While visiting several organizations in Pakistan, I joined current and former patients and their families, local and international celebrities such as Miss Zeba Bakhtiar, and staff in a ‘Open House’ event at the new TB care facility of Indus Hospital on March 23, a national public holiday.
“We really held this event for the patients. Today’s about them,” commented Tariq Qaiser, the building’s chief architect. Patients took a tour of the facility, learning what to expect when they soon returned for appointments. Some shared their struggles with the illness, the difficulties in accessing effective treatment and their gratitude for the program, while others won prizes by answering trivia questions on TB. The hospital leadership provided words of encouragement to current patients and congratulated those who had successfully completed their treatment course. Hundreds traveled several hours to attend the event. Excitement was palpable, one patient rejoicing “This is just like a picnic!”
Dr. Abdul Bari Khan, CEO of Indus Hospital, speaking at the event.
Pakistan is ranked 8 out of 22 high burden TB countries, and accounts for an estimated 57% of MDR-TB in the WHO’s Eastern Mediterranean Region, with 250,000 TB cases reported in 2008 by the National Tuberculosis Program, or 181/100,000.
According to the most recent WHO report on MDR-TB, many countries including Pakistan do not have sufficient surveillance infrastructure to accurately assess their burden of MDR-TB; only 59% of all countries have been able to collect high quality, representative data on drug resistance. When not diagnosed properly – the WHO estimates that only 7% of patients with MDR-TB are diagnosed worldwide – patients end up taking the same regimen multiple times which leads to resistance.
Built primarily with local materials, the new TB facility combines a regal design with expert advice on infection control, and applies recent lessons learned on natural ventilation by providing a shady outdoor waiting area with stone benches and an open structure allowing for a constant natural breeze. Though still controversial and not always possible or reliable depending on climate and varying conditions (wind direction, seasons, etc.), “there has been an outpouring of enthusiasm for the natural ventilation approach,” notes TB Infection Control expert Dr. Ed Nardell. Dr. Aamir Khan, Executive Director of Interactive Research and Development, a partner of Indus Hospital in several of its service-research initiatives including MDR-TB, commented,
This building is a testament to Indus Hospital’s mission of providing quality care to all its patients with dignity, completely free of cost. My hope is that this building is known not just for its striking architecture, but for the integration of airborne infection control and the functionality of every day use. It inspires me to do more, faster and better for the control of drug resistance TB in Pakistan and the developing world.
Open structure allowing for a constant natural breeze
Indus’ TB treatment model includes lay-people in the community who provide treatment support, and the use of a sophisticated electronic medical record system developed using the open-source technology OpenMRS. In addition, Indus’ partners at Interactive Research & Development are currently working to integrate cell phones with the EMR system to allow community-based staff to access and enter patient information in their daily activities. As the program expands in Karachi and is potentially replicated elsewhere in Pakistan, having a robust delivery model that includes smart management of information will be critical to patient adherence necessary to effectively combat MDR TB.
Opened in 2007 with the aim of providing high quality care at no cost to patients, Indus Hospital also provides specialized services such as orthopedic surgery, dialysis treatment, and angioplasty – services whose prohibitive costs make them unaffordable to many poor patients, or come at the expense of selling all one’s property. Over the past two years, several new departments were added, and Indus’ leadership is now strategizing about how to increase the care it delivers at the community level.
From TB infection control issues to management of MDR-TB treatment, many of these topics are addressed by GHDonline members. We invite you to discover the following discussions and resources on GHDonline:
- Importance of ceiling height in a common ward
- Glass-protected counters for patient reception area?
- Passive ventilation using stack effect for Health Facilities in resource-limited setting
- Isolation rooms for MDR-TB patients: Window and design details
- Discussing issues for TB Lab Proficiency Standards
- External quality assessment for TB Lab
- Psychosocial support for MDR-TB patients
- MDR-TB treatment outcome
- N95 Masks and Personal Respiratory Protection challenges and recommendations
- Recommendations and trouble-shooting for Ultraviolet germicidal irradiation (UVGI)
