Thomas Albuquerque, a TB infection control officer with MSF Mumbai, is responsible for implementation of ‘Airborne Infection Control’ (IC) measures in the MSF clinic, patient households and communities. Airborne IC refers to putting infection control practices in place that reduce the risk of transmission of infectious agents from one person to the other through air. Although particularly challenging in slum settings, IC measures that are feasible, affordable and acceptable can be implemented in such settings using simplified and standardised tools. Here, he shares his experience in the role, the patients who touched his heart and what it means to be a part of MSF.
Photo: Siddhesh Gunandekar
“Safety of patients, their family members and healthcare workers is our priority”
Continuous attention to hygiene and infection control measures is central to a healthy and safe environment for our doctors, nurses, cleaners and especially our patients. TB IC involves daily implementation of a series of simple measures. For instance, enhanced ventilation in the clinic ensures natural air movement, thereby reducing the risk of TB infection. It is for this reason that despite space being a big challenge in Mumbai, we have made sure that a separate open waiting area is allotted to our patients. Installation of fans at appropriate places throughout the clinic also ensures that the air is constantly circulated.
At our clinic, separate floors for consultation of patients with infectious TB disease and patients with non-infectious TB disease also ensures that transmission of infection is reduced.
At the entrance, our security guard hands over surgical masks to every patient and their accompanying relatives, and makes sure that they put it on properly before heading inside the clinic building.
According to a study on TB by MSF in South Africa, if the patient is wearing a surgical mask, the risk of transmission of infection is reduced by 52%. Clinic staff is provided with N 95 respirators - a special respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. All staff is fit tested for the use of N95 respirators. The staff is also trained in the use of uniforms for different services and other personal protective equipment like gloves, masks and goggles wherever needed.
These are all part of MSF’s safety protocols, which are constantly updated and we strictly abide by them – whether in the field or in the clinic.
Photo: Dr Peter Saranchuk
“It is challenging at times”
For effective infection control, we give a choice to our patients to decide whether they want to stop going to work to avoid further spread of infection or continue working by adopting IC measures (like use of masks). However, given the strong stigma attached to this infection, patients usually lose their jobs. This can be very challenging as sometimes, the patient himself/herself is the only bread earner for the family. In one of the cases, one of our patients - a young girl, who worked with a dental clinic was diagnosed with multi drug resistant TB (MDR-TB). The dental clinic she worked at was centrally air-conditioned. Air conditioners are the worst for TB control, mainly because they tend to recycle the same air hence providing supportive environment for TB bacilli to survive. This patient hence put everyone else at the dental clinic at risk of being infected.
“The parents gave up hope, but MSF would never give up on a life so easily”
Counselling support is an essential part of TB treatment. The difficult treatment that involves taking too many pills with side effects for a long period along with the stigma attached to the disease necessitates counselling support for the patient and his/her family. The counsellor in our patient support team always builds trust with the patients and attempts to ensure that every patient completes his/her treatment.
In this case, I personally went to the dentist and requested for his help. I told him that our patient needed to take a break for three months, or at least till the time she converted to sputum negative status. He was very cooperative and in fact asked me how else he could help. Considering the patient was a major support to her family, financially, the doctor agreed to pay her partial salary, encouraging her to continue her treatment without worrying about losing her job.
“Infection control in households of drug-resistant tuberculosis patients is important” (Infection control in households)
Infection control in households is very vital in how we deal with further spread of the disease. In MSF, we offer IC services at family level. After initiating the treatment for the young lady, I went to her house to assess and put in place infection control measures for the rest of the family. We provided them with surgical masks and made sure all windows were kept open at all times and installed exhaust fans for proper ventilation in the house. DR-TB treatment usually lasts for more than 24 months, includes more than 14,600 pills in one course along with a daily injectable for the first 6-8 months.
“She was strong and had unbeatable hope – and that’s what’s needed to be cured”
We as medical professionals understand the risks associated with a chronic infection like DR-TB. But we also know that TB and DR-TB are treatable. The girl had good endurance and followed our treatment regularly, visiting the clinic regularly. In the beginning, her father used to accompany her, but later she began coming alone. She is currently working and is a source of immense inspiration in terms of determination and staying healthy with necessary support.
In most other clinics or hospitals, counselling is often overlooked. Medicines are viewed as the end all of the treatment. Whether or not there is adherence - no one can say, as there is no follow up. At MSF, however, we believe in individualised treatment regimens and hence follow all our patients very closely. We try and go that extra mile which we believe is what makes the difference. There is a personal touch and it’s only human to get involved emotionally.
“You look at a patient and begin with the conviction that the patient has to get out of this”
I remember this young, 11-year-old girl. She had MDR-TB, but wasn’t HIV positive, so it wasn’t a co-infection. She was severely malnourished and had trouble breathing. I looked at her and I questioned myself, “Will she be able to make it?” And today, she’s gained good health and is fine! You look at a patient and begin with the conviction that the patient has to get out of this. This conviction often stems from the fact that we treat our patients with the best possible care suitable to their individual condition.
“At MSF, it’s just a will to keep patients alive that keeps us all working towards it”
I’ve been in the corporate world for so long, but I’ve never felt this satisfied. The satisfaction that comes from helping people get better is incomparable. I thoroughly enjoy what I do and feel really happy reaching out to people who need medical care the most. I am on the infection control committee of the Sewri TB Hospital - the largest TB hospital in Asia and provide technical support in implementing IC measures in the hospital. Sewri TB hospital appreciates MSF’s support in infection control and counselling.
Thomas has recently taken a position outside of India with MSF, currently working as regional infection control officer in Uzbekistan & Tajikistan missions.
About the project: Doctors Without Borders / Médecins Sans Frontières (MSF) has been working in Mumbai since 1999. While MSF began with provision of technical support for diagnosis to the National TB Programme back then, it is a quality, comprehensive and free healthcare provider for complex cases of HIV/AIDS, drug-resistant tuberculosis (DT-TB) and HIV/Hepatitis C co-infection today. Since 2006, MSF has been running a clinic in the western suburbs of the city in the Khar district, treating patients from all over Greater Mumbai.