Master’s in Public Health (ICSa-UAEH) Institute of Health Sciences, Autonomous University of the State of Hidalgo, MexicoMexico
Department of Nursing [ICSa-UAEH] Institute of Health Sciences, Autonomous University of the State of Hidalgo, MexicoMexico
Department of Pharmacy (ICSa-UAEH), Institute of Health Sciences, Autonomous University of the State of Hidalgo, MexicoMexico
Department of Medicine (ICSa-UAEH) Institute of Health Sciences, Autonomous University of the State of Hidalgo, MexicoMexico
Division of Surgery, HGZ 89 IMSS, Guadalajara Jalisco, México
Independent Researcher, former Professor in the Academic Area of Medicine and Masters in Public Health, Institute of Health Sciences, Autonomous University of the State of Hidalgo, MexicoMexico
Also available as PDF (figures and tables appear in the PDF).
Pulmonary tuberculosis is the second leading cause of death among adults worldwide due to infectious diseases. The 2019 pandemic and socioeconomic inequalities have reversed years of progress in the fight against tuberculosis and have further increased the burden on those affected, especially the most vulnerable. Objective : To understand the experiences and knowledge of patients with pulmonary tuberculosis regarding their condition and treatment. Methodology : A qualitative study using in-depth interviews with an ethnomethodological approach was conducted with four patients with pulmonary tuberculosis who were treated through the Strictly Supervised Short-Course Treatment program in the municipality of Metztitlán, Hidalgo. The analysis was performed using grounded theory. The categories analyzed were: knowledge of the disease, access to the health services network, patient attitudes, patient self-care practices, perceptions of healthcare providers’ actions, and community participation. Results . Their understanding of their illness is very limited, health care services are inaccessible, and their accounts express sadness and fear of infecting their loved ones. Among the patients interviewed, two are health care workers and report adverse drug reactions. Conclusions . Conducting a qualitative analysis of the experiences of patients who have been diagnosed and are receiving drug treatment is of the utmost importance, as it allows us to identify strengths and weaknesses to design intervention strategies that will have a positive impact on this vulnerable population, which lacks knowledge, has limited access to health services, and experiences adverse treatment effects.
Keywords: TB patients; pharmacological diagnosis; patients diagnosed with TB; social inequalities and TB; Qualitative analysis of TB; TBpatients; pharmacologicaldiagnosis; patientsdiagnosedwithTB; socialinequalitiesandTB; QualitativeanalysisofTB
Tuberculosisisadiseasethataffectsnotonlythepatient’s physical health but also their mental health; patients’understandingoftheirillnessandhowthey experiencetuberculosissignificantlyaffecttheirtreatment adherence. It is estimated that between 2000 and 2021, 74 million lives were saved thanks to the diagnosisandtreatmentoftuberculosis[1].
More people worldwide die from tuberculosis than fromanyothercurableinfectiousdisease.Ninety-eight percentofdeathsfromthisdiseaseoccurindevelopingcountries.Mortalityandmorbidityratesarehigher amongadults,andmenarethemostaffected.Morbidityratesaremuchhigheramongdisadvantagedpopulationgroupsandaregenerallyhigherincitiesthanin ruralareas[2].
In2022,Hidalgoreported205newcasesofTBinall forms,withanincidencerateof6.6,amortalityratefor allformsofTBof0.7,andamortalityrateforpulmonary tuberculosisof0.5.Themunicipalitywiththehighest incidencein2022wasMetztitlánat35.8,followedby Zacualtipánat15.9andJacalaat14.2,whileHuejutla reported13.5[3].
Twocategorieswereidentified:“CareNetworkforPeoplewithTuberculosisandPublicPolicies”and“ChallengesinNursingCareforPeoplewithTuberculosis,” whichhighlightthechallengesinestablishingabond betweenthepatientandthenursingstaff,thelength oftreatment,vulnerabilityasafactorthathindersadherence,andthesideeffectsofmedicationfromthe startoftreatment.Thechallengesfacedbynursesin caringforpeoplewithtuberculosisrangefrompatient recruitmentandengagementtotreatmentadherence, aswellasalackofinitiativesaimedatpreventionand healthpromotion[4].
Thenursingconsultationisconsideredaprivateactivity ofthenurse,andthenurse’sactionsenabletheimplementationoftheNursingProcess,whichcomprisesfive stages:assessmentordatacollection,nursingdiagnosis,planning,implementation,andevaluationofcare. Theobjectiveofthisstudyistoevaluatetherecords fromfollow-upconsultationswithpeoplewithtuberculosis(TB)conductedbynursesatprimaryhealthcare unitsundertheCommunityHealthManagementsystemin2017andtoidentifynurses’perceptionsoftheir practiceincaringforthesepatients[5].
Diabetesmellitus(DM)increasestheriskofactivetuberculosis(TB)andworsensTBoutcomes,jeopardizing TBcontrol, especiallyinTB-endemiccountrieswith risingDMprevalencerates.“Thisstudyshowsthatthe prevalenceofDMandtheclinicalcharacteristicsofTB- DM vary across settings. Diabetes is largely undiagnosedanduntreated,hyperglycemiaisoftensevere, andmanypatientswithTB-DMareatsignificantrisk forcardiovasculardiseaseandsevereTB.Thisunderscorestheneedtoimprovestrategiesforbetterclinical managementofcomorbidTBandDM.”[6].
Accordingtothearticle“ASocialPhenomenological ApproachtotheDailyLivesofPeoplewithTuberculosis”byWilfredoCarcaustoetal. (2020),oneofthe mainfearsisinfectinglovedonesandbeingdiscriminatedagainstbysocietybecauseofthedisease.These feelingsofguiltandhelplessnessamongpeoplewith thisdiseasemaketreatmentdifficult,astheymayeven becomedepressed[7].
“ThisstudyevaluatedtreatmentoutcomesamongpatientswithpulmonaryTB(PTB)andidentifiedpredictorsoftreatmentfailure. Thetreatmentsuccessrate amongpatientswithPTBwaslowerthantherecommended success rate of 85%. Patients with TB who areathigherriskoftreatmentfailureshouldreceive enhancedsupervisionandtreatmentfollow-uptoimprovethesuccessrateofTBmanagementinPakistan.” [8].
Thisstudyincluded138patientswithsuspectedpulmonarytuberculosis.Theresultsshowedasignificant increaseinthenumberofsamplescontainingpurulent particlesandavolumegreaterthan5mL,aswellasan increaseintheproportionofpatientsdiagnosedwith tuberculosis following the educational intervention. Itwasdemonstratedthat,followingtheeducational intervention,higher-qualitysputumsampleswereobserved,withappearanceandvolumesuitableforeffectivesmearmicroscopy[9].
In the case study conducted by the author, Serra et al.(2015)emphasizethatpulmonarytuberculosishas beenatruescourgeforhumanity,as20millioncasesof tuberculosisweredetectedworldwide,with9million newcasesdiagnosedeachyear. Itposesathreatto global public health, despite existing programs and effectivetreatments,therearestillshortcomingsinthe implementationofthenationalprogram[10].
Tuberculosistreatmentadherencecanbedefinedas theextenttowhichapatient’smedicationintakealigns withtheprescribedtreatment. Thecombinednumberofcuredpatientsandthosewhocompletetreatmentarepragmaticindicatorsoftreatmentadherence (WHO)inthearticle“FactorsRelatedtoTreatmentAdherenceinPatientswithTuberculosis,”Pereira,Colombia.DueñesMetal.(2013)conductedacross-sectional studyof174patientrecordsfromthetuberculosiscontrolprogram. Theresultsshowedthattreatmentadherenceamongpatientswithpulmonarytuberculosis was94.8%andwashigheramongpatientsinthecontributoryhealthinsuranceplan(p = 0.035).Treatment nonadherencewas5.2%.Drugintolerancewashigher inthegroupthatdidnotadheretotreatment. Lack offamilysupport,lossofemployment,economicimpact,anddissatisfactionwiththetimelinessofcareat thehealthfacilitywereimportantfactorscontributing tononadherence. Basedonthesefindings,itisconcludedthatenrollmentinthehealthsystemanddrug toleranceweretheobjectivefactorsassociatedwith treatmentadherence[11].
In the article “Alterations in Functional Patterns in People with Pulmonary Tuberculosis, Villavicencio, Colombia,”writtenbyAponteGarzónetal. (2011),it wasconcludedthatthemostsignificantlyalteredfunctional patterns were activity and exercise, nutrition andmetabolism,thecognitive-perceptualpattern,and theself-perceptionandself-conceptpattern.Fatigue andshortnessofbreathmakeitdifficulttotraveltothe healthcarefacility,andreducedenergymakesithard toholddownajob,whichaffectsfamilyincome.There isalackofawarenessregardingaspectsrelevantto diseasemanagement.Manifestationsofsadnessand isolationarepresent,associatedwithnegativesocial perceptionsofthedisease.Thestudyemphasizesthe crucialrolethatnursingplaysinensuringcompletion ofTBtreatment,suggestingthatoncethesepatterns are identified, individualized interventions should be implemented using care guidelines to improve theinformationprovided,treatment,strategies,and transmissioncontrol[12].
Vinaccia,etal.(2007),intheirarticle“Health-Related QualityofLifeandPerceivedSocialSupportinPatients DiagnosedwithPulmonaryTuberculosis,”emphasize thattheprogressionofthediseasesignificantlyalters the patient’s quality of life, noting that, in general, chronic diseases affect important aspects of life, starting from the initial acute phase, when patients experienceaperiodofcrisischaracterizedbyphysical, social,andpsychologicalimbalanceaccompaniedby anxiety, fear, anddisorientation, aswellaschanges inphysical,occupational,andsocialactivityandthis conditioncanlastalifetime[13].
Thetreatmentofpulmonarytuberculosisisofgreat importance.Bolduetal.(2007)emphasizetheimportanceoftreatmentadherenceandtheimportanceof urgingpatientstostrictlyfollowtheirprescriptionsby involvingfamilymembersorsupportnetworks[14]. Healthservicesareakeydeterminant,asareaccessto medicalcareandmedications.
Anotherarticlerelatedtotheresearchtopicis“TreatmentNonadherenceforTuberculosisinNicaragua”: resultsofacomparativestudyconductedbySoza,etal. (2005),whichidentifiesthemainfactorsrelatedtotreatmentdiscontinuationforpulmonarytuberculosis.To gatherthisinformation,theauthorsconductedacasecontrolstudywithage-matchedcontrolsandfound thatmalesaremorelikelytodiscontinuetreatment thanfemales.Otherfactorsincludeunstablehousing, a change of address during treatment, alcohol consumption,illicitdruguse,difficultyaccessinghealth services,andtheirperceptionofthecarereceived.It isconcludedthatitisessentialtoestablishmeasures withinhealthservicesthathelpreducetheriskoftreatmentdiscontinuationandrestorethehealthsector’s socialparticipationthroughcommunity-basedactions [15].
Zavalaetal.(2004),intheirarticle“PerceptionsRelated toPulmonaryTuberculosis,”mentionthatinthemunicipalitiesofsouthernNuevoLeón,Mexico,patients withTBclaimthatthecausesofthediseasearethat theydidnotreceivetheirfullcourseofvaccinations,excessivework,smoking,alcoholism,andpoornutrition haveledtotheircontractingthedisease,furthermore, alackofawarenessofthesymptomscontributestothe spreadofthedisease,astheydonottakeprecautions regardingwheretocoughandspitupphlegm[16].
AccordingtoRomero,(2004),inhisarticle“GenderDifferencesinSocialSupportNetworksAmongPatients with Pulmonary Tuberculosis”: A Qualitative Study inTwoTownsintheStateofVeracruz,Mexico,itwas foundthatgenderinequalityexistsintherelationship betweensupportnetworksandthetreatmentofthe disease;althoughtherearemorecasesofTBamong men,mortalityratesamongwomenareevenhigher, reachinglevelscomparabletomaternalmortality;The main reason is that women lack social, moral, and economic support networks from family members and/or friends to continue treatment; out of fear of being rejected by their husbands, they hide their illness. Incontrast, menareprimarilysupportedby their wives or ex-wives, sisters, etc., which leads to successful treatment and results in lower mortality rates[17].
Álvarez,etal.(2000),intheirarticle“Perceptionsand PracticesRelatedtoTuberculosisandTreatmentAdherenceinChiapas,Mexico,”notethatalackofknowledgeaboutthediseaseleadspeopletoseekalternativeformsofcare.Theyhighlighttheimportanceofa properdoctor-patientrelationshiptoensuretimelydiagnosisandadherencetotheprescribedtreatment;as arecommendation,theyemphasizetheneedtocreate outreachprogramsonthebasicaspectsofthedisease anditstreatment[18].
AccordingtoRomero,(1999),inhisarticle“Beliefsand Social Consequences of Pulmonary Tuberculosis in TwoIndigenousCommunitiesintheStateofOaxaca,” weobservedacompleterejectionofthedisease;peoplewithtuberculosisdonotacceptitandprefertoattributeitto“witchcraft,”andthefearofsocialrejection leadstotreatmentnon-adherenceandcontributesto furthertransmission,thisisduetoalackofknowledge aboutthedisease[19].
Inthearticle“StrictlySupervisedShort-CourseTreatmentforPulmonaryTuberculosisintheCityofChiapas” byÁlvarez,etal. (1998),theauthorsnotethattreatmentnonadherenceforpulmonarytuberculosisisone ofthemainriskfactorsfordrug-resistanttuberculosis. Itsuggeststhathealthcarepersonnelshouldbemore accessibletopatients,regardlessofwhichinstitution theybelongto,andshouldverifydailymedicationintakethroughouttheentirecourseoftreatment[20]. Werealizethatknowledgeisessentialtothesuccessof treatment;thatiswhywemustnotonlyprovidemedicationbutalsoeducatepatientsaboutthedisease,addresstheirconcerns,buildtrust,andinvolvesupport networkssothatpatientsdonotfallintodepression andabandontreatment[21].
Theimportanceofunderstandinghowapersonwith tuberculosislivesstemsfromthefactthatitremains apublichealthproblemeveninourcenturyduetoits multiplecauses,withmarginalizedpopulationgroups identifiedasthemostseverelyaffected;controllingthe diseasedependsonimprovementsinthegeneralliving conditionsofthepopulation[22].
To understand the experiences and knowledge of patients with pulmonary tuberculosis and their treatment.
What has been the experience of people with pulmonarytuberculosisanditstreatment?
A qualitative study was conducted using in-depth thematic interviews with an ethnomethodological approach among four patients with pulmonary tuberculosis who were treated through the Strictly Supervised Short-Course Treatment program in the municipalityofMetztitlán,Hidalgo.Theanalysiswas basedongroundedtheory. Thecategoriesanalyzed were:knowledgeofthedisease,accesstothehealth servicesnetwork,userattitudes,userself-carepractices, perceptions of health care providers’ actions, andcommunityparticipation.
Anin-depthinterviewwasconductedtogatherinformationaboutthefactorsthatinfluencenon-adherence totreatment.
Fourpatientswithpulmonarytuberculosisenrolled in the Strictly Supervised Short-Course Treatment program in the municipality of Metztitlán, Hidalgo, wererecruited.Datawillbeanalyzedusinggrounded theory,employingthefollowingkeywords:tuberculosis,treatmentdiscontinuation,re-emergingdisease, knowledge.
Comprisingtwosections,SectionAcontainspersonal information,andSectionBcontains14questionsin sixcategories:knowledgeofthedisease,accesstothe healthservicesnetwork, attitude, practices, perceptionofhealthcarepersonnel’sactions,andcommunity participation.
Theknowledgereflectedintheparticipants’discourse revealsaverypoorunderstandingofhowthedisease istransmitted.
“Ithinksomeonepasseditontome,becauseIwasfine—Idon’tevengoout.”
“I’d been coughing for a long time; they saythat’showyoucatchit. Iwasgetting desperatefromallthatcoughing.”
“It spreads from person to person when someoneexpelsparticles”(SeeTable1).
Her account of her attitude even suggests a certain acceptanceoftheillness,asshenotesthattheycame tovisithereveryday,thatshewasafraidofnotknowing anything,andthatshedoesn’tbelieveshecaughtit.
“WhenIdidhavethatillness,Iactuallyfelt goodbecausepeoplecametoseemeeveryday.”
“Fear because we don’t know anything, andevenattheendtheytoldusthatthe goodnewsisthatit’scurable.”
“IfeltbadaboutmyselfbecauseIcouldn’t believeI’dgotteninfected.”(SeeTable2) Whenaskedabouthowtotaketheirmedication,we foundintheirdiscourse,whichreflectedareluctanceto takesomanypills,thefollowingresponsesregarding theirmedicalconsultation: Understanding Howdoyouthink E1.P1. Ithinksomeonepassedit ÁlvarezGordilloG.C.etal.(2000),in thedisease pulmonary ontome,becauseIwasfine,I theirarticle“Perceptionsand tuberculosisis don’tevengoout.
transmitted?
“They told me I have to take those darn pillseveryday.”
“Take the four maintenance pills on an empty stomach from Monday through Saturday.”(SeeTable3) Regardingtheirperceptionofhealthcareworkers’actions, as described in their narrative, they perceive theseactionsas: “Poor,becausenoonetellsyouwhereto go;theysendyoufromonepersontoanother.Theworstpartisthatthewaittimes areverylong,anditdrivesyoucrazy.”
“Prettygood,allthingsconsidered,since I was diagnosed because one of my fellownursesatworktestedpositiveforTB, andtheyperformedsmeartestsonallstaff membersbecauseweweredirectcontacts.
Well,Itestedpositivetoo,andsinceI’mnot from there, they gave me my treatment hereatthePachuquillahealthcenter.”
“I’dsayit’sfine;I’mnotcomplaining.”(See Table4) Accesstothehealthcaresystemsuggeststhat:
“Wegototheclinictoseethedoctor.”
“There’snohealthcenterwherewelive;we gototheonethat’sjustdowntheroad.”
PracticesRelatedtoTuberculosisand TreatmentAdherenceinChiapas, E2.P2. Thethingis,I’dbeen Mexico,”notethatalackofknowledge coughingforalongtime.Theysay aboutthediseaseleadspeopleto that’showyoucatchit.Iwas seekalternativeformsofcare.They gettingdesperatefromallthat highlighttheimportanceofaproper coughing,especiallybecauseI’m doctor-patientrelationshiptoensure goingupnorthwithmydaughter, timelydiagnosisandadherencetothe andwiththatdamncough,I prescribedtreatment;asa thoughttheywouldn’tevenletme recommendation,theyemphasizethe boardtheplane,they’dsayIhad needtocreateoutreachprogramson thediseasethat’sgoingaround thebasicaspectsofthediseaseand rightnow.
itstreatment[21].
E3.P3. Well,Idon’tknow, becausenooneevertoldmeIhad it.Iwenttoseealotofdoctors, andnoneofthemsaidanythingto me.
E4.P4. Itspreadsfrompersonto personwhensomeoneexpels particles.
“There’s a health center, but we hardly evergobecausetheyaskforlettersstating you’renotcoveredbyanotherplan,and my husband enrolled us in the IMSS, so the closest one is in Pachuca and appointmentstakealongtime.”
“Well, since I’m in an urban area, I have accesstothehealthcentersinmymunicipality,andasastudentdoingcommunity service,theschoolkeptaneyeonus.”
“Well,Ican’tcomplain,althoughitisvery differentfromthetownsI’vebeento,since thecarethereismuchmorepersonal—or maybebecauseI’madoctor,theyassume I’dalwaystakemymedication.‘Which,if thatwasthecase,it’sbecauseIwasthe onemostinterestedingettingthroughthis, butanyway”(SeeTable5).
Thenarrativeregardingactivitiescarriedoutwithinthe familyandbythecommunityhighlightsthesearchfor medicalcare.
“WhenIwasdiagnosed,thepeopleIwas mostworriedaboutweremyfamily,soI didn’thesitatetohavethemundergothe necessarytests, andtheysupportedme alotthroughouttheentireprocesssince theyfollowedalltheinstructionswewere given. AndIcansaythat,sincewewere Attitude Howdoestheillness E1.P1. No,I’mnotsickwiththat makeyoufeel? anymore,notanymore.Mybones Accordingtothearticle“ASocial Howmuchhasyour E3.P3. Mywholelifechanged;I physical,occupational,andsocialactivity, lifechangedbecause couldn’tdoanythingbecauseofthe andthisconditioncanlastalifetime[13]. ofthiscondition? cough,itgottothepointofdespair.
Howhaveyoufelt gastritis;Ihadtotakeastomach whileontreatment? protector.
inthemidstoftheCOVID-19pandemic,it was very normal for everyone to wear a mask”(SeeTable6).
Althoughtuberculosisrepresentsapersistentpublic healthproblemandanindicatorofpovertythatalso signifiesavulnerablepopulationwithloweducational attainmentwhereveritoccursinthestateofHidalgo,
hurt,butthat’sjustfromwalkingso PhenomenologicalApproachtotheDaily much.BackwhenIhadthatillness,I LivesofPeoplewithTuberculosis”by actuallyfeltgoodbecausepeople WilfredoCarcaustoetal.(2020),oneof cametoseemeeveryday. themainfearsisinfectinglovedonesand facingdiscriminationfromsociety E2.P2. Itjustmakesmeworry becauseofthedisease.Thesefeelingsof becausethenIcan’tsleep,my“sugar” guiltandhelplessnessamongpeople mustbegoingup.
withthisdiseasemaketreatmentdifficult, E3.P3. Fear,sincewedon’tknow astheymayevenbecomedepressed[7]. anything,andintheendtheyeven toldyouthatthegoodnewsisthatit’s curable. VinacciaStefanoetal.(2007),inthe article“Health-RelatedQualityofLifeand E4.P4. Ifeltbadaboutmyself PerceivedSocialSupportinPatients becauseIcouldn’tbelieveI’dgotten DiagnosedwithPulmonaryTuberculosis,” infected.
emphasizethattheprogressionofthe diseasesignificantlyaltersthepatient’s E1.P1. Well,Ikeepdoingmylittle qualityoflife,notingthat,ingeneral, things,Igoouttopasture.Thenurses chronicdiseasesaffectimportantaspects tellmeIhavetotakemypillsand oflife,startingfromtheinitialacute wearamask,butIdon’tfeelsick.
phase,whenpatientsexperienceaperiod ThenIgotothemill.
ofcrisischaracterizedbyphysical,social, E2.P2. Alot,becauseIcouldn’tgo andpsychologicalimbalance seemydaughter,andifIdidn’tgo,my accompaniedbyanxiety,fear,and dadcertainlywouldn’teither. disorientation,aswellaschangesin
E4.P4. Well,itturnedeverything Inthearticle“FactorsRelatedto upsidedownbecauseIhadtoput TreatmentAdherenceinPatientswith partofmycommunityserviceonhold Tuberculosis,Pereira,Colombia,”Dueñes and,atthetime,takeactiontomake M.etal.(2013)conducteda sureIdidn’tinfectmyfamily. cross-sectionalstudyof174patient recordsfromthetuberculosiscontrol E1.P1. WhenItookit,Ikindoflost program.Theresultsshowedthat myappetite,butthatwasall.Now treatmentadherenceamongpatients thatI’mnolongertakingit,I’mfine. withpulmonarytuberculosiswas94.8% E2.P2. Itseemstobehelpingalittle, andwashigheramongpatientsinthe butthenI’dgetreallyanxious,andmy contributoryhealthinsuranceplan stomachjustwon’tletmebe. (p =0.035).Treatmentnonadherence was5.2%.
E3.P3. I’mjustabouttostartit;they justtoldmeIhavetotake4pillsaday. Drugintolerancewashigherinthegroup thatdidnotadheretotreatment.Lackof E4.P4. AtfirstIgothives,andthen familysupport,lossofemployment, economicimpact,anddissatisfaction withthetimelinessofcareatthehealth facilitywereimportantfactors contributingtononadherence.
Basedonthesefindings,itwasconcluded thatenrollmentinthehealthsystemand drugtoleranceweretheobjectivefactors associatedwithtreatmentadherence [11].
oneoftheareasmostseverelyaffectedisMetztitlán, Hidalgo,Mexico. Thediseasehasahigherincidence amongmen[1][4].Althoughthemortalityrateishigher amongwomensincemenappeartohavegreateraccesstosupporttocontinuetreatment[19],thishealth problemistypicallyfoundindevelopingcountries,This meansthatMexico,inadditiontoremainingadevelopingcountrywithnoalternativesolutionstotheshortageofmedications,supplies,equipment,andhospital infrastructure,willcontinuetofaceseriousdifficulties PRACTICE Pleaseexplaintome: E1.P1. Ididn’twanttotakesomany HowdoItakethis medication? E2.P2. Thegirlsfromtheclinicwould
Whatprotective doctortoldmeIdon’thaveanything, measureswouldyou wedon’tneedtowearthosedarn taketoavoid masks.
infectingyourfamily E2.P2. Justwearingfacemasks. agent,toperiodicallymonitorthehealth orfriends?
Ifyoudiscontinued treatment,whatwas E2.P2. Theydidnotdiscontinue shouldbemoreaccessibleto thereasonyou treatment,sothisquestionwasnot patients—regardlessofwhichinstitution stoppedtakingyour asked.
medication?
initslocalhealthsystemsand,consequently,willhave amorevulnerablepopulationduetoloweducational attainment,poverty,andre-emergingdiseasessuch aspulmonarytuberculosisandotherformsofthisdisease.
OneofthetownsinthestateofHidalgomostseverely affectedbytuberculosisisMetztitlán(4). Althoughit isknownthattreatmentnon-adherence,educational attainment,poverty,andotherriskfactorsinfluence thepersistenceofthisdisease,anddespiteeffortsand researchinthisarea,pulmonarytuberculosiscontinuestobepresentinvulnerablepopulations[18][19] [20][23]thiswasconfirmedinthepresentstudy,andit isconcerningthatthisissueisnotbeingaddressedin
pills. Thetreatmentofpulmonarytuberculosis isofgreatimportance.Boldu,J.,etal.
(2007)emphasizetheimportanceof cometoseeme;Ionlywentwhenit treatmentadherenceandtheimportance wasmyturnforanappointment.
ofurgingpatientstostrictlyfollowtheir E3.P3. TheytoldmeIhavetotake prescriptionsbyinvolvingfamily thosedarnpillseveryday. membersorsupportnetworks[14]. E4.P4. Takethefourmaintenance pillsonanemptystomach,Monday Occupationalexposuretoinfectionsisa throughSaturday.
seriousproblem;duetothenatureof theirwork,healthcareworkersare E1.P1. Well,I’mjustwithmywife, consideredtobeathighriskfor andshe’sfine;thenmydaughter contractinginfectionssuchas comestoseeme,butsincetheother tuberculosis.Topreventnosocomial transmissionoftuberculosis,itis essentialtocomplywiththebiosafety measuresestablishedforitsinfectious
statusofworkersatoccupationalrisk, E3.P3. No,theytoldmetostayaway frommyfamily,buttowearaface andtoprovidehealthtrainingto mask,especiallyaroundmychildren. healthcarepersonnelingeneral[25]. E4.P4. Themainprecautionsare handwashingandwearingface Inthearticle“StrictlySupervised masks. Short-CourseTreatmentforPulmonary TuberculosisintheCityofChiapas”by E1.P1. Becausemysontookmeto ÁlvarezGordilloG.C.etal.(1998),the seeadoctorinPachuca,andhetold authorsnotethattreatment usthatifIhadtakenpillsbeforeand discontinuationforpulmonary wastoldInolongerhadthedisease,I tuberculosisisoneofthemainrisk didn’thavetotakethemagain factorsfordrug-resistanttuberculosis.It becauseI’malreadywell. suggeststhathealthcarepersonnel
theybelongto—andshouldverifydaily medicationintakethroughouttheentire E3.P3. Theydidnotdiscontinue courseoftreatment[20].
treatment,sothisquestionwasnot asked.
E4.P4. Theydidnotdiscontinue treatment,sothisquestionwasnot asked.
termsofhealtheducation,improvinglivingconditions andlifestyles,andthedefinitivefightagainstpoverty. Otherwise,itwillnotbepossibletoeradicatethisdiseaseoneday.
Thisresearchsupportstherecommendationtoadopt theprincipleofsharedresponsibilityinpublichealth; thismeansthatboththegovernmentandsocietyhave anobligationtocontributetothecommongood. In thefaceofthisdisease,thereisnochoicebuttoaccept andfulfillthegovernment’scommitmentsandresponsibilitiestoworktowardimprovinglifestylesandeffectivelyreducingpoverty,notthroughemptyrhetoricor failedwhims.Insociety,healthcareworkersmustlearn, throughacademictraining,toworkwithpatientsina Perceptionsof Tellme E1.P1. Well,theyusedtocomesee AccordingtoPAHO/WHO,health Healthcare meeverydayandtalktome,butnow promotionisacomprehensivepolitical Whatisthecarelike Workers’ nobodycomesanymore. andsocialprocessthatencompasses fromhealthcare Actions workerswhenyousee them?
mannerconsistentwithhealtheducation,andpatients mustadheretotheirtreatment;thismeansthateveryonemustfulfilltheirobligationsand/orparticipatefor thecommongood.[24].
Theirunderstandingoftheirillnessisverylimited,it dependsontheirlevelofeducation.Theyhaveaccess tohealthservices,althoughthesearenoteasilyaccessible.SometraveltoPachucatotheIMSSbecausethey arebeneficiariesandreportthattheyreceivecareonly afterverylongwaittimesforappointments.Additionally,peoplewithpulmonarytuberculosisreceivesupportfromtheirfamilies;however,theyfeelsadknowingthattheycaninfecttheirfamilymembers.
Theygraduallylearnaboutthetransmissionmechanismastheyprogressthroughtreatment; theyalso mention in their narratives that it is transmitted by coughing or sneezing in front of others. They often wenttoseeadoctor,butthedoctordidnottellthem whattheyhad;theyfearedinfectingtheirneighbors andfamily.
ThepersoninE4mentionsthattheyareadoctor;perhapstheysuggestthatthepatientwilltakeallthepills. Anothercaseinvolvesanursewhotestedpositiveat work,perhapsfromoneofhercoworkersbutitcould alsobeduetocontactwithpatientswhoareunaware theyhavethishealthissue. Someperceivethecare theyreceiveassomewhatpoor,feelingtheyaren’tbe-
actionsaimedatmodifyingsocial, E2.P2. I’dsayit’sfine;I’mnot environmental,andeconomicconditions complaining.
inordertofostertheirpositiveimpacton E3.P3. It’sbadbecausenoonetells individualandcollectivehealth.[1][2]. youwheretogo,theysendyoufrom onepersontoanother.Theworstpart isthattheappointmentstakeforever, anditdrivesyoucrazy.
E4.P4. It’sokay,allthingsconsidered, sinceIwasdiagnosedbecauseoneof myfellownursesatworktested positiveforTB,andtheyperformed smeartestsonallthestaffbecause weweredirectcontacts.Well,Itested positivetoo,andsinceI’mnotfrom there,theygavememytreatment hereatthePachuquillahealthcenter.
ingattendedto,sotheyseekprivatecare. Thereisa lackofinformationaboutthedisease,buttheyknowit iscurable,andtheirattitudeistocontinuetakingthe medication,eventhoughitappearstobequitedifficult totolerateduetosideeffects.Onepersonmentionsa casewheretheydevelopedhives,followedbygastritis, andnowmusttakeanothermedicationaswell.
Conflictofinterest. Theauthorsdeclarethatthereis noconflictofinterestregardingthepublicationofthis article.