Tuberculosis Education and Cooperation in Mumbai

Introduction

Tuberculosis is one of the ten leading causes of death around the globe. Its air transmission, and the inability to recognize the symptoms at early stages make this disease dangerous for millions of people. Each country has a number of organizations that deal with tuberculosis and other health problems through the promotion of health, reducing poverty levels and inequality, and ensuring access to treatment (The United Nations Association of Greater Philadelphia, n.d.).

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From the global point of view, the achievements of the World Health Organization in its fight against infections should be defined. For example, the WHO approves the use of DOT (Directly Observed Treatment) strategies to treat infections and predict epidemics (Narayan, 2015). In this paper, special attention will be paid to the treatment of tuberculosis (TB) and the prevention of TB epidemics in a certain region of India. The promotion of healthy living through the reduction of epidemic TB causes will be discussed with specific regard to the current achievements and challenges observed in Mumbai, the west coast of India, as well as education and training courses offered to the local citizens.

Tuberculosis may be fast spread, and every person can get it even if no specific risks are observed. In Mumbai, 12.4 million people are in panic of being faced with new bacteria that can spread fast live (Narayan, 2015). The prevention of epidemics is a step to be taken in such regions as Mumbai, India, in the shortest possible period of time. With frequent and increasing migration and globalization, the results achieved by one country or even by one region may greatly influence the health conditions of other countries. A program with clear objectives to support Mumbai people in their intentions to reduce the incidence of epidemic TB diseases will be developed, considering such issues as target population needs and possibilities, timeline, costs, and expected outcomes.

Background

Despite the fact that India is a middle-income country, it is the second most populated country in the world, with a population of around 1.3 billion, and has the third-largest recorded epidemics (Vasanthakumari, Vijayalakshmi, & Patlia, 2015). In the whole country, death rates caused by TB are about 27% of all global deaths in 2013 (Murray et al., 2014). Millions of children are living with TB, among other serious infections, with many of them already have lost their parents or caregivers due to this disease. Particularly in Mumbai, the annual rate of deaths because of TB is 213, with about 30,000 new cases registered annually (Narayan, 2015). The quality of life in Mumbai is not high, and people have to use all available resources to try and achieve improvements on their own.

Many countries are focused on reducing mortality rates from TB. India, in its turn, has already had notable success in battling HIV/AIDS (the number of cases has been reduced by 39%) but has so far failed to achieve similar results with TB (Prasad, 2014). These results prove that India has serious potential in the fight against such diseases that are responsible for the death of millions annually. However, the existing challenges for the citizens of Mumbai, such as a profound nursing shortage, uncontrolled sexual contacts, the absence of health education, and the prevalence of addiction, affect health care and determine the quality of life (Garner, Raj, Prater, & Putturaj, 2014).

The studies developed by Vasanthakumari et al. (2015), Abhilash (2015), Garner et al. (2014), and Lundberg, Doan, Dinh, Oach, and Le (2016) not only prove the urgency of the health issue chosen for analysis but also demonstrate various ways and methods that can be used to support Mumbai people and provide them with informative guides on how to ensure healthy living.

In Mumbai, much attention is paid to the causes that make the population vulnerable. As a rule, people of all ages are challenged by the inability to fulfill their basic needs and deal with such problems as poverty, infections, inappropriate nutrition, homelessness, and limited access to medications on a daily basis (Vasanthakumari et al., 2015). It is impractical to believe that the solution to all these issues for all citizens of Mumbai is possible through just one program.

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However, it is reasonable to hope that at least several steps can be taken to achieve certain specific goals. The example of Vietnamese healthcare workers can be used to understand how a lack of education about the basics of diseases is one of the main problems in society (Lundberg et al., 2016). Babu, Madan, Veluswamy, Mehra, and Maiya (2014) underline the necessity of skill-oriented knowledge and motivational messages to deal with risk factors and threats. Finally, Garner et al. (2014) help to demonstrate how community education is one of the best strategies in terms of ensuring the improvement of social perceptions of health care, nursing, and the possibility of prevention.

The campaign to eradicate TB in Mumbai has the potential to touch and improve thousands of lives through detecting and reporting TB cases and providing access to effective TB services (“TB in India,” 2017). One of the initial steps that can be offered to the population is the promotion of a program that is called “Education through Cooperation.” Mumbai people are ready for communication and cooperation to protect themselves against TB. It is also possible to use a DOT strategy and involve DOT providers in specific activities to control and treat TB among the population (Narayan, 2015). The peculiar feature of this program is the possibility to rely on governmental commitment, drug supply, and TB detection. An education program is a good chance to understand the worth of DOT in India and improve the population knowledge.

Objectives

“Education through Cooperation” is a new program that can be undertaken by the citizens of Southern India to ensure good, or at least better, health. However, it is necessary to acknowledge that an idea to ensure health for people of all ages is a very general topic, and it is better to narrow it down so that clearer steps and objectives can be explained. The United Nations Association of Greater Philadelphia (n.d.) proposes several supplementary targets to guide people in their intentions to practice healthy living. As such, the eradication of TB is one of the targeted aspects. The overarching goal of the offered program is to reduce the number of TB deaths among the Mumbai population by 50% within the next two years by ensuring good health activities and education. To achieve this aim, it is possible to take the following SMART steps:

  1. By the end of the educational program, 200 citizens of Mumbai will be asked about epidemic diseases and give approximately 85% of correct answers to demonstrate their readiness to prevent TB;
  2. By the end of the first week of the program, it is expected to identify how many TB cases in Mumbai have occurred during the last two years and investigate the prevalence, epidemiology, and epistemology of the disease in the chosen population.
  3. By the end of the program, it is necessary to create 50 strong social media advertisements and organize 50 face-to-face meetings with the citizens of Mumbai in terms of which TB threats and prevention can be discussed;
  4. In the middle of the program, five medical employees will be invited to organize three one-hour-long educational courses for the citizens of Mumbai about the importance of hygiene and care;
  5. By the end of the program, a chosen group of Mumbai people should participate in meetings, take courses, and follow guidelines in order to demonstrate the decrease of TB cases by up to 50%.

Health communication is an integral part of the prevention of epidemic diseases. Mumbai is the region where the availability of medication and quality healthcare services is higher than in other Indian parts. TB is an infection that anyone can take, and people with low income are under a more serious threat than other citizens (Jacobsen, 2014). Instead of thinking about how to find new sources or fund innovations, it is better to use what is already available to hospitals, medical workers, and nurses to support the Indian people in Mumbai.

Description of the Program and Its Innovativeness

The “Education through Cooperation” program is a comprehensive set of steps that can be offered to Mumbai citizens in their local hospitals and medical facilities by nurses or other healthcare workers. It includes intervention measures and several pre-and post-intervention investigations that aim at decreasing TB cases in Mumbai. There are five members in a research group. A leader who solves financial and organizational problems, develops, and approves plans, two people who work with statistics and research, and two people who communicate with local people, gather the material and organize meetings.

Taking into account all these studies and experiences, the program of “Education through Communication” includes the following details:

  1. Recognition of what Mumbai citizens know about TB. This program should have a starting point. A group of researchers communicates with local people, visits hospitals, and cooperates with local medical workers to gather information about TB cases during the last 2 years. Simple questions to the population such as, “Do you know what TB is?” or “Do you know if some of your relatives have tuberculosis?” are posed face-to-face and recorded.
  2. Visits to local schools and hospitals are required to identify what sources of information about TB are available to Mumbai people. This should be done in cooperation with hospital leaders, nurses, and educators who can explain the goals of the program and the expected outcomes.
  3. Means of communication have to be identified. This step helps to clarify what the most convenient way is to share information about TB. It is expected that people would support the idea of face-to-face communication and would be keen to visit free meetings.
  4. There is a hope to invite several experts from other countries. They can share their knowledge and experience with local medical workers and nurses. International practice and cooperation with international professionals introduce a significant element of innovation to the program.
  5. The above-mentioned interventions would ideally last two years. This approach can enable proper evaluation of its benefits, as well as the challenges faced. As soon as people get access to health education and international communication, the possibility to take the first step and end epidemics in India can be realized.

The main policies that have to be taken into consideration in this program are:

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  1. Health communication offers new opportunities to Indians in their intentions to ensure healthy living. A group of people from a research team organizes free weekly meetings to discuss the details of TB, its symptoms, diagnosis, treatment, and prevention. All meetings will be outside so that any person can join a conversation. Special tents will be placed on the streets. One flat will be rented for a research team (5 people including the leader).
  2. Training, education, and communication help to identify their knowledge gaps and correct mistakes. The citizens are invited to take tests and quizzes in order to recognize if they are ready to fight against TB in their region. A research group gathers contact information, sets the date of a new meeting, and brings the results of tests to be discussed.
  3. It is never too late to study. Therefore, people aged between 18 and 25 or 55 and 70 are all invited to participate in the program. The results of the tests help to identify the gaps in knowledge and the aspects that have to be improved. People who meet the chosen age criteria are gathered under the control of a research group leader to listen to a lecture, participate in learning activities, and discuss the expected outcome of interventions.

Target Population

One of the significant steps of the development of this program is the identification of its target population. In addition to the fact that all participants will be citizens of Mumbai, it is also necessary to clarify such characteristics as age, gender, social status, language, and education degree (if any). Two groups are created: the first group includes people of both genders, aged between 18 and 25; the second group consists of males and females aged between 55 and 70.

The distinguishing feature of these groupings is their personal experience. Younger participants may rely on fresh approaches and modern education, while older participants can use their past experience, knowledge, and family history. Today, about 12 million people live in Mumbai. It is hard to invite all people to participate in the program because of their personal affairs, social responsibilities, and the necessity to work every day. Therefore, it is expected to choose one district in the city and focus on people of a certain age (those who are not bound by the obligation to work and earn money).

Another important aspect is the identification of social status and education. It is hard to invite people with the same indicators. Therefore, these two factors have to be optional. People from different social levels may participate, learn something new, and share their knowledge with other representatives. Finally, the participants of the program have to speak and understand English. There are many official languages in India, but English is the most frequently used foreign language. Therefore, Indians who know English well are invited.

Timeline

The “Education through Cooperation” program has been created as a long-term project in Southern India. A two-year period has been determined for the implementation and evaluation of the outcomes of the policies and interventions. Two years is the initial time given to implement the program and observe its first results. The following timeline is used:

Task Time Period
1 Recognize the number of TB epidemic diseases among the citizens of Mumbai during the last 2 years 4 months
2 Communicate with Indian doctors, nurses, and researchers. 1 month
3 Research recent epidemics, main diseases, preventive methods, and epidemiology. 1 month
4 Organize meetings, planning, and analysis. 3 months
5 Create educational brochures and booklets about the prevention of epidemics in the country. 2-3 weeks
6 Establish contacts at the international level, including a search for appropriate participants, communication with the representatives of different countries, exchange of contacts, and setting the date of online meetings. 1-2 months
7 Organize lectures and online conferences with medical workers, talking about the importance to take precautionary measures against TB 2-3 meetings per month, over the next 2 years
8 Evaluate the results, communicate with the participants, investigate new options. 1-2 months

This timeline is not final and can be modified over time, as soon as one stage is over or when new details or requirements are established.

Approximate Cost

It is a difficult task to predict the approximate cost of the program because much depends on the participants and their intentions to cooperate. At this moment, it is possible to identify several aspects and their approximate price:

Flight from the United States to Mumbai – approx. $500-700

Living costs in Mumbai for one month – approx. $1500-2000

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Brochures – approx. $150-200

Services of 1-2 educators in the country for one month – $5000-10000

Blood tests for TB – $3-5 per test (expected to test at least 100 people of different ages) = $300-500

Additional costs (to cover unpredictable losses or new meetings) – $500

The total cost for this program to be developed for a group of American researchers in India for 2 years is about $100000.

Outcomes

If the goals of the program are met and the plan of intervention is followed, several short-term and long-term outcomes may be expected. One of the main benefits is the recognition of current health problems in Mumbai. Research of recent TB epidemics, social concerns, and global problems promotes the creation of a general picture of the quality of human life in Mumbai. Another short-term goal is the recognition of the number of people who want to improve their lives and the possibility to increase this number up to 30%.

It is also possible to increase international donations for the improvement of Mumbai lives by up to 10%; when people become more aware of recent health problems, some may be ready to help and involve new participants. Several long-term outcomes have to be mentioned. First, changes in mortality rates from TB are expected (increase up to 50%). Second, the quality of life in Mumbai can be improved. Finally, Indian experiences in battling epidemics can help other countries to achieve similar results.

Conclusion

In general, the evaluation of the studies and the analysis of statistics show that India is a country with a population challenged by frequent cases of TB. Despite numerous attempts to find a solution and decrease the number of deaths caused by TB, Indians are still in need of additional resources and medication to be offered at the international level. The program “Education through Cooperation” is a chance for Indian people to access international knowledge and experience and apply this to local practices and everyday life activities.

The exchange of knowledge and precautionary methods are potential affordable approaches that can be offered to India. It is a middle-income country, and it is wrong to believe that extensive financial support can be achieved. Therefore, it is better to rely on the steps that can be taken by ordinary people who are ready to work and share their knowledge with each other. Education through cooperation at the international level is an innovative idea for Southern India, where not everyone is able to communicate with foreigners and have the opportunity to learn something new about health. Health communication and education cannot be ignored, and Indians have to take as much as possible from this program.

References

Abhilash, V. (2015). A study to assess the knowledge and attitude of adolescents regarding the prevention of HIV/AIDS in selected higher secondary schools at Calicut district. Indian Journal of Advanced Nursing, 1(4), 45-50.

Babu, A.S., Madan, K., Veluswamy, S.K., Mehra, R., & Maiya, A.G. (2014). Worksite health and wellness programs in India. Progress in Cardiovascular Diseases, 56(2014), 501–507. Web.

Garner, S. L., Raj, L., Prater, L. S., & Putturaj, M. (2014). Student nurses’ perceived challenges of nursing in India. International Nursing Review, 61(3), 389-397.

Jacobsen, K.H. (2014). Introduction to global health (2nd ed.). Burlington, MA: Jones & Bartlett Publishers.

Lundberg, P.C., Doan, T.T.K., Dinh, T.T.X., Oach, N.K., & Le, P.H. (2016). Caregiving to persons living with HIV/AIDS: Experiences of Vietnamese family members. Journal of Clinical Nursing, 25(5-6), 788-798.

Murray, C.J., Ortblad, K.F., Guinovart, C., Lim, S.S., Wolock, T.M., Roberts, D.A., … Vos, T. (2014). Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990-2013: A systematic analysis for the global burden of disease study 2013. Lancet, 384(9947), 1005-1070. Web.

Narayan, B. (2015). Tuberculosis in India: A need of public awareness & education. University of Mauritius Research Journal, 21, 1-27. Web.

Prasad, R. (2014). India scores by battling HIV/AIDS but falls short fighting TB and malaria. The Hindu. Web.

TB in India – Elimination, private care, TB burden, NSPs. (2017). Web.

United Nations Association of Greater Philadelphia. (n.d.). The sustainable development goals 2015-2030. Web.

Vasanthakumari, S., Vijayalakshmi, S., & Patlia, M. (2015). Correlation of psychological stress and nutritional status in HIV infected children residing in selected residential home, Chennai. Indian Journal of Advanced Nursing, 1(2), 8-16.

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