Visit to Tuberculosis Clinic

Today I had a visit to a Tuberculosis clinic with one of the public health professors from Hacettepe University and a few public health students. The clinic is run by three doctors and four nurses and follows about 50 regular patients. The main purpose of the clinic is to both identify cases and treat cases of Tuberculosis in Ankara. I believe they said that there are seven clinics total in Ankara. Tuberculosis used to be a major public health problem in Turkey. Now the problem is lessened, but there are still a significant number of cases in the country, especially in the most populated areas like Istanbul and Ankara. The doctor we met with at the clinic said that they do get quite a few cases of drug resistant Tuberculosis and Multi-drug resistant (MDR TB) Tuberculosis in Turkey. I believe that she also mentioned a recent case of Extreme multi-drug resistant TB in Turkey, though she said that most of those cases are being imported from Russia. The clinic follows the DOTS (Direct Observed Treatment, short-course) method of treatment. This is the method recommended by the World Health Organization for treatment of TB (http://www.who.int/tb/dots/whatisdots/en/index4.html). The main point of DOTS is to have health personnel observe the patient each time that they take their medication to ensure compliance and completion of the course of treatment. This is extremely important for TB, because not completing the course of treatment is what has lead to the evolution of drug-resistant forms of TB. She said that normal cases of TB involve a course of treatment that lasts about 6 months, and drug resistant forms can have treatment lasting up to two years. It can be difficult to remain vigilant and continue a course of treatment faithfully for such an amount of time and people will often stop taking the drugs once the symptoms disappear. The DOTS method creates a system of accountability that has proven to be very successful with TB patients. The clinic we visited in Ankara has patients come into the clinic to take their medications in front of a doctor or nurse to ensure that the medications are taken. Those who live too far away to travel to the clinic frequently have their drugs shipped to their family doctor who will conduct the treatment. The patient has to come into the office to take the pills under observance. They have to sign a record each time that says they have taken their pill and the nurse or doctor also has to sign off that the patient has taken their pill. Family members and contacts of TB patients are also tested and sometimes given preventative treatments to avoid the spread of the disease.