Delivering Tuberculosis Care On A Motorcycle

By Kai T. Hill

Revving up a motorcycle packed with tuberculosis test kits gives Aladin Ali a sense of empowerment.

A village council member in the eastern Philippines, the 35-year-old has long felt his community's despair in not having adequate access to health care.

The population in Buluan in the province of Maguindanao is composed mainly of marginalized farmers and fishermen. Economic setbacks, along with a lack of infrastructure and — in large part — transportation, hamper the local communities' access to health services that are available. The area's mountainous terrain and marshy lowlands make traveling even short distances time-consuming.

That's why bringing testing, transportation and treatment to the doorsteps of residents has shown early success, especially as the region battles an alarming rise in tuberculosis.

Already working in areas of child health, Catholic Relief Services and our local partners established the Maguindanao TB Control project in 2005. The project uses innovative ways to bridge gaps in overall health care, with a focus on stemming tuberculosis.

Expected to serve over 475,000 residents by 2009, the project partners with the province's Integrated Provincial Health Office to detect tuberculosis early and increase cure rates in 28 municipalities. Funding from the U.S. Agency for International Development has also helped to upgrade existing medical facilities, hire additional medical technicians and provide training for proper testing and handling of samples. Aladin, a farmer by trade, is a gracious volunteer who uses his motorcycle to transport test kits, lab results, medicine and even patients to clinics.

"I am truly happy when I am able to help people in need," said the father of two, who underwent extensive training in sample collection and lab preparation. Because of such training, medical technicians can perform testing and read results for a more accurate diagnosis.

A Rising Epidemic

The World Health Organization estimates that the highest percentage of new tuberculosis cases in 2005 — of the worldwide total — occurred in Southeast Asian countries such as the Philippines. The island nation now ranks as one of the health agency's target countries for addressing tuberculosis.

The contagious, airborne bacteria attacks the lungs and can be fatal, but is curable given adequate testing and treatment facilities. Unfortunately, the situation in rural areas of the Philippines isn't ideal. Many government-funded health centers are more than five hours' walking distance from rural communities. "These are poor people who struggle to buy a bus ticket," says Elena McEwan, a senior CRS technical advisor for health. She also notes that faulty test results and miscommunication between private and public health providers create further setbacks.

Health Care On Wheels

Much of the problem in Maguindanao stemmed from the lack of access to health facilities. Therefore, project coordinators built services using existing modes of transportation in the community. What is dubbed "microscopy on wheels," as a major component of the TB Control project, uses commercial drivers and vehicle owners, like Aladin, as transporters. The extra workers and volunteers help man the region's existing free health care centers, increasing staff availability for walk-ins and patient care.

"CRS and partners identified barriers and developed a plan with [the locals]," says McEwan, who surveyed residents during the project's mid-term evaluation to identify areas of improvement.

In the more than two years since the project started, the efforts have already proven successful. Tuberculosis detection rates for the entire province increased from 70 percent in 2005 to 81 percent for 2006. The cure rate also went up by 6 percent from 2004.

McEwan credits the results in part to the willing volunteers.

"These are ordinary people living there with a special gift to help others. They are people who commit to do extra work and have willingness to learn new skills," she says.

Dispelling Myths

Involving community members in this project has helped lessen stigma and create open dialogue about health issues.

In early stages of the project's planning and community research, health workers found that many residents were generally aware of some of the symptoms of tuberculosis, yet had developed their own belief systems about the disease. Most thought a sick person should be kept in a ventilated room. The stigma against tuberculosis also ran high, as 61 percent of those surveyed said they avoided people with tuberculosis or segregated the eating utensils of sick family members. Others attributed sickness to evil spirits.

Those cured of tuberculosis or being treated are encouraged to join support groups to help foster awareness within their families and the wider community.

These activities are paying off. "They are less afraid of seeking care when they show TB symptoms," McEwan says. "It's like a happy ending marriage."

Our Work in the Philippines

CRS has been working in the Philippines continuously since 1945. In addition to addressing health, the agency provides relief to victims of emergencies, and conducts programs in peace and reconciliation, enterprise development, agriculture, and natural-resource management.

Kai T. Hill is an associate web producer for CRS. She works in the Baltimore headquarters.