Involving Community Mobilizers in TB Control Saving Lives Amid Conflict in South Sudan

 {Photo: MSH staff}Nimeri and his family relocated to Yei when war broke out in Juba. Nimeri was in his sixth month of TB treatment.Photo: MSH staff

Ripenti Nimeri Yotma is a 40-year-old soldier who has lived through war and being displaced. But it was a battle with Tuberculosis (TB) that almost killed him. The father of three children (aged 14, 4, and one and a half), Nimeri presently lives in Logobero Village, Yei Boma. However, his illness started in April 2013 while he was still living in Juba. When his persistent cough eventually led to him coughing up blood-stained mucus, Nimeri’s wife took him to the nearest health center in Juba City, where he was examined.

“On 5 May 2013, the health worker told me that I had TB. This information shocked me, but after being educated on TB, I was started on treatment,” Nimeri says.

After four months of treatment, Nimeri improved and his cough had subsided. Then, in December 2014 during his sixth month of treatment, war broke out in Juba and Nimeri and his family relocated to Yei to start a new life. Nimeri cleared bush and started to lay bricks for building a tukul, a home for his family.

Soon after his move, Nimeri started feeling weak again and suddenly developed a cough with blood and foul-smelling sputum. By April 2015, Nimeri had developed a skin problem, his cough had worsened, and he was too weak to move.

His friends and children started to avoid him because of his bad breath and the smell of his sputum.

“I became depressed and wished the disease would kill me,” Nimeri says. 

[Community mobilizers visit Nimeri's tukul (home).] {Photo: MSH}Community mobilizers visit Nimeri's tukul (home).Photo: MSH

Challenge TB, through US Agency for International Development (USAID) funding, trained 43 TB community mobilizers in Yei River county on basic knowledge of TB to increase awareness of TB disease and available services through community sensitization activities in all Boma villages. The community mobilizers completed door-to-door active TB screening and identified and referred presumptive TB cases to the nearest health facility for diagnosis and treatment. They also encouraged patient adherence to TB treatment, identified defaulters, and initiated tracing. The community mobilizers also referred TB patients on treatment for follow up sputum smears, and contact investigation. Finally, the mobilizers completed records of necessary information in relevant community TB tools.

On June 26, 2015, three young men, community mobilizers who were educating people on TB and screening them, visited Nimeri’s home. Nimeri’s wife immediately asked them to see her husband.

Nimeri explains:

They asked me about my cough and previous treatment of TB and I explained to them. However, I could not produce the patient’s card because it was destroyed during the crisis in Juba. I was given a waraga (referral slip) and they requested me to go to the hospital for sputum examination.

One community mobilizer saw that I was too weak to move. He ran to the hospital and came with a container, and told me to breath deep, cough and spit in [it] early in the morning before eating any food, and bring it to the hospital.

The next morning, Nimeri went to the Yei Civil Hospital, eight kilometers from his home, with his wife, where the sputum examination was done and the results were smear-negative for TB. Nimeri was sent for a chest X-ray which was suggestive of TB, and he was started on TB treatment a few days later.

“After seven days on tablets and injections I started feeling better and was able to move and eat well, and the cough has reduced. I only cough at the dawn as compared to before,” says Nimeri.

One of the community mobilizers returned to check on Nimeri and advised him to stop smoking and drinking alcohol and to sleep in a separate room from his wife and children until he completes treatment. Says Nimeri:

Since that day I stopped sharing tukul [home] with my family because I fear my family will get the same disease. I am happy that they have been checked for TB and none has it.

The community mobilizer will continue to visit with Nimeri to ensure that he takes the drugs regularly and goes to the hospital for follow up and refills after every 2 months.

Between May and July 2015, 241 health education sessions about TB were conducted; 3,321 people (1222 men, 1252 women, and 847 children) were reached with TB messages and screened for TB, out of which 6.9 percent (231) presumptive cases of TB were identified and referred to the health facility for TB diagnosis. Thirty-two TB patients like Nimeri were followed up with to promote adherence. 

“I have started seeing life because of the community mobilizers. I don’t know what to give to the mobilizers but I am praying that God open their ways to success. Oh! I would have died,’’ Nimeri says.