When Nguyen Thi Hong Hanh first noticed she was running a fever, she didn’t think much of it. The 26-year-old Vietnamese factory worker bought some over-the-counter drugs at a local pharmacy and went about her life. She endured a month of persistent symptoms before finally visiting a hospital, where she was diagnosed with lymph node tuberculosis. The news came as a surprise to Hanh, who knew little about the disease and had no idea a non-pulmonary form existed.
Do Kim Lang, a local health volunteer, is trying to prevent more cases like this. Several times a week, the 65-year-old straps on her helmet and rides her moped around Hanh’s Ho Chi Minh City neighborhood, a low-income area known as District 8. She visits people’s homes, educating them about tuberculosis and encouraging those with symptoms to get tested. She sees Hanh at her tiny one-bedroom house as well as others already undergoing treatment to make sure they’re taking medication correctly. “People’s knowledge is very limited,” Lang tells me. “They don’t know how to maintain their health or prevent their family members from getting TB.”
Volunteers like Lang play a crucial role in Vietnam’s ability to fight tuberculosis. Here, treating disease isn’t as straightforward as it is in developed countries, where people are more educated about health risks, commonly seek professional care, and generally understand how to follow treatment regimens. In the developing world, the greatest challenge often occurs before treatment: it’s seeking out and educating people in need of diagnosis before they spread the disease to others.
Because many low-income Vietnamese aren’t educated about tuberculosis, they don’t know how to protect themselves and others. Lang says some people in her community don’t know the disease exists, while others believe it’s genetic and many are afraid to visit clinics. According to a 2013 study by PSI, a global health organization, 31 percent of Vietnamese who had TB symptoms weren’t able to correctly identify any symptoms of the disease. Only 56 percent of respondents were able to identify the more common symptom: a cough lasting longer than two weeks.
As a result, many people ignore symptoms or, like Hanh, buy over-the-counter drugs rather than seeking a TB test from a local health clinic. Some who are aware of the disease still skirt diagnosis because of stigma, while rural patients often stay away because they can’t afford to travel to TB clinics in larger cities. These tendencies can make the disease more difficult to treat and give it more time to spread. That’s a problem because people with pulmonary TB can infect between 10 and 15 people during the course of their disease, according to Laurel Fain, director of the USAID Health Office in Vietnam. “The earlier they can get on treatment, the lower the chance their disease will spread,” Fain says.
The role of the community health volunteer is especially relevant in a country like Vietnam, where the health care system is better at treating tuberculosis than detecting it. Once diagnosed, Vietnamese TB patients have a 92 percent treatment success rate. Yet the country’s incidence rate remains stubbornly high—at 147 people per 100,000 inhabitants—because of an inadequate detection rate. “You can’t wait in a hospital or a clinic for somebody who has had a cough for several weeks or months to come in and seek care,” Fain says. “You have to go out and screen people who have been in contact with people who have TB and people with depressed immune systems.”
That’s exactly what Lang is doing. So what’s the downside? In Vietnam, volunteer health workers are just that—unpaid volunteers. While many locals might want to help the community, few have the economic means to work for free. Lang says she used to be one of four volunteers covering her area, and now she’s the only one left. Plus, she says she used to receive a small stipend from an international organization, but that was recently cut. A solution would be more funding for community outreach programs, but there are obstacles. Subsequent posts will explore the challenges to TB funding in Vietnam and worldwide.