By Prabin Shrestha and Basanta Joshi
"It is very difficult to counsel teenage TB patients," said Ms. Anita Khadayat, Nursing In charge at DOTS Clinic of Friends of Shanta Bhawan, Lalitpur. "When we talk about their smoking habits during the counselling session, they simply answer how many times do they have to say that they don’t smoke." Ms. Anita was sharing her experience about TB counselling sessions, in a one-day workshop organized to review the existing IEC materials on 21 August 2018 at HERD International premises, Kathmandu.
Another DOTS facilitator of Urban Health Centre (UHC) -18, Naradevi Clinic Ms Yashoda Khatri (K.C.) found counselling mature TB patients easier compared to the teenagers. "Teenagers get irritated within few minutes during the counselling session," she said.
Sr. Health Education Administrator from National Health Education Information and Communication Centre (NHEICC) Mr. Kunj Prasad Joshi added that the youth have ability to resist their habits.
The main objectives of the workshop were to share the experiences of DOTS facilitators on implementing behavioural support activities for TB patients to help them quit tobacco use and to collect feedback for revision of existing IEC materials, and NTP recording and reporting tools. The workshop was attended by NTP Director, NTP Planning Chief, representatives from Kathmandu Metropolitan City, Tobacco Focal Person from NHEICC, DTLO and DOTS facilitators from 8 DOTS centres implementing TB-Tobacco activities.
While facilitating the workshop, Executive Director of HERD International, Dr Sushil Baral explained about the need and importance of implementing Tobacco Cessation Intervention in TB patients.
DOTS facilitators of UHC-29 Dillibazaar Clinic Ms. Sunita Bohara raised the issue of privacy for the TB patient. She said, "we operate in a small single room and it is very hard to find place to counsel the patient in privacy as there are other patients coming for different services." Many UHC centres were facing similar problem due to lack of counselling room in their Health Facilities.
Some DOTS facilitators have practice of counselling TB patients for quitting tobacco by explaining them about the advantages and disadvantages of tobacco use for prognosis of TB disease.
The workshop included group discussions and presentations from DOTS facilitators regarding the revision of IEC materials as well as existing NTP forms and formats to include tobacco related information based on their working experiences in the DOTS centres. They suggested for few changes in the existing materials and the possibility of incorporating tobacco related information in TB register and patient card.
NTC Director, Dr. Bhim Singh Tinkari suggested to include clear, comprehensive and complete information in the IEC materials so that there will be no confusion among the patients. He also suggested to link some information about MDR TB in the IEC materials. NTC Planning Chief emphasized on the need of collaboration between TB and Tobacco cessation interventions by developing specific plans to incorporate tobacco cessation interventions in regular TB program.
During discussion, Dr Baral raised the issue about lack of interventions to address tobacco cessation activities within the primary health care system in the country. Sr. Health Education Administrator from NHEICC, Mr. Joshi informed about the plan of NHEICC to conduct capacity development training for health workers about tobacco cessation under the WHO FCTC guidelines with the technical support from WHO, starting in November 2018.
HERD International has prepared a plan to revise the existing IEC materials based on the feedback received during the workshop and coordinate with NTC to incorporate tobacco related information in existing NTP recording and reporting forms and formats.