Cambodia: MSF's nurse manager describes the challenges in managing TB
“Africa was my plan. Even in my interview I said that Africa was my preference,” Helen said. “But when Médecins Sans Frontières (MSF) called they offered me Cambodia. I had to talk myself into accepting. But to be honest, there was no way I was going to turn it down,” she said. Helen has now worked as MSF’s TB Nurse Manager at Kampong Cham Provincial Hospital since October 2013.
In that time Helen has seen many challenges such as “witnessing the extreme levels of poverty every day, the lack of resources and seeing people die from preventable diseases,” she said. As the nurse manager for the TB department, Helen manages both the outpatient area and the inpatient area, which is divided into two: one for confirmed cases of TB and the other for suspect cases and paediatrics, which are kept separate from the confirmed adult cases.
“I am also involved in the DR-TB (drug resistant) programme which very much has a home-based care aspect to it,” Helen said. “And I do a lot with health promotion – going out to schools and villages and raising awareness about TB.”
Second highest rate of TB in the world
Due to the enormous prevalence of TB in Cambodia—the second highest in the world with a rate nearing 800 per 100,000 of population—health promotion is critically important. “The prevalence is so high that everyone has some knowledge of TB. But it’s more basic knowledge,” Helen said.
“It’s very much ‘yes we’ve heard of TB, we know it’s a cough’, but that’s all,” she said. And as a country with such high levels of poverty, malnutrition is also playing a devastating role in Cambodia. “Tuberculosis is a disease of poverty and malnutrition is very connected to it,” Helen said.
'People are malnourished'
“People are malnourished so their immune system is suppressed. And then with TB, you don’t eat so you become weaker,” she said. “People who weighed 50kg now weigh 35kg or even 30kg and children who are badly stunted and who look five years younger than they are.”
An example of this was a 13-year-old boy that Helen got to know early in her mission. “I didn’t believe he was 13. I actually thought he was seven, he was that malnourished. You could see every breath he took. The skin was sucking in through his ribs,” Helen said. “I went to see him every morning for a week but when I arrived one day his bed was empty. He was too weak and had died. It was a real shock.”
The poverty and lack of resources also reveals just how difficult the battle against communicable diseases can be, such as the slow rise of MDR-TB (multi-drug resistant) which, while not yet critical, cannot be ignored. However the treatment between developed and developing countries is contrasting.
In developed countries, if you have MDR-TB you are placed in isolation for as long as six months or more, until none of the bacteria is left in your body – something that needs to be laboratory confirmed. “Here in Cambodia, once your clinical condition is stable, treatment has commenced without problems and treatment support is arranged in the community, you simply go home and are advised to stay away from your family, to not eat with them, to sleep apart from them,” Helen said.
But despite the challenges, finding and treating people with tuberculosis in Cambodia does and will continue. Helen’s work in Cambodia will also continue. Despite her original desire to work in Africa, Helen asked for her Cambodia mission to be extended. Her request was recently approved.
“I think there’s hope for the overall picture with TB in Cambodia. In 2012 WHO announced that TB rates in Cambodia had halved in the past decade and while we still have one of the highest rates of TB in the world, they continue to decline,” Helen said. “I think MSF's involvement has played a part in this success.”