Category: Guest Blog

World Tuberculosis Day

Today is World Tuberculosis (TB) Day, 2017 is the second year of the “Unite to End TB” campaign. The UN Sustainable Development Goals and the WHO End TB Strategy target is to end TB by 2030. Click here to read more about World Tuberculosis Day and how you can support the “Unite to End TB” and “Leave No One Behind” campaigns.

The following article, first published in Health Matters Magazine in 2016, written by Majok Wutchok, (a member of the Sudanese community in Perth) outlines how West Australian Tuberculosis Control Program could be improved from a consumer perspective.

Tuberculosis (TB) is considered the second most deadly disease after HIV/AIDS in developing countries. Every year there is a mass movement of Australian’s travelling overseas on holiday and returning home. A major concern is there isn’t proper health promotion and public health education to protect consumers when they and their relatives return from overseas. Due to the lack of public health education they and their family may not be aware they are coming home infected with a tropical or communicable disease.

I recommend the WA Health Department set up a consumer overseas travellers screening task force, to avoid a future catastrophic spread of disease across the state. There is also a need to engage with healthcare providers to empower those infected with Tuberculosis and other communicable diseases and to support and empower their community.

Western Australia Tuberculosis Control Program

The current program, ‘Western Australia Tuberculosis Control Program’ is administered by the North Metropolitan Area Health Service (NMAHS). However, the program only endeavours to screen and treat the disease once it has been acquired, it does nothing to educate those at risk on prevention methods. ‘Western Australia Tuberculosis Control Program’ detailed as follows:

‘The program manages Tuberculosis in Western Australia and offers a state-wide public health service that operates as a resource centre and clinic. Aspects of the service include:

• Treatment of Active TB: Diagnosis, treatment and case management
• Surveillance and prevention of TB
• Active screening of high risk groups
• Contact tracing
• Diagnosis and treatment of latent TB infection (preventative therapy)
• Tuberculin Skin Test (TST), also known as Mantoux testing and BCG vaccinations to selected populations. Training and accreditation can be provided for relevant health professionals.
• Free Health Service: All services related to the diagnosis, treatment of TB and relevant medications are provided at no charge. (See “Fees and charges related to the diagnosis and management of tuberculosis and leprosy” (Operational Directive OD 0229/09))
• TB Infection Control
• Advice on pre-employment screening of Health Care Workers and Tertiary Students
• Advice on Management of TB risk in health care settings
• Assistance with contact tracing in health care settings
• Hansen’s Disease (Leprosy): Outpatient clinic service and consultative advice
• Consultation: Specialist advice from medical and nursing staff is readily available, including preventative advice, health service education and access to information programs.
• Policy and Operational Directives: Develop, implement and review policy relevant to TB management and control
• TB Notification and Enhanced Surveillance data base: Maintenance and reporting on TB epidemiology’

(http://www.health.wa.gov.au/acc/tb/)

Prevention is better than Cure

Even in 1918 the thinking regarding Tuberculosis, was ‘Prevention is better than a cure’ (Cobbett, L 1918, British Journal of Tuberculosis, vol. 12, no. 1, pp. 16-19). According to the World Health Organisation (WHO 2014), prevention strategies involve encouraging and conducting research. It has been suggested that integrated intervention programs with consumers and their communities involved can be very beneficial. As opposed to vertical programs which are considered limited, integrated programs are considered far more effective for prevention. However, integrated programs need established communication and consistent health education together with consumers’ participation across all aspects.

Engaging Consumers is the key

Regarding primary healthcare and consumers, the involvement of a population group from high-risk consumers is paramount. At the same time public health education and community health promotion are also considered important, and are associated with the continuous use of those preventive measures by the consumer’s communities.

In short it is important sustainable prevention measures are taken to educate those at risk, to prevent them catching Tuberculosis and other communicable diseases while travelling, rather than simply screening and treating the disease when it has already been contracted.

Majok Wutchok | Consumer Representative | ANUTR | MPH Student

(This article was first published as ‘Consumer Approach Vs Tuberculosis Control in WA’ in HCC Health Matters Magazine 2016 Issue 2)

If you would like assistance partnering with consumers in health, the HCC Consumer & Community Engagement Team can help!

Partnering With Consumers

HCC facilitates on-site workshops that assist health care staff to increase their understanding of effective partnering with consumers in the governance and operational structures of your organisation. Principles of consumer participation within the context of health service accreditation can also be a key component of this bespoke fee for service training. Training can be conducted specifically for board members, executive committee members, management and point of care delivery staff, or with a whole of organisation approach.

Safety And Quality Committees

We can provide new and existing consumer members with information on the elements of quality and why patient safety is a critical area of focus in health care. This fee for service training can be tailored to meet the needs of specific safety and quality committees.

Register Your Interest

Please complete the form here to register your interest in HCC’s workshops.

For Further Information

Please contact the Health Consumers Council Community and Consumer Engagement team on 9221 3422 or email:

Louise Ford: louise.ford@hconc.org.au

Steph Newell: stephanie.newell@hconc.org.au

Going blind & mental illness

In 1993, I started having trouble seeing properly through my right eye. It was as if I was looking at the world through a spider’s web. An ophthalmologist diagnosed a condition which he called “collagen stringing”. He explained that all the ‘lines’ interfering with my sight were in fact strings of collagen cells which had formed inside my eye. He told me the condition couldn’t be treated and I would eventually go blind in that eye.

A year or two later, other symptoms started to appear. I began to forget things. My family, friends and staff picked up on changes in my personality. Like most people with an emerging mental health problem I was not aware that something was wrong and typically I refused to listen and seek medical help. The eye problem hadn’t got any worse and I had accepted it as normal. My family and I did not connect it with these new symptoms that were causing serious problems in my private and professional life.

A second opinion

In December 1999, an optician advised me to seek a second opinion ( another ophthalmic examination) and referred me to arguably the leading eye clinic in Perth. This time, the very senior ophthalmologist (who denied any knowledge of a condition called “collagen stringing”) took one look in my eye and sent me off for a CT scan. This happened on a Friday afternoon at 3.30pm and by 6.00pm that same day, I was in the consulting rooms of a neurosurgeon to discuss how to deal with a primary but fortunately benign brain tumour called a meningioma the CT scan had revealed behind my right eye.

The meningioma was wrapped around my right optic nerve which explained why I had been having vision issues in that eye for so long. The meningioma was as large as a squash ball and had pushed the right frontal lobe of my brain out of alignment inside my skull. As a result, I had been and was still living with a mental health condition called Frontal Lobe Dysfunction – the sinister source of all my personality issues and some very costly and unexplainable decisions I had made in my business which was by now heading south at an alarming rate.

A question of life or death

The neurosurgeon told me I had two choices – I could leave it in situ or have it taken out. He then told me that it would kill me within two years if I left it in – it was still life threatening despite being non-cancerous and not metastatic. What to do? Perform a craniotomy as quickly as possible.

From then on, things moved quickly. I was introduced to MRI machines and was admitted to hospital early the following week. Subsequent blood tests indicated I experienced a cardiac event during the craniotomy which took nine hours or so to perform so after a short spell in ICU, I was transferred to the CCU where I remained for two days. Presumably because there were no further symptoms of a heart problem. I was then transferred back to a surgical ward where I remained until discharge a week or so later.

Medication side effects

Among the post-discharge medications prescribed for me was one called Dexamethasone. It is a corticosteroid with potentially major side effects including elevated aggression, agitation, anxiety, irritability and pronounced mood swings. I experienced all of these to such an extent that I became an extremely unpleasant person to be around – so much so that my relationships with members of my family were strained to their limits. I did not know then whether my behaviour was due to the medication or the effects of head entry surgery which I believe can have much the same effect on behaviour and personality etc. as a serious acquired head injury. Either way, life was not good – so much so, I tracked down an organisation known then as the Head Injury Society and left a request on their voicemail for an urgent call back. Three weeks later, I got that call only to be told that the first appointment they could give me was in three months’ time!

There were some other subsequent issues relating to life insurance policies and our business which caused even more heart-ache than the dexamethasone but these are not relevant to a patient’s story from a health service provider’s perspective other than to say that serious injury or illness impacts on many more aspects of one’s quality of life than merely those which are typically considered in a health service care plan.

What could’ve helped my patient experience

Hindsight is a wonderful thing but my family’s and my experience of the continuum of care would have been better if the following could have occurred before and/or during the events in question.

1. A campaign to educate the community about how to recognise the early symptoms of mental health problems for individuals and their families could have helped me to react more appropriately to the very genuine and now appreciated attempts by my family to convince me that I needed medical advice. Such a campaign these days could be incredibly effective given the knowledge distribution capability and reach of the internet.

2. Had I sought a second opinion about a diagnosis of “collagen stringing”, the real cause of my sight impediment may have been discovered years earlier and the size and life impacts of the meningioma reduced accordingly. In those days, however, the thought that a clinician could be wrong just did not enter people’s minds and most people, including me, just went along with what they were told. Here again, a public education programme conducted by an appropriately trusted organisation would enhance public understanding of a consumer’s right to question a medical opinion and the wisdom of not placing blind trust in a health practitioner.

3. At the time, bearing in mind that I was recovering from major surgery, no effort was made by the hospital to make sure that I fully understood why I was being sent to the CCU. Equally, no further tests were done so I was kept totally in the dark about my symptomology and progress if any. Likewise, I was given no opportunity to start coming to grips with the prospect of a future with a potentially serious heart condition.

4. Three days after leaving the hospital, I went to see the latest James Bond film. Imagine my wife’s and my horror when, another two days later, the nurse removing the sutures from my head told us that I should not have gone as loud noises and bright lights could have caused me to have a fit thanks to the side effects of my head entry surgery and the dexamethasone. No such advice was given during my discharge from the hospital – all we did learn was that I was not allowed to drive a car for the following three months.

Today

My patient experience has a good ending. The removal of the meningioma restored the sight in my right eye immediately. A subsequent angiogram and stress ECG confirmed that I did not have a heart problem. My personal and business lives are now back on track and I have learned a lot – and met some fabulous people – by investing my time in the promotion of consumer involvement in how the health system should look as it faces the challenges of the future – particularly from a patient’s perspective!

Tony Addiscott | Health Consumers’ Council Deputy Chair

Register now for FREE Patient Experience Week Community Conversation | April 27

Tickets Are Limited! Register Now! April 27 – Community Conversation

Powerful Change Can Happen When There Is A Shared Vision Of What Works. Join The Health Consumers’ Council And The Australasian College Of Health Service Management As We Start A New Conversation About Patient Experience.

Expertise is found at both ends of the discussion between patient and healthcare provider. It is in administration, in hospitals and community settings. It is found in homes, with our carers and the community at large.

So join the conversation to create a shared vision, SHARE… What matters to me about the patient experience is… and ASK… What matters to you about the patient experience?

If you are obese your chances of achieving normal weight without surgery are slim to put it mildly. If you are male, you have a chance of one in 210. Women fare a little better; their chances are one in 124. These depressing statistics come from a ten-year study of 77,000 obese men and 100,00 obese women in the UK. To compound this picture at least half of those who managed to lose substantial amounts of weight put it back on within five years. No wonder the diet and gym industry is booming.

Dr Simon Rosenbaum, national director of Exercise and Sports Science Australia, writing in The Conversation says weight loss important but fitness, not fatness is a better focus. He says many people who start an exercise program to lose weight are setting themselves up to fail because exercise in the absence of dietary modification is not all that effective for weight loss.

An online survey carried out by CSIRO says Australians are their own worst enemies when it comes to eating better and controlling their weight. The survey, which looked at the weight management habits of more than 2300 Australians, found 69 per cent of respondents identified themselves as the main barrier to achieving their weight loss goals. CSIRO’s Research Director for Nutrition and Health, Professor Manny Noakes said it was critical that those looking to lose weight seek support.

“For many Australians losing weight is a challenging experience. The survey also showed that 40 per cent of dieters stated that no one supports them in their weight loss attempts.”

“Health professionals, friends and family can all play a role in helping dieters eat better and control their weight.”

The good news for seniors is that being overweight (but not obese) is not a health hazard. Ms Ngaire Hobbins – a dietician who specialises in the care of older Australians – warns that a healthy weight once you are over 65 is not necessarily the same as applies for younger adults. She says a Body Mass Index (BMI) between 23 and 28 is probably ideal for older adults. Being thin in older age is associated with a higher likelihood of dementia, of having a fall, of general poor health and even death. Those who are a bit heavier fare best. Ms Hobbins’ conclusions are supported by researchers at the University of Western Australia.

They studied over 12,000 Perth men selected at random from the electoral roll. All were between the ages of 65 and 84 and had no symptoms of dementia.  Overweight – but not obese – older men were healthier than either their slimmer or fatter colleagues. “We are struggling to explain the results,” said Leon Flicker, Professor of Geriatric Medicine and one of the study authors. “Being overweight after 70 doesn’t have the same negative effects that it does in younger men.” “Men over 70 and in reasonably health good health but overweight, are less likely to develop dementia. Exactly why we don’t know. We can speculate that fat tissue may have some important protective role in older men or it may build some resilience into the system.”

Dr Rosenbaum says exercise is important, but for other reasons. It helps protect against developing chronic diseases, such as type 2 diabetes, even for people who are obese.

By Frank Smith – HCC Blog Contributor