Maputo, Mozambique—Isabel Chumbe’s persistent cough convinced her that she was “bewitched.” But community health counselor Leta Ernesto Majonise suspected another cause—tuberculosis.
Majonise’s visit to the home of Chumbe and her husband, Adam Chitofo, in the town of Pambarra is part of a government-supported, community health initiative to expand access to health services in Mozambique. And Majonise is one in a team of community health counselors who go door-to-door to test residents for HIV, check for symptoms of tuberculosis and other health conditions, provide wellness information and, as needed, connect people with health services.
A consortium of Mozambican organizations operate the Jhpiego-supported program, which has provided HIV counseling and testing services to more than 700,000 citizens since the fall of 2008.
People living with HIV are at increased risk of developing TB. To help reduce TB-related deaths, Jhpiego promotes a prevention and treatment approach that integrates TB and HIV services. Mozambique has the 14th highest burden of TB in the world, with an estimated 130,000 cases. Sixty-two percent of TB patients in the country are HIV-positive.
During Majonise’s visit to the home of Chumbe and Chitofo, both tested negative for HIV. But because the 75-year-old woman showed signs and reported symptoms suggesting tuberculosis (persistent coughing, feeling feverish and repeatedly spitting up blood), Majonise referred the couple to the local Rural Hospital de Vilanculos—about 12 miles from their home.
A hospital test for TB confirmed that Chumbe was positive for the bacteria that cause the disease, and the woman immediately began treatment. At some point, however, she stopped taking her medicine, believing that she wasn’t getting any better because she was still bewitched. When community health counselor Majonise next visited, she explained to Chumbe the true cause of her illness and convinced her to return to the hospital for continued treatment. Upon being released after two days in the hospital, Chumbe vowed not to go off her medicine until the treatment regimen was completed. And Chumbe’s husband made sure his wife stuck with her treatment.
“I just want to get better and return to work in fields,’’ said Chumbe, adding that the community health counselor had really helped in her recovery.
Jhpiego has been working since 2004 with the government of Mozambique, supported by the President’s Emergency Plan for AIDS Relief (PEPFAR). In 2008, in collaboration with other local nongovernmental organizations (NGOs), Jhpiego developed a community-based counseling and testing program to help identify and reduce new cases of HIV and TB. Today, 186 counselors from nine local NGOs—including faith-based and civic organizations—are working in 42 districts, across 10 provinces, in the country.
Chumbe and her husband were among the 538,761 Mozambicans counseled and tested for HIV and screened for TB and other conditions during the 18 months ending in December 2011. Of those tested, 45,367 were referred to health facilities for further evaluation. A counseling package implemented after June 2010 features material aimed at intensified identification of TB, including a five-item screening questionnaire to identify symptoms related to TB, such as: a cough lasting for more than two weeks, weight loss, excessive night sweating, spitting up blood and loss of appetite.
Jhpiego continues to support this innovative strategy to reduce deaths from HIV, TB and HIV/TB co-infection through prompt recognition of signs and symptoms and access to diagnostic services, as well as prompt treatment. This integrated, community-based approach to essential health services also includes screening for hypertension, malaria and diarrheal diseases. It is part of Jhpiego’s ongoing efforts to preventthe needless deaths of women and families in Mozambique by building the capacity of health care workers and strengthening health systems. The organization also develops innovative, low-cost technologies to address today’s global health challenges and works with partners to increase frontline health workers’ capacity to deliver lifesaving care.
Jhpiego Mozambique is also training health care workers in TB infection control. These trainings help to ensure that people using the health care facilities in the country do not contract TB when they come to receive care. Infection control practices help to protect health workers in these facilities, too, who are in constant contact with patients who have TB. Protecting the health care workers is vital because they are an invaluable resource; without them, Mozambicans—people everywhere—are unable to access lifesaving treatment. From July 2011 to February 2012, 326 health care workers were trained in TB infection control.
Majonise, 34, joined the ranks of Mozambique’s community health counselors because she knows that many people in her community are suffering from preventable diseases. Trained by Jhpiego, she has counseled and tested 581 people since last summer and referred 70, including patients who are HIV-positive or suspected to have TB, for additional services.
Majonise is very proud to know that 42 of her patients are now in treatment.
“I enjoy my work,” she says, “because I am convinced that this program is helping people change their minds [about accessing health services] and their lives.”