Hospitals in Metro Manila helping more TB patients

“ Ang payat-payat ko noon. Ngayon mataba na ako at malakas” (I was emaciated then, now I had gained weight and became stronger” – a smiling Frediric Seridio from Malabon , Metro Manila remarked. A 42-year old company driver with two children, he is on his third month of treatment for TB at a health centre in Malabon. Three months ago, he went to the emergency room of Jose Reyes Memorial Medical Center (JRMMC) due to loss of weight and weakness. Referred to the hospital’s TB clinic, he underwent series of diagnostic tests and later was found to have TB. Since JRMMC does not treat TB cases under NTP, the TB clinic nurse, Ms. Melinda Ramos, advised him to go the health centre for a six-month treatment. Within four days, he was registered and given anti-TB drugs for free under supervised treatment in the health center.

Frediric is just one of the 635 TB cases who benefited from the hospital TB DOTS initiative that started in JRMMC in June 2010. This is a 450-bed government hospital in Manila that is participating in the CATCH-TB cases project. The National TB Control Program of the Philippines, assisted by WHO and Canadian International Development Agency, implements the project.

Three years ago, most of the cases seen at the hospital were not diagnosed, treated nor notified according to NTP protocol. With trained hospital TB team (composed of 8 members headed by Dr. Elizabeth Cadena), the internal and external referral system for TB suspects and patients was strengthened. The medical technologist doing sputum microscopy was trained and the laboratory joined the external quality assurance system. A TB Diagnostic Committee reviewed the smear negative patients. Different departments such as the outpatient department and wards, refer TB suspects and patients to the TB clinic using an intra-hospital referral form. The TB clinic, in turn, refers the TB patients to the DOTS facility such as the health centre using an external referral form. These are facilities that are equipped to provide quality TB services.

The TB clinic nurse closely follows-up the outcome of referral. She does this through the reply slip, telephone call or short messaging system or popularly called “texting” either to the patient or the health centre. As a result of hospital TB team’s hard work, 96% of the cases referred went to the health centre, that registered and provided the patients with treatment under NTP protocol.

JRMMC is one of the 17 public hospitals enhancing its system and services to ensure provision of quality TB care in Metro Manila. Eight of these hospitals are also providing treatment for at least six (6) months while the rest are referring hospitals. In two years of implementation, the 17 hospitals successfully referred and managed around 10,500 TB cases.

Referral acceptance rate is almost 70%, and still increasing. Review of implementation showed evidence that hospital TB-DOTS is feasible and effective. In 2011, it is estimated that around 10% of cases reported by Metro Manila were contributed by the 17 hospitals. Hence, the NTP decided to expand this initiative nationwide. There are 1,800 hospitals in the Philippines. Hospitals are major provider of TB services. A national survey revealed that 42% of TB suspects consulted a hospital and only 25% went to the health centres or rural health units.

With the nationwide implementation of hospital TB DOTS, NTP is optimistic that this will contribute to the attainment of 85% case detection rate of all forms of TB in 2016 as targeted under the 2010 – 2016 Philippine Plan of Action to Control TB. Thus, more Fredirics will be smiling.