The multidisciplinary team facing the multidrug resistant form of Tuberculosis in the state of Amazonas (Brazil)

UNDP Tuvalu/Aurélia Rusek A 25 year-old tuberculosis patient is treated at her home in Funafuti, the main island of Tuvalu in the South Pacific.

This article was exclusively written for The European Sting by Ms. Camila Fonseca Carneiro, a third-year medical student at the State University of
Amazonas, Amazonia, Brazil. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

Dating studies with carbono 14 suspect the existence of tuberculosis-compatible bone lesions from 5,000 BC in Egypt. In comparison, the current prevalence of tuberculosis has led to the inclusion of disease eradication in the “Millennium Development Goals” implemented between 1980 and 2015. Nevertheless, it is the most letal infectious disease in the world, being the most prevalent of diseases with antimicrobial resistance. In this context, in 2016, less than 12% of resistant TB cases were cured.

The state of Amazonas, located in north of Brazil, leads the ranking of tuberculosis incidence, including the multidrug-resistant form. According to the Health Surveillance Foundation, 3,163 cases were reported in 2018. In the first months of 2019, there were 563 new cases. In addition to the high incidence rate, the problem is aggravated by the abandonment of treatment, favoring bacterial resistance. Given the psychosocial theme that causes evasion to medical care, the role of the multidisciplinary team in combating the resistant form of infection is paramount.

This group of trained professionals includes the social worker, the psychologist, the pulmonologist, the family doctor, the nurse or nursing technician, and the health department. The former is responsible for ensuring that the patient in a socially vulnerable situation (child, elderly or disabled) is well treated by the family, as otherwise avoidance of treatment is often due to lack of encouragement or labor exploitation, for example. The psychologist, on the other hand, plays an active role in building patient self-esteem and directing choices, such as seeking medical help, maintaining good communication with family and physicians, and, above all, not feeling embarrassed or guilty about taking on the disease or temporarily moving away from  job.

Thirdly, the pulmonologist should maintain an open relationship with the healthcare system user by warning about side effects, explaining the reason for requesting tests, clarifying doubts and listening to the individual’s complaints without interrupting them. Other complaints not related to the respiratory system may arise so that the doctor raises other diagnostic hypotheses and refers to the specialized service if necessary. The family doctor, in turn, performs the active search for the disease among the patient’s family members, making sure that the patient performs continuous treatment without fail. In addition, the nurse or nursing technician conducts educational campaigns in the community to make the population aware of preventive measures for infectious diseases in general. Screening services are also often performed by the nursing staff in Brazil, and are essential for the correct allocation of tuberculosis in the department.

The Amazon State Health Secretariat, in turn, performs a relevant administrative function for the supply of drugs for the multidrug-resistant form of tuberculosis. In Amazonas, patients with multiresistant form are referred to the Cardoso Fontes Polyclinic in the capital Manaus so that eventual complications are more effectively treated. Thus, avoidance of treatment leading to microbial resistance is attenuated.

About the author

Camila Fonseca Carneiro is a third-year medical student at the State University of
Amazonas, Amazonia, Brazil. She is local officer in the Public Health Committee of
IFMSA Brazil. She participates in the Academic League of Pulmonology and Tisiology
of Amazonas. She also volunteered in the Regional Electoral Court of Amazonas and in
the Vascular Surgery Outpatient Clinic. She is interested in writing, poetry and
promoting local campaigns to help people recognize their rights and create their own
beliefs so that a healthy society is built.