Managing fear

The presence of tuberculosis in some societies involves ritualistic processes to be completed to in the hope of clearing the ailment. The patient may be imbibed into this form of thinking and prefers to undergo the rituals due to fears of medicine. The fear has its base in poor awareness. The manageability of tuberculosis in these cases involves an understanding and due respect for the cultural mores of the society. The head of the society may be viewed as the source of wisdom and any hope of educating people must have the concurrence and advocacy of the head.

Secrecy

The doctors on their part must be under oath of secrecy regarding the outcomes of the tests if there is a threat to livelihood on account of tuberculosis. If the patient is cleared of posing a risk to others, there is no need to stop work. The patient must remain away from contact with others during the period before the medicines start to take effect. This communication must be managed with care and should take the family into confidence. The patient is likely to refuse to get sputum checks done for fear of the diagnosis of tuberculosis. If the patient is the sole wage earner, the survival of the family comes under pressure. Secrecy is essential to prevent employers taking a contrary stand to supporting the patient on grounds of inability to work and endangering other workers due to tuberculosis.

Assurance

The medical fraternity must assure the immediate family of the presence of rules to prevent the information of a tuberculosis being made available to outsiders. At the same time, there may be a need to carry out tests of people who have been in contact with the patient’s family. The patient must have the added assurance that outsiders are not informed of the presence of tuberculosis by the medical fraternity. The public awareness increases the possibility of a stigma affecting the entire family and information reaching the employer.

Old mores

The earlier views regarding tuberculosis highlight the possibility of spreading. These are relevant fears in the light of the absence of modern research understanding. Interior locations that have yet to see the spread of knowledge about current findings will continue to rely on old methods of management. These methods may assure that a patient is isolated but the lack of knowledge about how the disease spreads continues to make tuberculosis patients face a high mortality rate due to inadequate care.

Suspicion

Some people are suspicious about the presence of youngsters who come with information about the care of the patient and surrounding villagers. Strong paradigms about tuberculosis and the need to hold on to existing cultural mores come in the way of acceptance of the information. In such cases it is relevant to speak to the local head and explain the curability of tuberculosis through modern ways. The paternalism prevalent in these societies allow for quick acceptance of information that has been accepted by the local head. The allaying of suspicion is a pre-requisite to reaching medical care to the patient and containing the spread of tuberculosis.

Communication

A variety of notions about the management of the disease may be broken if international discussions and ideas are shared and implemented. Research on the management of tuberculosis patients to retain the ailment is necessary. Alongside this, doctors need to understand their personal needs as essential to effectively managing the disease. The need to return to work, confidentiality regarding the diagnosis due to possibility of loss of employment, rejection by the family and social group are just a few of the fears the diagnosis of tuberculosis brings with it.

Self management

The medical fraternity is the first set of people to whom the possibility of prevention of risk to their own persons must be demonstrated. A set of necessary processes to ensure minimal direct contact with the tuberculosis patients must be chalked out at a central authority and implemented across health centres. International standards in caring for the medical teams must be followed. Similarly, if the patient is to be taken care of in the house, the difficulties of the patient must be made known to the family. The pain, discomfort and loss of appetite that is shown in tuberculosis patients may lead to stressful situations to the other family members. Besides this, regular contact may lead to the spread of the disease in some cases. Family members must get checked for the prevalence of latent tuberculosis in themselves.

Communication

When communicating the implications of the disease, the care givers must be sensitive to the reactions of the family while reiterating the need that all members require to be tested for tuberculosis. This distress is worsened with the need for all individuals who have had contact with the family having to be checked for the presence of the bacteria. In such cases, discretion is dangerous since it can lead to an outbreak of tuberculosis.

Patient care

The possibility of loss of place in the family hierarchy, the fear of the effects of loss of livelihood and the incarceration on account of tuberculosis form barriers in the mind. The patient may reject the diagnosis and try to return to normalcy without maintaining the necessary discipline of taking medication. The loss of acceptance in social circles for the period of the disease and sometimes afterwards leads tuberculosis to a feeling of depression and loneliness. An effective approach to tuberculosis patient care must include an understanding of the emotional state.

Poor facilities

The prevalence of health care facilities with insufficient medicines and lack of space is a common phenomenon in poverty ridden areas. The absence of medicine comes in the way of preventing a tuberculosis epidemic while the absence of space makes isolation a difficult remedy. The rejection of the family by the local populace is a real possibility due to the fear of the disease spreading by air. Some patients may reach a stage of giving up and return to their old habits of alcoholism and drug addiction further endangering themselves and the lives of surrounding people.

Life with Tuberculosis

Despite medical advancement, the negative feelings surrounding tuberculosis abound. Families are isolated and the necessary support required for ensuring smooth recovery is lacking. Poverty and low education lead people to local doctors who claim to possess magical powers and delay the start of effective treatment. Superstitions surrounding the disease take precedence in the minds of people and the patient and lead to higher incidences of tuberculosis spread.

Young adult volunteers

Youngsters who have gone through the experience of tuberculosis and come out alive are capable of changing the thoughts and attitudes of families and communities. Volunteers from neighbouring areas should be assigned to visit locations where poverty and poor sanitation and initiate action with local authorities to clear the areas and prevent the onset of epidemics. Conducting discussions on tuberculosis and involving people in sessions that focus on the possible choices after the onset of the disease can go a long way in reducing the feelings of anxiety. Young people who are going through the experience of tuberculosis are better able to relate with others of their age and prefer to be frank in a non-judgmental environment.

Risk profile

Tuberculosis that appears in young children may point to the possibility of its prevalence in the parents. These individuals with latent tuberculosis may not appear to have symptoms but they pose a risk to others in the locality. Similarly, teenagers who are undergoing experiences that increase the possibility of developing HIV and tuberculosis need to be counselled on avoidance and safety. Cultural norms regarding sexual mores need a review since the absence of questioning leads to dangerous choices. Individuals who are already suffering from HIV must be educated on ways to improve the chances of leading normal lives and continuing to work.

Community mobilisation

Tuberculosis is a result of compromised surroundings or individual immunity or both. The presence of a single patient in a community living in close quarters, as in ghettoes or prison, increases the chances of rapid spread of the disease to others. The multiplication of sufferers affects the capability of recovery since the bacteria may mutate to bring about stronger strains in successive attacks on existing patients. All members of the community and its support systems must be made aware of the possibility of the development of tuberculosis in their surroundings if there has been contact with the community where a patient has been identified. Mass tests must be conducted rapidly among all these communities and isolation may become necessary to stem the spread.

Medicines

The consumption of medication and avoidance of a risky lifestyle is of interest to entire groups of people. If someone travels to or migrates from places with a high incidence of tuberculosis state authorities must demand immediate quarantine to prevent the spread of an epidemic. Public health authorities are concerned with the medicine consumption habits of patients and must make regular visits to the homes of tuberculosis patients to ascertain that necessary care is being taken by the individual and the family. The patient may be required to appear at the public health centre for regular checks to be sure that the right medicine choices are being prescribed by the doctor.

Empowerment

The involvement of the tuberculosis patient in the treatment and active discussion regarding choices and possibilities increases the sense of being in personal control of the disease. The doctor patient relationship must change from directive to collaborative for the long term treatment and cure. Doctors must increase their understanding of the context of the tuberculosis patient as they discuss the disease. The positive feelings exuded about the treatment and conscious involvement of the patient in developing a treatment regimen are essential to success. The patient’s feeling that the final cure lies in their own hands increases the sense of responsibility for self care that is so essential for the management of tuberculosis.

Know the body

Directing the patient towards physiological needs and symptoms that require attention is a useful method of engagement. The patient can expect to feel certain symptoms on account of tuberculosis and the medication to cure it. Some symptoms necessitate medical attention and should not be passed off as minor syndromes. Understanding the manifestation of fatigue and taking due care of rest and nutrition go a long way in curing the patient. When the primary symptoms reduce, the patient may start to feel that the fatigue is due to tuberculosis medication. There is a need to explain that stoppage of medication at this crucial juncture affects cure.

Development of faith

The presence of debilitation and feelings of depression come together. At times like this, transference of faith into the hands of an external source of energy is helpful. Belief in the treatment systems of tuberculosis coupled with faith when the body is embattled allows for the development of a sense that things will turn out all right though that is not how it feels in the present moment. Group faith healing sessions work towards developing a positive attitude in the individual and extended support system.

Existing disease

Patients who are suffering from the fear of stigma related to diseases like HIV are less willing to share the truth with others when they develop symptoms akin to tuberculosis. The medical files and reports must be maintained and provided to ensure effective treatment choices for the treatment of the tuberculosis patient. The family must rally around the patient and ensure that fears regarding disclosure are kept aside and medical attendants provided complete information. Tuberculosis often strikes patients with immune deficiency disorders and impact survival in the absence of immediate medical intervention.

Family support

Families must support the patient regardless of the circumstances that have led to the development of tuberculosis. An attitude of laying the blame on the patient for poor life choices does little to help the patient and affects the attitude towards treatment. There is no doubt of the financial strain due to tuberculosis and the family must be made to see that poor attitude in the immediate surroundings leads to poor attitude towards proper cure and survival. The family cannot afford to be critical of the patient’s condition and must consciously form an attitude of realising that their positive words and feelings can have a positive impact on the patient’s desire to be cured.

Peripheral support

Doctors, nurses, hospital staff and family members are the ones who rally round the patient and undergo the stress of finance, worry and stigma when a diagnosis of tuberculosis is made. There is a need to provide care for the care givers and understand and alleviate their suffering. Children are most likely to be affected as the stress creates neglect. The community may react to tuberculosis as it would have in the past, with a sense of fear and a desire to stay away from the family.

Care giver

Doctors and nurses are continuously exposed to a variety of diseases that threaten their immunity. Long work hours in conjunction with highly demanding jobs increase the sensitivity and pose a real threat of falling ill with tuberculosis. The emotional stresses of care givers who manage tuberculosis patients with multiple problems, that complicate the treatment, add to the severe stress and high burnout. Reduced attendance, errors in care giving and failing performance at the workplace are signs of a problem at a personal level. Some care givers have an attitude of wanting to save tuberculosis patients with many complications and undergo trauma when they perceive the failure as personal.

Families

The incidence of high numbers of tuberculosis patients in an area increases the need for external help. Care givers require attention to prevent slip-ups in care. Families need to adjust to the financial requirements and changing family responsibility patterns. Tuberculosis requires to be understood by the family and the need to provide support to the patient is essential. The adults may have to reconsider roles that have been played by each of them so that dependents if any are well taken care of. An understanding and a rejection of the stigma and fear associated with tuberculosis.

Children

Children are the worst affected since the pressure of having to take care of a parent with tuberculosis leads to increased financial burden and stress on the other. The event of tuberculosis can be confusing and distressful for young children if the elders are not taken into confidence and made aware of their context. Children with the ailment have to be made to understand why they feel a certain way and that they are getting better. There is the possibility of the child being neglected due to the absence of timely care by the family and the others in the community.

Community support

The community may refer to the neighbours and friends who stay near the tuberculosis patient’s family or to the relatives who can help without getting exposed to the possibility of infection. Caring for the young ones and providing them safe surroundings allows the elders in the tuberculosis patient’s family to focus on earning and providing care. This support greatly alleviates the stress on the family and improves the quality of care provided to the patient. Volunteering at the hospital to take care of the needs of patients is another way to reduce the burden on the medical staff and reduce the scope of error in care.

Tuberculosis patients

The declaration of the presence of tuberculosis leads to a variety of reactions. Disbelief, denial, disgust, anger, fear and depression is a common cycle of feelings in patients. Societal stigma and the possibility of familial rejection may drive the patient to a feeling of despair. Tuberculosis was once a dreaded disease with a low chance of cure and high risk of spread. This is no longer the case. Modern medicine is well able to curb the bacteria and bring about a complete cure

Isolation

At the start of the treatment, isolation may be recommended if possible. Local hospitals must have the wherewithal for isolating patients and maintaining the necessary levels of hygiene. If this is not feasible, it may be preferable to consider isolation in the home with caregivers taking recommended precautions. Tuberculosis patients are taught to regulate their habits of discarding sputum and made aware of the risks of carelessness. The breath, laughter, sneezing with or without sputum can lead to the spread of the bacteria through the air. Tuberculosis patients who have been cured may be willing to isolate themselves and care for other patients. The chance of successful treatment with reduced chance of disease spread is highest with this method.

Young patients

Children who develop tuberculosis are not recommended for isolation since the strain does not produce the communicable form of the disease. Health care workers are at little or no risk when exposed to young patients with the illness. There is a risk of the parent with the possibility undetected tuberculosis posing a health risk to caregivers at hospitals. It is recommended to provide the treatment at home with care being taken to increase the cleanliness around the patient if the local hospitals do not provide the necessary standards. In case of poverty affected families where the surrounding of the child cannot be controlled by the family, institutional care is preferable for paediatric tuberculosis. This is particularly advisable if the paediatric ward has the facilities required to keep the child engaged during the course of the treatment or if there are too many members in the family.

Mobility

Tuberculosis of the bone is a situation that leads to reduced mobility for carrying out personal functions. The patient undergoes distress as physical pain and limited scope of limb movement affect personal hygiene capabilities. This form of the ailment is not virulent to the surrounding family members but can require the extension of close support to the patient. Tuberculosis minor movements, muscle relaxation during sleep and the need to shift position in the bed can be challenges for the patient. Night sleep is disturbed as pain resurges and patient care becomes physically challenging to the care givers.

Multiple disorders

The presence of pre-existing conditions like HIV or diabetes mellitus can complicate the treatment of tuberculosis. Compromised kidney functioning requiring haemodialysis may give cause for latent tuberculosis infection upsurge. The patient may complain of digestive complaints and minor issues. At times the patient appears fine and suddenly shows rapid deterioration in a few days. This is because the tuberculosis has a rapid onset and a phase of urgent multiplying activity. So much so that by the time the problem is detected, the ailment has advanced and makes the possibility of recovery appear more and more distant.

Treatment

The traditional treatment of tuberculosis used to involve long periods of complete bed rest and isolation from society. Hill-side sanatoriums were considered suitable for the recovery of tuberculosis patients. This is no longer the case. Patients are allowed to return to work once the course of the treatment has begun. The bacteria are virulent before treatment starts and are effectively countered if the treatment is strictly followed.

Medicines

Strong doses of antibiotics are utilised to counter the various strains of possible tuberculosis bacteria in patients. The mix of medicines is maintained for a nine month period to ensure that the tuberculosis infection is completely wiped out of the body. Bodily secretions may be tested on a regular basis to ensure that the right bacterial strain is being targeted by the medication. The medicines may be changed at regular intervals to provide a multi-lateral attack on the organism.

Predisposition

Apart from the profile of poor people, teachers who are exposed to regular chalk dust entering their lungs and people who work in certain mines and factories are prone to the development of tuberculosis. Patients who undergo tremendous stress in their work life may find the development of the symptoms after a severe bout of infection. Children and adults may develop tuberculosis despite being in hygienic surroundings and consuming healthy food. Entire populations from poor countries are believed to harbour the bacteria in their bodies and this leads to the bacterial activity starting under stressful or suitable conditions.

How it works

The development of the disease is slow because the bacteria grow slowly. Often the disease appears as a mild form of ailment and the only issue is that of continuing tiredness. There are two types of tuberculosis- one that is virulent and another that remains within the body without manifesting symptoms or causing the spread of the ailment. Tuberculosis bacteria are constantly mutating and appear in strains that are resistant to known lines of treatment. Doctors often prescribe a mix of drugs to counter the problem.

Side effects

The tuberculosis medicine will play havoc with the digestive system and can leave the patient feeling lethargic. The patient may lose interest in activity and prefers to rest for long hours in the course of a day. Some tuberculosis patients experience skin discoloration and the appearance of many topical eruptions that take time to heal. The medication affects the effectiveness of contraception and calls for alternate measures. The course prescribed does not allow for alcohol consumption since it reduces the effect of the medicine.

Habit patterns

Tuberculosis patients are often advised to develop personal tools to remember the timing of their medication. This is an important part of the tuberculosis patient’s health plan. Timely medication and correct food consumption habits are necessary for complete cure to take effect. Patients, who tend to forget their treatment, attend social gatherings that compromise their treatment due to incorrect food and fluid consumption must know to plan their meals in a way that avoids mistakes in the cure regimen.

Medication

Once the diagnosis of tuberculosis is confirmed, the patient must maintain a strict dietary and rest regimen to remain on the path to recovery. This is not easy since the dosage recommended involves consuming eight pills in the course of a day for a period of nine months. The patient feels fatigued though the disease is under control. The dosage of tuberculosis medication must be meticulously maintained to prevent the development of drug-resistant strains of bacteria that make successful treatment difficult and worsen the cases of disease spread.

Lack of awareness

Patients of tuberculosis often lack awareness about the possibility of the disease returning if the medicines are not taken as prescribed. The profile of patients is normally poor, uneducated and desirous of returning to work to continue earning for the family. The absence of personal care and follow up further exacerbates the worsening and spreading of the disease. Public health officials insist on meeting tuberculosis patients on a regular basis to ascertain that medicine consumption is being adhered to.

Research on public health

Research by major agencies has found that education of patients and their families on the need to stem tuberculosis because of the potential spread and possible complications if medicines are not taken has been found to be effective. Many times, patients of tuberculosis prefer to return to their work on account of the financially constrained situation and find it difficult to remember to take the dosage as recommended for controlling and curing tuberculosis.

Reminder possibilities

Some agencies have set up the mobile reminder facility that rings at a specific time to remind the patient to consume the tuberculosis medication. Once the medicine is consumed, the patient is required to send back a code confirming it. Regularity is rewarded with a pre-agreed incentive. This is a cheaper and more effective route than the follow up of public health nurses. The patient is not to be isolated when the treatment starts taking effect and regular work starts. Family members may take turns to call the patient to consume and confirm that tuberculosis medicine has been taken.

Community centres

Tuberculosis care initiatives are often taken by states to stem the spread and conversion to an epidemic. This is possible when the line of communication involves the larger community. The maintenance of basic hygiene, spreading awareness of infected sputum in the vicinity and educating patients about the possibility of complete recovery are good ways to motivate tuberculosis patients and counter the disease. Friends and relatives of the tuberculosis patient who have been in contact with the patient in the recent past must be informed of the diagnosis and checked for the possibility that the disease has spread to them.

abdominal pain

Mycobacterium tuberculosis appears a in a number of organs, a few of which are explained here. Be aware of the different types of symptoms in order to take necessary precautions in time. In case of the slightest doubt on account of the continuation of symptoms, visit a physician for the necessary tests. Though this disease is prevalent it may affect any person at any time. ‘affluent tuberculosis’ may affect a person with limited exposure to sunlight. Sometimes, symptoms appear mild and continue to present themselves without causing upheavals and creating a sense about the need for immediate care. This results in lack of timely and sufficient care being provided to the patient. The condition may develop due to poor immunity though the surroundings are clean.

Lungs

Tuberculosis commonly attack the lungs. A cough that will not go away, low grade fever that appears for a long time, increasing weight loss, body pain and occasional appearance of blood in the sputum are the common symptoms of the incidence of tuberculosis. Night time may see bouts of intense sweating that leave the patient terribly weak and lethargic. Medication for cold and fever should not be provided when there is continuous low grade fever since they tend to hide the symptoms. If a set of symptoms appear that seem to be similar to the description, a doctor must urgently be contacted.

Tuberculosis of the bones

A patient who faces an inability to bend because of rigidity in the limbs may be a victim of tuberculosis. Other symptoms like low fever (around 99 degrees F) that appears in the afternoon along with back pain and local tenderness on the limbs must be considered as the possibility of tuberculosis. Typically the patient shows distinct weight loss and a severe loss of appetite. There may be occasional night sweats and the patient complains or there is a noticeable of difficulty in sitting for extended periods of time.

Lymph nodes

Lymph nodes constitute the drainage system of the body and can be attacked by tuberculosis. The incidence of bilateral swelling on the neck, underarm or groin must be treated as an urgent symptom. If the points show slow growth of nodes with the occurrence of continuing fever, it is a possibility of tuberculosis infection. A persistent cough may be treated as a confirmation for a test for the ailment. The doctor must carry out a fine needle aspiration of the swelling to send for testing and confirm or negate the presence of tuberculosis. The line of treatment must start on the receipt

Abdomen

If there is severe abdominal pain coupled with swelling in the area and irregular bowel movement, this may be a sign of the presence of tuberculosis. If there is sudden and rapid weight loss along with low fever that appears at a fixed time of day, a doctor visit and requisite tests are necessary to rule out the tuberculosis. A culture of abdominal output is checked for the growth of bacteria for three weeks to confirm the diagnosis.