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Frontline Tuberculosis Report

Sunday 24 March marks World Tuberculosis Day 2019. To raise awareness of this disease, Pearl Gan, a photographer in residence at Oxford University Clinical Research Unit, Vietnam, has spent a week in Bandung, Indonesia documenting the lives of people affected by tuberculosis as well as the people involved in diagnosing and treating the disease. 

I am a photographer who is currently involved in the tuberculosis programme at the Oxford University Clinical Research Unit (OUCRU), Vietnam. This trip is a collaboration with the Eijkman Oxford Clinical Research Unit (EOCRU), Jakarta. As part of OUCRU’s engagement efforts, I spent a week in Bandung, Indonesia documenting patients and their families affected by tuberculosis (TB), and the health workers and research scientists involved in its treatment and prevention. 

Dr Bachti Alisjahbana giving his expert opinion on a TB diagnosis and explaining the results to a patient’s mother in the
TB clinic at Puskemas Garuda health centre in Bandung, Indonesia. Copyright: Pearl Gan with OUCRU, Vietnam 

During this trip, I met TB expert Dr Bachti Alisjahbana and his team. Dr Bachti is a senior investigator and an infectious disease specialist.  He established the first TB unit in Bandung's Dr Hasan Sadikin Hospital and initiated collaborations in the field of TB and HIV with European partners. Dr Bachti also heads the TB operational research group which is affiliated with the Indonesian TB programme. The Dr Hasan Sadikin Hospital, where Dr Bachti and his team carry out most of their research, is currently the largest hospital in West Java with 1100 beds providing referral care to the people in Bandung.

Ms Titin Yuniarti, a lab technician at the Puskemas Garuda health centre in Bandung is reading the acid-fast smear using the Ziehl Neelsen (ZN) test. This is a rapid and useful method for detecting the causative agent of TB, M. tuberculosis, in low-income
countries such as Indonesia. Copyright: Pearl Gan with OUCRU, Vietnam 
Collection of sputum for diagnosis of TB is mandatory. It is the best way to find out if the patient has the disease and is also the best way to tell if the treatment is working. The lab will perform smear and culture tests on the sputum collected. Copyright: Pearl Gan with OUCRU, Vietnam 

Despite being curable in many cases, having TB is largely stigmatised and patient suffering is often compounded by society’s prejudice as well as their own self-discrimination. In this field trip, I could see first-hand that TB continues to stir fear of transmission and discrimination among people's expectations as well as the patients themselves. Without accurate diagnosis and prompt, effective treatment, TB is extremely difficult to cure and successful treatment can be a race against time. In many parts of the world, samples are quickly sent to a lab where they are examined under a microscope to confirm diagnosis. However, in remote parts of Indonesia, results are often delayed if the patient lives in a geographically challenged area. This often causes delay in TB diagnosis and treatment, reducing the chances of curing the disease.

Ms Nury Fitria Dewi (in black hijab) is a nurse working for Dr Bachti in Dr Hasan Sadikin Hospital, Bandung. She is paying a home visit to a
TB patient in Bandung. The patient was diagnosed when an X-ray on her kidneys inadvertently showed TB on her lungs.
The patient’s husband sells fruit at the local health centre; this is the family's sole source of income. Poor living conditions do not help
with her current TB condition. The air circulation is bad, which risks making the patient ill again even after treatment. Copyright: Pearl Gan with OUCRU, Vietnam 

Recovering patients need support from their family and friends to help them adhere to and complete their treatment cycle for TB. This may not happen if people within their support networks distance themselves from the patient for fear that they are contagious. To improve treatment outcomes, healthcare professionals should seek to educate TB patients and their families in order to break the current cycle of stigmatisation. Healthcare workers should also be aware of the ways in which TB treatment affects patients’ lives, and it would be beneficial to provide ways for them to share their anxieties and negative feelings. 

Dewi Nur is a TB nurse at Puskemas Garuda health centre in Bandung. Here, she educates a 2 year-old patient's family about TB.
Little Dena has been diagnosed with extrapulmonary TB. This is a TB infection which occurs in a location in the body other
than the lungs and is more common in the immunosuppressed and young children. TB education programmes such as these are 
important as they give the patients and their families the knowledge required to help fight TB. Copyright: Pearl Gan with OUCRU, Vietnam 

This Bandung field trip has provided me with the opportunity to document the engagement efforts and increase the awareness of the current TB situation in Bandung.  I applaud and respect the time and efforts which Dr Bachti and his team from the Dr Hasan Sadikin Hospital have dedicated to improving the TB situation in Bandung, and in Indonesia as a whole. I also truly appreciate the time they spent showing me around the hospital and primary care centres and educating me on their efforts in TB treatment.

The memories gathered in this trip will be treasured as it propels me to ensure the messages of suffering and hope will be communicated to those who can help to make a difference to the lives of TB patients as well as improving the medical scene in Indonesia.

Written by Ms Pearl Gan
Photographer in residence
Oxford University Clinical Research Unit  
Ho Chi Minh City, Vietnam 
Copyright of All Photographs : Pearl Gan with OUCRU, Vietnam