDR-TB Partnership and Lily’s funding and programmes with the shared goal of saving lives by preventing and treating multi-drug resistant tuberculosis (MDR-TB). As a nurse, how did you become interested in TB? I grew up in an era where TB held much mystery and stigma. People with it went "to the san" - meaning sanatoriums and you were cautioned to stay away from some families and their children. As a student nurse I was tested and received BCG though still with limited understanding of the disease. My interest grew when close family friends were infected and as I encountered patients in hospital and began to realise how easily lives could be changed and resources saved with knowledge and political will. Today, working for the International Council of Nurses (ICN) one cannot ignore the immensity of the problem, representing as we do more than 13 million nurses and 129 countries. Moreover, about 3 million nurses work or are registered in the 22 countries with the highest burden of TB. Nurses are usually the first - and frequently the only - health care professionals to see a patient with TB in high burden countries. Therefore, a big impact on TB control and care can be realized by strengthening nurses’ expertise. How do the International Council of Nurses and Eli Lilly work together to combat tuberculosis? ICN and nurses on the ground can play a key role in prevention, in delivering therapy, improving compliance and helping reduce suffering and control resistance. Lily understood this and reached out to ICN to engage nurses as part of their commitment to prevent and control MDR-TB.· Lilly provided an unrestricted educational grant to support ICN in developing TB guidelines and a training of trainers program for nurses in high burden countries so that they will be mobilized, motivated and equipped for TB and MDR-TB. Thanks to this vital training program nurses in Malawi, the Philippines, Russia, South Africa and Swaziland have been equipped with the knowledge and skills to deliver improved prevention, case detection, care and treatment for the individuals and communities living with TB prevention and care. An online Global TB/MDR-TB Resource Center has been launched to provide multiple tools for nurses in treating and caring for patients. These include:TB guidelines, fact sheets on TB in the workplace and TB stigma, discussion rooms for health care providers, a patient talk forum and policy statement. The Lilly Partnership is the only philanthropic MDR-TB program that combines early detection and treatment, health care worker training, surveillance, community and patient support, and transfer of drug manufacturing technology to companies in developing countries. Why are all of these elements essential to a successful partnership? You cannot successfully abate or eliminate this disease and, as importantly, minimise its impact on patients without the full gamut of players. Addressing one element alone is not enough. Providing the technology without understanding who, how, why and how they are needed, simply wastes resources. Only an integrated approach involving a full range of private and public players - health care professionals, academia, patients, advocacy groups, governments, international organizations, donors and the pharmaceutical industry can address the expanding global crisis of TB and MDR-TB. Our experience is that partnership enhanced collaboration on the ground extends resources, influence and outcomes. For example, in South Africa, ICN and the International Hospital Federation cross-fertilised their training of nurses and hospital managers to ensure a more robust implementation of the new skills and knowledge. In Russia, we were able to integrate into the Partners and Health programme in Tomsk, where they badly needed nurse training programmes. And later this year all the partners will be delivering an inter-professional workshop on health care worker and workplace safety at the Union conference in South Africa. Lilly’s TB program also emphasizes that it is important for health workers to go on to train others in health centres, hospitals, and universities. Why is it important to share information and promote knowledge dissemination? We know that access to current information is essential to effective, prevention, treatment and care. We also know that education and training funds are wasted if we do not ensure sustainability, and only quality initiatives, championed locally and provided regularly, are truly sustainable. That is why the training of trainers approach is ideal. It equips the health care provider to train others working in their facilities regionally. Through this programme, more than 100 nurse trainers have been equipped with the capacity to train other nurses. Each nurse has committed to preparing a further 20 nurses. This means that in the space of just 2 years a minimum of 2,000 nurses can be trained. The ICN training of trainers program provides nurses with powerful knowledge skills, tools and practice to develop and implement effective training programmes to build nursing capacity in TB/MDR-TB. |
