THE BURDEN OF TUBERCULOSIS IN COSTA RICA KIMMY HOGUE NURS 445: SUMMER 2014 SAN JOSE, COSTA RICA COSTA RICA 4.805 million (2012) Spanish is the official language GDP per capita 9,386.30 USD (2012) Ranked 63rd in 2012 United States of America: GDP 51,748.56 USD (2012) San Jose is the capital of Costa Rica & the largest city 315,909 live in the city Universal health care provided to all citizens
Mix of both private and public hospitals Average life expectancy is 79.07 years http://data.worldbank.org/indicator/NY.GDP.PCAP.CD Artwork is commonly found throughout San Jose, Costa Rica LEARNING OBJECTIVES (1) (1) TO LEARN ABOUT THE EPIDEMIOLOGY OF TUBERCULOSIS IN COSTA RICA (2) (2) TO UNDERSTAND THE ROUTINE TREATMENT OF TUBERCULOSIS WITHIN THE MEDICAL ORGANIZATION OF COSTA RICA (3) (3) IDENTIFY PREVENTATIVE MEASURES THAT ARE IN PLACE TO DECREASE THE SPREAD OF TUBERCULOSIS (4) (4) COMPARE INCIDENCE OF DISEASE-RESISTANT TUBERCULOSIS BETWEEN COUNTRIES
The wheel of an ox cart which is commonly used by local farmers in the mountainous regions of Costa Rica (5) (5) TO STUDY THE PREVALENCE OF TUBERCULOSIS IN CHILDREN AND ADOLESCENCE AND THE LONGTERM EFFECTS OF THE DISEASE. TUBERCULOSIS BACKGROUND Tuberculosis (TB) is the second leading cause of deaths due to an infectious agent In 2012, 1.3 million deaths occured due to TB 11 per 100,000 people contracted TB in Costa Rica (2013) Approximately 530,000 children contracted TB worldwide Majority of TB deaths happen in low & middle income countries (over 95%) From 1990-2012, the TB death rate has declined by 46% In 2009, 16 per 100,000 people were infected with TB in Costa Rica
TB is caused by Mycobacterium tuberculosis & spread from person to person contact TB is preventable & curable World Health Organization, 2014 HOSPITAL CLINICA SANTA RITA Private hospital specializes in Plastics, Obstetrics, Pediatrics, and Orthopedics The clinic can service approximately 30 patients Connected with medical tourism Established in 1965 & expanding Recently using electronic documentation for surgical procedures Additional services: public
pharmacy, blood bank, and nutritional programs http://hospitalclinicasantaritacr.com/about-us.shtml Currently the front entrance of Clinica Santa Rita & the future expansion PRIVATE VS. PUBLIC FACILITIES HOSPITAL CLINICA SANTA RITA HOSPITAL NACIONAL DE NINOS Two operating room (OR) suites & a single delivery room Approximately, ten patients to every nurse More than 20 nurses & care assistants
Hospital began purely on donations in 1942 One patient for the entire nursing staff for two days Private rooms for patients & family High burn out rate Mural from the public hospital Private hospital room in Hospital Clinica Santa Rita TUBERCULOSIS
MYCOBACTERIUM TUBERCULOSIS AFFECTS THE LUNGS & IS SPREAD BY A SNEEZE, COUGH, OR SPIT IN THE AIR OVER A YEAR, TB PATIENTS CAN INFECT 10-15 PEOPLE BY CLOSE ENCOUNTERS Isolation rooms are limited in public hospitals Personal protective equipment is required RISK FACTORS INFECTED PATIENTS WILL HAVE A CONSTANT RISK OF DEVELOPING TB AGAIN YOUNG ADULTS & IMMUNO-COMPROMISED INDIVIDUALS ARE MOST AT RISK TO DEVELOPING TB OVER 20% OF TB CASES ARE CAUSED BY SMOKING IN COSTA RICA (MacPherson et al., 2014) Before & after the pharmacy of Hospital Clinica Santa Rita was opened to the public
RECOGNIZING & DIAGNOSING TB TB SYMPTOMS: COUGH, FATIGUE, FEVER, CHEST PAIN, & NIGHT SWEATS Ranges from mild to severe DIAGNOSING TB IN CHILDREN IS ESPECIALLY CHALLENGING Latent tuberculosis infection (LTBI) poses new threat SPUTUM SMEAR MICROSCOPY IS USED TO DIAGNOSE MAJORITY OF TB CASES Chest x-ray confirms the presence of TB bacteria Test takes 48 hours to process The US commonly uses TB skin tests (Mantoux tuberculin skin test) or TB blood tests MDR-TB AND HIV-TB DIAGNOSING IS MORE DETAILED & A SEPARATE TEST IS NECESSARY Trained lab technicians read the test results Centers for Disease Control and Prevention, 2014 Malorie Schuler lending a helping hand by checking the expiration dates of medications
COMMUNITY-LEVEL PREVENTION VACCINATIONS HAVE DRASTICALLY DECREASED THE RATE OF TB HOSPITAL CLINICA SANTA RITA REQUIRES ALL NEWBORNS TO RECEIVE THE VACCINATIONS Community strategy: Educational pamphlets are given to parents Pharmacists and nurses work together to convince parents of the benefits of vaccinations Government strategy: All citizens are required by law to receive vaccinations VACCINATIONS ARE REFRIGERATED & CLOSELY MONITORED Pharmacy checks all TB vaccinations daily Stocking and organizing medications to help prepare for the grand opening of the pharmacy
GOVERNMENT- LEVEL PREVENTION COSTA RICAN GOVERNMENT REQUIRES ALL CITIZENS TO RECEIVE TB VACCINATION Government employees go door-to-door to check for vaccinated residents If unvaccinated, trained professionals will provide immunization immediately VACCINATIONS ARE ACCESSIBLE TO ALL POPULATIONS DIRECT OBSERVATION OF TREATMENT Trained professionals will monitor TB patients to ensure compliance World Health Organization, 2014 San Jose is a considered the central hub of health care for Costa Ricans due to its accessibility TREATMENT TB IS TREATED WITH ANTIMICROBIAL DRUGS (RIFAMPIN & ISONIAZID)
Comparable to the US COMPLIANCE OF MEDICATION IS NECESSARY FOR AROUND SIX MONTHS CERTIFIED VOLUNTEERS OR HEALTH PROFESSIONALS ENSURE COMPLIANCE Can be monitored inside or outside of a health facility Meant to prevent MDR-TB MULTIDRUG-RESISTANT TUBERCULOSIS (MDR-TB) IS TREATED WITH SECOND-LINE DEFENSE Pharmacists provide patient education and encourage Costa Ricans to consider the use of medications and vaccinations to improve overall health CHEMOTHERAPY TREATMENT CAN LAST UP TO TWO YEARS FOR MDR-TB Severe adverse effects are common with second line treatment Anowar et al., 2013 CONCLUSIONS & SUGGESTIONS
Patient education is key Introducing pharmacological interventions to patients Costa Rican culture strongly believes in natural remedies Inter-professional team work to strengthen staff knowledge Monitoring TB treatment closely to ensure proper compliance DOT training (World Health Organization, 2012) Increase number of health care professionals in the public setting Vaccinations were performed in the nursery at the Hospital Clinica Santa Rita during the first bath of the newborn
CLINICAL EXPERIENCE Inter-professional team work affects patients and staff Having a strong relationship with coworkers strengthens commitment to the health profession Learning and teaching is continuous with a trusting environment Inter-professionalism allows open communication that influences all facets of the team Working & learning from Diana & Carolina, the pharmacists of the clinic. We were able to open up the pharmacy to the public. CULTURAL EXPERIENCE Finding ways to communicate with others through verbal or body language
The importance of trying to learn another language or cultural customs Adapting to cultural nuances My supportive friends and mentors. Like having a tree frog on your face! REFERENCES Anowar, M., Petpichetchian, W., Isaramalai, S., & Klainin-Yobas, P. (2013). Using nursing practice guidelines for the prevention of multidrug-resistant tuberculosis among hospitalized adult patients in Bangladesh. International Journal Of Nursing Practice, 1981-88. Cegielski, J., Griffith, D. E., McGaha, P. K., Wolfgang, M., Robinson, C. B., Clark, P. A., & Wallace, C. (2013). Eliminating Tuberculosis One Neighborhood at a Time. American
Journal Of Public Health, 103(7), 1292-1300. Furlow, B. (2010). Tuberculosis: A Review and Update. Radiologic Technology, 82(1), 33-56. Jaganath, D., & Mupere, E. (2012). Childhood tuberculosis and malnutrition. Journal of Infectious Diseases, 206(12), 1809-1815. MacPherson, P., Houben, R. J., Glynn, J. R., Corbett, E. L., & Kranzer, K. (2014). Pre-treatment loss to follow-up in tuberculosis patients in low- and lower-middle-income countries and high-burden countries: a systematic review and meta-analysis. Bulletin Of The World Health Organization,92(2), 126-138. World Health Statistics retrieved from http://www.who.int/tb/dots/treatment/en/ Statistic retrieved from http://www.cdc.gov/TB/TOPIC/testing/default.htm
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