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Issue 1, July-September 2012
Life of an inmate with TB
several months and took only symptomatic medications. He felt loss of
appetite and experienced weight loss
and had to seek consultation at the
jail’s clinic. It was the first week of
July 2011 when he was subjected to
sputum examination. The specimens
are collected at the clinic and sent to
the City Health Office for smearing,
staining and reading.
sputum exam in July of same year.
Results were negative so he was
considered a non-TB case until the
condition recurred in October once
again, his repeat sputum exam revealed negative results.
It was only in December when he
was subjected to Chest X-Ray that
he was treated with anti-TB medications.
The result came out negative so he
was prescribed with antibiotics for 2
weeks and repeat sputum exam was
done. Result after a week again revealed negative so he was advised to
The WHO support staff of the Deundergo Chest X-Ray. It took more
tecTB Project was able to interview
two prison inmates of Puerto Prince- than a month for Rolly before he was
sa City Jail. For the sake of confiden- diagnosed of TB and started on
tiality, we will call them by the names DOTS.
of Rolly and Eddie. Rolly is 57 years
old, was born in Bicol and migrated to Eddie on the other hand, was not that
lucky as Rolly. Eddie is 28 years old,
Palawan when he was 3 years old.
a native of Ilocos region, and was
He worked as a carpenter until the
brought here by his sibling to work as
day he was convicted of rape and
a household helper but unluckily was
was sentence to serve term at Puerto
involved in the murder of their emPrincesa City Jail.
ployer. While in jail he experienced
He experienced on and off cough for cough, loss of appetite and weight in
April of 2011. He was subjected to
D
These are just two cases of prison
inmates who have experienced delays of TB diagnosis because they
are screened late by X-ray examination.
DetecTB project gives priority to
these people because the project
believes they don’t deserve delay in
TB diagnosis. One of their jail officers
was already trained in sputum smearing and once the project starts implementation, the city jail’s more than
400 inmates will be the first beneficiaries of the One-Stop DetecTB Service where TB will be diagnosed with
new high-tech diagnostic methods
with the same day.
What is DetecTB Project?
etecTB stands for
“Diagnostic Enhanced
Tools for Extra Cases
of Tuberculosis”. The
project is funded by the Korea Foundation for International Healthcare
(KOFIH) in collaboration with the
Department of Health, World Health
Organization, Korean Institute of TB
and the local government units of
Palawan Province and Puerto
Princesa City.
Flourescence Microscope (LED-FM)
and molecular identification of TB
bacilli through the Genexpert. With
the use the following technology, the
project also aims to improve the
turnaround time for TB diagnosis to
only within one day. The current
NTP protocol takes about a week or
more to diagnose TB, depending on
the need for Chest X-ray and referral to the TB Diagnostic Committee
(TBDC).
The project’s main objective is to
increase case detection of all forms
of TB to 10% or more in target
areas. The project will employ modern, fast and reliable diagnostic
equipment such as digital Chest
Radiography, Light Emitting Diode-
The mobile clinic
Delivery of the DetecTB services is
through a mobile clinic equipped
with the abovementioned diagnostic tools. All the diagnostic equipments are available inside the mobile clinic including X-Ray Machine
connected to a computer for digital
imagery. The laboratory, aside from
the LED Flourescent Micrscope and
Genexpert machine also has a slide
warmer, biosafety cabinet and refrigerator where sputum can be stored
temporarily. The Genexpert machine
is attached to a UPS to ensure nonwastage of cartridges in case of
power interruption which is common
in the province.
DetecTB: INNOVATION In TB Detection
Target Population of DetecTB
The marginalized sector and people
highly vulnerable to Tuberculosis
more often have poor access to TB
diagnostic services. These include
the indigenous peoples, prison inmates, urban and rural poor, and
people living in congested communities.
The project aims to give priority to
these groups in the conduct of TB
case finding when the DetecTB operate in the field. Palawan has a high
number of indigenous peoples which
include Palawan, Tagbanua, Batak,
Tau’t Bato, Panimusan, Molbog,
Cuyunin and Agutaynin. The Municipality of Aborlan, which is adjacent to
Puerto Princesa City and an hour
drive from the heart of the city has
the most number of indigenous peoples which accounts for about half of
the population of the town.
With regards to prison inmates, Iwahig Prison and Penal Farm is one of
the institutions managed by the Bureau of Corrections that has a large
population of around two thousand.
Also within Puerto Princesa City are
two prisons where each team can
conduct their active case finding
among inmates. These are the Palawan Provincial jail which has an average population of 800 and Puerto
Princesa City Jail with around 400
inmates.
Mobile teams’ training in Korea
The Provincial Health Office (PHO) of Palawan and City Health Office (CHO) of Puerto Princesa City each formed
a team which is composed of two Physicians, one Nurse, one Medical Technologist and one Radiologic Technologist.
Palawan PHO
Dr. Louie Ocampo, Team Leader
Dr. Eduardo Cruz
Ms. Pamela Garcia, Nurse
Mr. Cyrus Caabay, Medical Technologist
Mr. Herminio Bitara, Jr , Radiologic Technologist
Puerto Princesa CHO
Dr. Juancho Monserate, City Health Officer
Dr. Janeth Reston, Team Leader
Dr. Dean Palanca
Ms. Mary Joy Tianchon, Nurse
Dr. Francisco Ogsimer Jr., presenting the
DetecTB Operational Guidelines.
WHO/WR-PHL staff under the supervision of Dr. Woojin Lew, STB Medical Officer. In the succeeding days,
the team members had separate
sessions with experts from Korean
Institute of TB (KIT) and Korea National TB Association (KNTA) depending on their professional role in
the mobile team. The physicians
were acquainted on reading digital
Chest X-ray images of TB cases, the
medical technologists on how to
operate the Genexpert and the radiologic technologist on the digital X-ray
machine.
The two teams together with the
WHO-KOFIH Project Coordinator,
Dr. Francisco Ogsimer, Jr., were
sent to Korea for two weeks, May 28
- June 9, 2012 to train on the use of
a mobile clinic. First days were spent The team was able to witness operaon the discussion of the Operational tions of a centralized X-Ray reading
Guidelines which was developed by facility where digital images from
different health care facilities and
institutions are received through the
internet. The two teams also had the
opportunity to observe how the mobile clinics of KNTA operated in two
institutions, one that cares for the
elderly and a school for college students.
Dr. Woojin Lew, discussing the DetecTB Diagnostic Protocol during discussion of Operational
Guidelines.
2
Advocacy Meeting with Local Officials
O
ne of the criteria for selecting
target areas by the PHO and
CHO is the 2011 case detection rate.
Among the municipalities selected
are mostly from the southern part of
Palawan namely: Aborlan, Narra,
Rizal, Espaňola, Bataraza, Brooke’s
Point and one from the north, Taytay.
The DetecTB team of Palawan Province together with the WHO-KOFIH
Project support staff visited every
municipality from July 16 – 20, 2012
to conduct courtesy call and advocacy meeting with the local officials.
Mayor Jaime Ortega of Aborlan and
Mayor Zenaida Gomez of Espanola
were among the local chief executives (LCEs) whom the team were
Target areas of Puerto Princesa City
able to talk with during the visit.
include the four Barangays with peMayor Ortega even encouraged the
nal colonies such as Iwahig, Sta.
Barangay Officials of Aborlan to proLucia, Montible, and Inagawan and
vide necessary support during the
those with big population of targeted
implementation of the project.
group namely Tanabag, Concepcion,
Bagong Silang, Langugan, Mabuhay In other municipalities, the Sanguniat Pagkakaisa.
an Bayan members (municipal coun-
Aborlan Mayor Jaime Ortega addressing his constituents during
one of the advocacy meetings held July 16, 2012 at Magsaysay
Hall.
cilors) and Barangay Officials were
present. The WHO-KOFIH Project
Coordinator provided information
regarding the project and solicited
the needed support from their end.
Part of the advocacy meeting is the
signing of the “DetecTB Pledge of
Commitment and Support”.
The City advocacy meeting was held
in Asturias Hotel on September 4,
2012. This was attended by Vice
Mayor Lucilo Bayron and SB Member Miguel Cuarderno. Ms. Hyun
Kyong Kim, Manager of Project
Operations of KOFIH was present to
discuss a brief introduction of KOFIH
as the funding agency.
Dr. Ogsimer, Project Coordinator and Dr. Ed Cruz
having courtesy call with Mayor Zenaida Gomez of
Municipality of Española.
Ms. Hyun Kyong Kim, presenting the Introduction of Korea Foundation for International
Health Care (KOFIH) during City Advocacy
Meeting.
Orientation/Training of target areas’ health
workers and field assistants
day orientation / training among selected health workers to provide capacity to assist in field operations.
September 5, 2012, both in A&A
Hotel, Puerto Princesa City.
The participants were oriented on
the project operations and several
forms that will be used. They were
also taught on how to perform several procedures and their role when
the team visits their area.
In the conduct of field operations,
some health workers of target areas
will be requested to assist the mobile teams. These will include organizing of clients, conduct of interview, signing of consent, health eduFor the Provincial team the activity
cation and others. The WHO-KOFIH
was conducted on July 24, 2012
project support staff together with
the DetecTB teams conducted a one while the City team was done on
3
DetecTB: INNOVATION In TB Detection
Field Training
Prior to the actual field implementation,
the DetecTB teams were able to experience actual field implementation under
the supervision of technical experts from
WHO and Korea. The WHO, through Dr.
Woojin Lew and a Korean team observed
the DetecTB teams’ field performance.
The field training was done on August 27
- 31, 2012 at the Provincial Jail and Puerto Princesa City Jail. Several inmates
were requested to act as subjects for this
purpose. Both Provincial and City teams
were able to serve 212 inmates within a
period of four days.
Dr. Hee Jin Kim, headed the Korean team during
field training.
The last day, August 31, was utilized to
discuss technical issues and concerns
that need to be addressed. The activity
was conducted at Skylight Hotel in Puerto Princesa City.
How will DetecTB operate?
The two teams will use the DetecTB
service bus alternately for one week.
Coordination will be done with local
officials at least one week prior to
the field visit. Initial target for the first
few months of operations will be 50
clients per day. The teams will setup a suitable area to accommodate
clients. In case there are no covered
working area (e.g., covered court or
gymnasium), available canopy tents
will be used. The WHO project sup-
port staff will oversee the operations
of the two teams and will report and
coordinate all activities to major
partners.
4
Training of Smearers
Health Workers practicum on sputum smear preparation.
Ms. Cadiente, facilitated the recapitulation of day 1 training, prepared questions were written in pieces of paper for the participants
to pick and answer.
One of the identified needs for
field activities are additional
human resources such as
smearers who will assist the
Medical Technologist in doing
smearing of sputum for LEDFM reading. In case of high
workload, the Medical Technologist might not be able to cope
with all the task, thus, the DetecTB project decided to conduct a training of smearers
who will help the Medical
Technologist in the conduct of
smear preparation.The Medical
Technologist will perform two
confirmatory test for TB, sputum microscopy and Genexpert.
from Iwahig Prison and Penal
Farm and Puerto Princesa City
Jail which are two of the priority sites of the project.
The WHO-KOFIH Project support team together Palawan
PHO and Puerto Princesa
CHO facilitated the conduct of
the training of smearers which
was attended by 12 Barangay
Health Workers from target
municipalities (Rizal, Taytay
and Aborlan), 3 selected laboratory aides from the City
Health Office, one nurses each
Facilitators of the training were
Mr. Cyrus Caabay, Provincial
Mobile Team Med. Tech, Ms.
Jocelyn Calalin, City Mobile
Team Med. Tech, Ms. Jojie
Cadiente, Carmona Med.
Tech, Ms. Pia Crisolo, Rizal
Provincial Med Tech, and Ms.
Rio Oriel, Laguna Provincial
Med Tech.
The training was conducted at
Bulwagang Princesa Tourist
Inn and Restaurant on September 25-27, 2012. The training provided capacity to the
participants in performing quality sputum smearing taking
into consideration quality assurance system standards.
Several participants were not
able to join the training due to
flooding in most parts of Palawan cause by heavy rains before the start of the training.
the project. The Puerto Princesa City tory and Ms. Jocelyn Sosito, Senior
launching was held at Asturias Hotel Health Program Officer of Bureau of
in the afternoon.
International Health Cooperation.
Included among the Korean continHeads and representatives of partner
gent are officers of KOFIH and meagencies graced the two events.
dia reporters who covered the story
These inlude Dr. Pauline Jean Rosell
and conducted interviews of key perUbial, Assistant Secretary of the
sonalities.
DOH; Dr. Gloria Balboa, Director of
Center for Health Development 4B;
The following day after the launching,
Dr.
Lee
Soo-Ku,
President
of
KOFIH;
the DetecTB teams conducted a
DetecTB Launching
Mr. Ahn Jeong In, Director of KOFIH; demonstration of the field operation
The project was officially launched on Dr. John Patrick Ehrenberg, Director in the Provicial Jail. This was witSeptember 18, 2012 with two sepaof Combating Communicable Dinessed by the Dr. Lee Soo-Ku and
rate ceremonies for Palawan Prosease Division of WHO-WPRO; Dr.
other officers of KOFIH.
vince and Puerto Princesa City. The Woojin Lew, Medical Officer of
Provincial launching was held in the StopTB and Leprosy Elimination of
morning at Legend Hotel which was WHO/WR-PHL.
hosted by the Honorable Governor
Included among the guests are DOH
Abraham Kahlil V. Mitra who delirepresentatives namely Dr. Rosalind
vered a speech expressing his support to the project and committing to Vianzon, Manager of the National TB
Program, Dr. Noel Macalalad, Head
utilize whatever resources the Province have to ensure the success of of the National TB Reference Labora-
5
The WHO Philippines– DetecTB: INNOVATION In TB Detection
Dr. Soe Nyunt-U, WHO Representative in the Philippines
Dr. Woojin Lew, Medical Officer, STB – Leprosy Elimination
Madeleine Oriondo, Secretary
Dr. Francisco Ogsimer Jr., Project Coordinator, WHO-KOFIH Project
Lenie Infante, Project Assistant, WHO-KOFIH Project
Korea Foundation for International Health Care
Hyunkyong Kim, Manager
Chanhee Kim, Deputy Manager
Palawan PHO
Dr. Louie Ocampo, OIC-PHO,Team Leader
Dr. Eduardo Cruz
Pamela Garcia, Nurse
Cyrus Cecilio Caabay, Medical Technologist
Herminio Bitara Jr., Radiologic Technologist
Puerto Princesa CHO
Dr. Juancho Monserate, City Health Officer
Dr. Janeth Reston, Team Leader
Dr. Dean Palanca
Mary Joy Tianchon, Nurse
Jocelyn Calalin, Medical Technologist
Walter Gonzales, Radiologic Technologist
The DetecTB project is funded by the Korea Foundation for International Healthcare (KOFIH) in collaboration with the World Health
Organization, Department of Health, Korean Institute of TB and the local government units of Palawan Province and Puerto Princesa
City
.
For questions, suggestions or concerns, please contact WHO-KOFIH Project through:
Address: G/F Building 3, Department of Health Compound, Sta. Cruz Manila