BARRIERS TO IMPLEMENTATION OF DOTS IN

ZAMBOANGA CITY

A Research Paper Presented to

The Faculty of the

Ateneo de Zamboanga University

Graduate School

In Partial Fulfillment of the Requirements For the

Degree in Masters in Public Health

AISA RATAG PRESAS

APRIL 2008

i

APPROVAL SHEET

This research entitled, “BARRIERS TO IMPLEMENTATION OF DOTS IN

ZAMBOANGA CITY” prepared by Aisa Ratag Presas, in partial fulfillment of the

requirements for the degree of Masters in Public Health, is hereby accepted.

___________________________________

Fortunato L. Cristobal MD, MPH

Research Adviser

_______________________________________________________________________

Approved by the Oral Examination Committee with a grade of PASSED.

__________________________

Rosemarie S. Arciaga MD

Chairman

_____________________________ __________________________

Servando D. Halili, Jr. PhD Ricardo N. Angeles MD, MPH

Member Member

__________________________

Jocelyn D. Partosa PhD Member

________________________________________________________________________

ACCEPTED in partial fulfillment for the degree of Masters in Public Health

_____________________________

Servando D. Halili, Jr. PhD

Dean, Graduate School

Ateneo de Zamboanga University

ii

ACKNOWLEDGEMENT

The researcher would like to give her deepest gratitude firstly to the Almighty Allah, for

the gift of wisdom, providence and He who made things possible.

To her mother, Sitti Sharra Ratag Presas, who had been the strength behind all her

endeavors.

To her late father and sister (Lorenzo Navales Presas and Shiela), for continually being

there for her spiritually.

To her brothers (Mudzmar, Alkasmar, Audimar and Vlademar) and to her sisters-in-

law (Ache Jen and Ate Sheila), for the love and continuous encouragement.

To the angels of her life, Jarviz, Rhaisa and Princess Sharra, for making her realize

about her loving and caring role in life.

To her Auntie Jing, Tita Nels and Tito Loury for the financial support and the much

needed advise throughout the medschool years.

To her uncle doc Henry, for the advise on how to cope and plan for the medical career.

To the rest of her family who have been continuously supportive of the dream she is

pursuing.

To ate Suy(Allen), for being more than just a sister, for keeping her in balance despite of

the contradicting views they share and for keeping her company in the conduct of the research.

To Daring and Jackerz, for being true, for staying beside her and standing as her stress-

relievers especially in her weakest moments.

To LG, for being her Yin and her Yang.

To Mrs. Gina Gregorio and family for accepting her as she is and for always being

ready to lend a hand.

To her “Make Your Lolo Proud” Brothers (Big Dad JP & Mohkish) for the security,

enjoyable rides, for the companionship and sincerest friendship.

To her other classmates (Ruchee, Mamae, JR ‘d Alien, Cookie, Ate She, Noy2x, Seph,

Janet, Sitti, Shaf, Ella, Babes, and Nor) for their significant contributions in her medschool life

which she will never forget for the rest of her life.

To her research adviser, Dr.Khryss, for the patience, for imparting the best of his

knowledge and values, and for believing she can always do better.

iii

To Dr.Bridget Cristobal and Dr.Junee Rivera, for the motivations and for suggesting

this topic for research.

To Ate Chic2x Dagapioso, for sharing her experience, expertise and friendship.

To Dr.Ben Halili, for not only being a good mentor but also for being a friend.

To Dr.Lito Concepcion, for not being biased and for the assistance and expertise he has

rendered during the research.

To Dr.Ric Angeles, for welcoming queries and for always being ready to help for the

success of this paper.

To Dr.Marie Arciaga and Dr.Jo Partosa for the helpful criticisms they shared for the

improvement of this paper.

To Mrs.Louella Danoco of PRCM, for helping out with the transcriptions and

formulation of questionnaire.

To Mrs.Jo Bue of the Zamboanga City Health Office, the health provider and defaulter

respondents of this study, for their willingness to participate in this research to disclose the

barriers to implementation of the DOTS program in Zamboanga City.

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iv

TABLE OF CONTENTS

APPROVAL SHEET i

ACKNOWLEDGMENT ii

LIST OF TABLES v

LIST OF FIGURES v

ABSTRACT vi

CHAPTER I INTRODUCTION 1

Background 1

Related Studies 3

Statement of the Problem 7

Significance 7

Definition of Terms 8

Conceptual Framework 9

CHAPTER II METHODOLOGY 11

Research Design 11

Research Setting 11

Respondents 12

Sampling Design 12

Research Instrument and Data Gathering 13

CHAPTER III RESULTS AND DISCUSSION 14

CHAPTER IV CONCLUSION AND RECOMMENDATION 45

BIBLIOGRAPHY

APPENDICES

CURRICULUM VITAE

v

LIST OF TABLES

Table Page

1 Demographic Profile of the Health Provider and Defaulter Respondents 14

2 Knowledge and Perception of the Health Providers on the Program 20

3 Health Provider Respondents’ Perception on Barriers Related to

Detection and Enrolment of Patients to the DOTS Program 22

4 Health Provider Respondents’ Perception on Barriers Related to

Care Process 24

5 Health Provider Respondents’ Perception on the Barriers Related to

Government Support for the DOTS Program 25

6 Health Provider Respondents’ Perception on Barriers Related to

Health Personnel 25

7 Health Provider Respondents’ Perception on Barriers Related to Anti-

TB Drug Supply 26

8 Health Provider Respondents’ Perception on Barriers Related to

Health Services 27

9 Health Provider Respondents’ Perception Regarding Interpersonal

Relationship with the Patient 28

10 Health Provider Respondents’ Perception on Patient’s Characteristic 29

11 Health Provider Respondents’ Perception on Patient’s Reasons for Defaulting 30

12 Comparison of Perception of DOTS Stakeholders and Defaulters Regarding

Health System Barriers 40

13 Comparison of Perception of DOTS Stakeholders and Defaulters on

Barriers Associated to Interpersonal Relationship Between

Health Providers and Patients 43

14 Comparison of the Perception of DOTS Stakeholders and Defaulters on

Barriers Associated to Patients’ Behavior and Characteristics 44

15 Summary of the Barriers to Implementation of DOTS in Zamboanga City 44

LIST OF FIGURES

Figure Page

1 Conceptual Framework 9

vi

ABSTRACT

This paper reports findings from a descriptive cross-sectional study of the perceptions of

DOTS stakeholders and defaulters on the barriers to implementation of DOTS in Zamboanga City.

The respondents of this study were taken from the 2 health districts with highest TB cure rates

(Talon-talon and Mercedes) and from the 2 health districts with lowest TB cure rates (Manicahan

and Canelar). There were a total of 41 respondents gathered via purposive sampling which

comprised of 1 TB administrator, 33 health providers and 7 defaulters. Different interview guides of

7-9 questions were prepared for the in-depth interview with the TB administrator, health provider

(nurses, midwives and barangay health workers) and defaulter respondents. The same interview

guide was also used for the FGD with the health providers. Voice recordings were transcribed and

were analyzed by identifying key issues. These issues were subsequently used to formulate a survey

questionnaire that was administered to the health provider respondents. The results of the study

gave us an understanding that tuberculosis is not simply a biological problem. It transcends a

merely medical approach. It is social disease entailing socio-cultural approach in order to improve

the existing DOTS program in Zamboanga city. This study identified major barriers to success of

DOTS which are the following: Health system barriers, Barriers associated to interpersonal

relationship between the health providers and patients, and Barriers associated to patient’s

characteristic and behavior. Specific barriers under the health system barriers were identified and

were found to be related to the 5 components of the DOTS strategy. These are: Insufficient financial

assistance for transportation expenses, Absence of separate room for DOTS patients, Lack of

awareness on the mechanics of the DOTS program among health providers and patients, Poor

diagnostic skills of the health providers, Shortage of streptomycin drugs, Charging patients for drug,

Poor sputum microscopy follow-up at the end of treatment course, Questionable recording and

reporting of treatment outcome, and Continuous migration as transients. Barriers associated to

interpersonal relationship between health providers and patients revealed that there is poor

interpersonal communication between health providers and patients. Barriers associated to

patient’s characteristics and behavior revealed that patients who are most likely not to adhere in the

treatment regimen are those who are lazy and lack self-motivation

CHAPTER I

INTRODUCTION

Background

According to the World Health Organization(WHO), the Philippines ranks fourth

in the number of Tuberculosis(TB) cases in the world and is among the 22 high burden

countries (Easton,1998). In 1998, TB ranked 5th among the 10 leading causes of illness

and mortality in the country (TB DOTS Benefit Package, 2007). In 1997, 63% of the

population were believed to be infected with TB, estimate at 200,000 to 500,000 cases

can infect 2 million to 10 million more Filipinos annually. The reported TB annual

deaths are 28,000 or 75 a day. TB therefore continues to remain a major health problem

in the Philippines (Tuberculosis FHSIS Annual Report, 1997).

Tuberculosis is curable and Directly Observed Treatment-Short course (DOTS)

has been declared as the global strategy for TB control by the WHO since 1991. The

goals of the DOTS strategy are to decrease the risk of infection, reduce morbidity, reduce

transmission of infection, and prevent TB deaths. It involves the need to identify TB

cases in communities around the world particularly those in developing countries, and to

treat TB cases by directly observing the medication intake by patients for six to eight

months. This is to ensure that medication is taken at the right combination and

appropriate dosage to prevent the development of multi-drug resistant TB. The DOTS

strategy focuses on the following operational objectives and targets: To detect at least

70% of the new smear-positive TB cases and to cure at least 85% of these cases. With

direct observation treatment, it is anticipated that 80% of deaths attributed to TB

worldwide will be prevented (STOP TB,2005).

Zamboanga City has been recognized for the increase in its detection rate from 86

percent in 2006 to 96 percent in 2007 and improved cure rate from 82 percent in 2006 to 84

percent on 2007(Hermosa town unveils TB treatment center, 2008). “Zamboanga City is one

of the first cities that created an anti-TB council in line with the campaign to prevent and

control tuberculosis”(Lobregat, 2007). However, despite these efforts, the CHO records still

ranks TB as 7th in the leading causes of morbidity with 2,559 cases registered. It is also the

6th in the leading causes of mortality for 2007 with 180 registered deaths (Hermosa TB

council sets priorities,2007).

Success of the DOTS depends on the successful interaction between patients and the

DOT providers. Although the drugs are primary essential for successful treatment of

patients, still an important aspect that motivates the patient to complete the treatment is the

human bonding between patients and health provider during the direct observation treatment

period (Ganguly and Walia, 2002).

As human behavior plays a critical role in this strategy, a better understanding of the

interaction between patient and provider is important for the planning and implementation of

a successful TB DOTS program. Most of the previous studies regarding tuberculosis have

drawn information from the perspective of patients regarding health system, perhaps it may

also be important to explore views of health providers as powerful stakeholders in the

implementation of DOTS program. This paper will report findings from a descriptive cross-

sectional study seeking to explore barriers to implementation of the DOTS program in

Zamboanga City from the point of view of the TB administrator, health providers and

defaulters. It will likewise hope to identify possible approaches for structural and functional

improvements to services that are responsive to the needs of both stakeholders in the

program.

Related Studies

The development and expansion of WHO’s DOTS strategy was shown to be

successful in reversing the TB epidemic in many countries. Treatment success in the 2003

DOTS cohort of 1.7 million patients was 82% on average, close to the 85% target (Bulletin of

the World Health Organization, 2005). However, there were also reports of DOTS failures

elsewhere. The WHO report on Global Tuberculosis Control 2008, finds that the pace of the

progress to control TB epidemic slowed slightly in 2006. The most recent data available

documents a slowdown in progress on diagnosing people with TB. Between 2001 to 2005,

the average rate at which new TB cases were detected was increasing by 6% per year; but

between 2005 and 2006 that rate of increase was cut to half (3%). The reason for this decline

of progress is because those programs that were making rapid strides during the last five

years have been unable to continue at the same pace in 2006. Moreover, in most African

countries there had been no increase in the detection of TB cases through national programs.

Other studies have also shown that many patients are treated by private care providers, and

by non-governmental, faith-based and community organizations, thus escaping detection by

the public programs (Schmid, 2008). It is important to identify barriers to continuous

progress for a more improved DOTS program.

Research from the last decade shows health promotion interventions for Tuberculosis

have failed because they were designed without knowledge of the health behavior of the

health provider and the target population. The relationship between culture, health-related

beliefs and health behavior is complex. Personal experience, attitudes of the social network

and health beliefs of patient interact and influence the later health-seeking behavior. Several

authors agree that the human elements in TB control have often been overlooked (Liefooghe,

et.al, 1997).

Adherence to the long course of TB treatment is a complex, dynamic phenomenon

with a wide range of factors impacting on patients’ treatment-taking behavior. Patients’

adherence to their medication regimens can be influenced by the interaction of a number of

factors. A study done on the relationships between treatment partner’s characteristics with

treatment outcomes of new sputum positive TB cases under DOTS strategy in selected

provinces in western Visayas, Philippines in 2004 showed that BHWs had higher mean

attitude and interpersonal skills score than midwives. It also showed that with regards to the

relationships of treatment partners with treatment outcomes of TB cases, there was a 1.2

chance of being “cured” having had a BHW as the treatment partner compared to a midwife

(Gonzaga and Navarra, 2004).

Russia is also one of the countries noted with marked rise in rates of TB over the

past decades despite substantial program of investment and advocacy in implementing

the WHO’s DOTS strategy. A qualitative study was done in Russia in 2006 regarding

health service providers’ perceptions on barriers to tuberculosis. The data were analyzed

using a framework approach for applied policy research. It revealed that barriers to

health care access were interconnected. These includes: barriers associated with the

health care system; care process barriers; barriers related to wider contextual issues; and

barriers associated with patients’ personal characteristics and behavior. In the health care

system, insufficient funding was identified as an underlying problem resulting in a

decline in screening coverage, low salaries, staff shortages, irregularities in drug supplies

and outdated infrastructure. Suboptimal collaboration with general health services and

social services limits opportunities for care and social support to patients. Behavioral

characteristics were identified as an important barrier to effective care and treatment, and

health staff favoured compulsory treatment for noncompliant patients and involvement of

the police in defaulter tracing. TB was profoundly associated with stigma and this

resulted in delays to access care (Dimitrova B. et.al., 2002).

In Tuguegarao City, DOTS was launched in December 2001. Almost a two—fold

increase in cure rate was noted, a range from 35 to 87%. The case detection rate only

ranged from 17 to 20%. A group of researchers subsequently studied about the factors

affecting the TB control program implementation of this city. It was a study aimed to

determine the factors contributory to the increase in cure rate for the implementation of

DOTS. It found that the success were due to the following: The key implementers

followed the strategies and components of DOTS; trainings were conducted to improve

the skills and knowledge of the city health worker in the program; the presence of

treatment partners; improved patients’ compliance in treatment completion on sputum

examination microscopy. All these factors contributed to increase the cure rate in 2001

(Velasco, et.al, 2003).

A study was also done in Sibuco, Zamboanga Del Norte on the effect of TB

educational program on compliance to short-course chemotherapy among 14 TB patients.

Fourteen(14) patients were gathered to represent the control group which received no

health education. Results affirmed that compliance rate is higher among patients who

have received health education as evident by the increase in their knowledge base,

positive change in attitude, and 11 increased in compliance to the required 6 month

chemotherapy. Since the study was done on a small sample population, the result could

not be generalizable to conclude that TB education conducted was more effective in

improving patients’ compliance rate over the DOTS strategy. Further study on a wider

sample population was recommended to establish the impact of patient education strategy

over DOTS strategy on the SCC compliance (Edding, 1998).

Another study was done in Zamboanga city to identify risk factors for treatment

default among DOTS enrolled TB patients in Baliwasan District. The researcher of the

said study gathered 33 treatment defaulters and 66 controls who were given survey

questionnaire. Answers to the survey were verified through a focus group discussion

with the same respondents. The study showed that being single, knowledge deficiency,

and experiencing treatment side effects were found to be strongly predictive for treatment

default. The paper recommended that more attention be given to the treatment needs of

those who are single who are four times more likely to default from treatment compared

to the other 2 risk factors mentioned (Samson,2007).

Many studies have already been done regarding the perception of patients

specifically the defaulters regarding PTB but unfortunately, only a few have been done

regarding the perception of the other stakeholders on the DOTS program. This study

aims to determine the perception of stakeholders regarding the barriers to implementation

of DOTS in Zamboanga City. The researcher believed that recognizing the barriers to

implementation of DOTS in Zamboanga City will help formulate strategies for the

improvement of the existing program.

Statement of the Problem

This study aimed to look into the perception of the DOTS stakeholders regarding

the barriers towards implementation of DOTS in Zamboanga City.

Specifically, it aimed to:

1. To describe the perception of the DOTS administrator, Health providers, and

PTB Defaulters regarding barriers to implementation of DOTS.

2. To compare the perception of the health providers and defaulters.

Significance

TB remains to be significant cause of morbidity and mortality in Zamboanga City.

While the DOTS is now established, there are still many patients who eventually become

defaulters, particularly as dropouts. Health provider-patient relationship is crucial in the

success of TB treatment completion. It is therefore important to study the perceptions of

health providers as well as defaulters regarding the barriers to implementation of DOTS

particularly because the former provide vital roles in the delivery of TB health care.

What they say can contribute for the improvement of the of the DOTS program in

Zamboanga City. The findings of this study could help inform the development of

interventions that will address the barriers to patient treatment adherence and ultimately

contribute to a more successful of DOTS in Zamboanga.

Definition of Terms

Cure- a sputum smear positive patient who has completed treatment and is sputum smear

negative in the last month of treatment and on at least one previous occasion.

Completed- a patient who has completed treatment but does not meet the criteria to be

classified as cure or failure.

Defaulter- a patient whose treatment was interrupted for two consecutive months or

more.

DOTS – Direct Observation Treatment Short-Course

Failure- a patient who, while on treatment, is sputum smear positive at 5 months or later

during the course of treatment

Others- a patient who is starting treatment again after interrupting treatment for more

than 2 months and has remained or became smear-negative; or, who was initial registered

as new smear negative case, turned out to be smear-positive during the treatment; or who

is sputum positive at the end of a re-treatment regimen.

Relapse- a patient previously treated for tuberculosis who has been declared cured or

treatment completed, and is diagnosed with bacteriologically positive tuberculosis.

Smear-positive case- Two or more initial sputum examination positive for AFB or, one

sputum smear examination positive for AFB plus radiographic abnormalities consistent

with active pulmonary tuberculosis or, one sputum examination positive for AFB plus

sputum culture positive for AFB.

Smear-negative case- At least three sputum specimens negative for AFB and

radiographic abnormalities consistent with active pulmonary tuberculosis and no

response to a course of antibiotics or symptomatic medications.

Conceptual Framework

Figure 1. Conceptual Framework

The conceptual framework in figure 1 simply shows that there are still high TB

cases in Zamboanga. DOTS is the strategy for decreasing these TB cases and it has five

components. These include: (1) Political and administrative commitment. (2) Good

quality diagnosis which involves high quality microscopy, at designated microscopy

centers is provided. (3) An uninterrupted supply of short-course chemotherapy drugs. (4)

Standardized intermittent drug regimens administered under direct supervision which is

the "heart" of the DOTS strategy. (5) Systematic monitoring and evaluation on which the

TB cure rate is the main indicator of program success (The five Elements of DOTS,

2001). Barriers to implementation of DOTS had been drawn from the perspective of the

stakeholders of the program. Identified major barriers were health system barriers,

barriers associated to patient-provider interpersonal relationship, and barriers associated

to patient’s behavior and characteristics.

CHAPTER II

METHODOLOGY

Research Design

This is a descriptive, cross-sectional study that reports on the barriers to

implementation of DOTS program in Zamboanga City from the perspective of DOTS

stakeholders and defaulters.

Research Setting

Zamboanga City is one of the first chartered cities and the sixth largest in the

country. In this study, Zamboanga City is represented by four health districts. These are

namely: Manicahan, Canelar, Talon-talon and Mercedes. Manicahan has a population of

40,365, located 20.10 Km east coast from the city, and has a TB case detection rate of

54% and a TB cure rate of 59%. Canelar has a population of 49,224, located 1.13 Km

west coast from the city proper, and has a TB case detection rate of 65% and a TB cure

rate of 73%. Talon-talon has a population of 65,681, located 4.71 Km east coast from the

city proper, and has a TB case detection rate of 87% and a TB cure rate of 95%. Lastly,

Mercedes has a population of 41,516, located 12.75 Km east coast from the city proper,

and has a TB case detection rate of 55% and a TB cure rate of 96% (Zamboanga

Barangays, 2001 and Zamboanga CHO Treatment Outcome, 2006).

Respondents

The respondents of this study were taken from the 2 health districts with highest

TB cure rates (Talon-talon and Mercedes) and from the 2 health districts with lowest TB

cure rates (Manicahan and Canelar).

Inclusion Criteria for Health Districts:

Must be a health district with high TB cure rates and low TB cure rates

Inclusion Criteria for Health Providers:

Must be a health provider of the districts with high and low TB cure rates

included in this study

Health providers who have at least served 2 years in the districts will be

included in the study

Inclusion Criteria for PTB Defaulters Respondents:

Must be a defaulter of the districts with high and low TB cure rates

included in this study

Must be a registered NTP patient of 2006-2007

NTP patient categorized as defaulter

NTP patients with ages 14-65

Sampling Design

Purposive Sampling was employed to gather health provider and defaulter

respondents.

Research Instrument and Data Gathering

Different interview guides of 7-9 questions to elicit information regarding the

barriers to implementation of DOTS were devised for the in-depth interview with the TB

administrator, health provider (nurses, midwives and barangay health workers) and

defaulter respondents. The same interview guide was also used for the FGD with the

health providers. Voice recordings during the in-depth interviews and focused-group

discussions were transcribed taking into consideration the respondents’ tone and

nonverbal behavior. The whole transcription was analyzed by identifying key issues

during the discussion. Issues from the FGD were subsequently used to formulate the

survey questionnaire.

The survey questionnaire was initially formulated in English. The content of the

questionnaire was face validated and approved by the research adviser. Since the health

provider respondents came from diverse ethnicities, the researcher decided to translate

the questionnaire to Tagalog (The National dialect) with the help of a research assistant

who also did the back translation. Subsequently, the questionnaire was pre-tested in

Sta.Catalina, also a health district of Zamboanga City. Comments and suggestions were

gathered regarding the questionnaire and were used for its revision. This survey

questionnaire was again pre-tested in the same health district before it was administered

to the health provider respondents of this study.

CHAPTER III

RESULTS AND DISCUSSION

Demographic Profile

There were total of 40 respondents: 33 from the health providers and 7 from the

defaulters. Majority were female [35(88%)], married [37(92%)], belonging to the age

bracket 41-50 [13(32%)] and employed [36(90%)]. It also showed that majority of the

health providers have already spent more than 10 years in the service [15(46%)]. On the

other hand, majority of the defaulters have defaulted once in the treatment course

[4(57%)].

Table 1. Demographic Profile of the Health Provider and Defaulter Respondents

Demographic Profile

Health

Providers

N=33

Defaulter

Respondents

N=7

Total

No. of Respondents 33 7 40(100%)

Sex

Female 33 2 35(88%)

Male 0 5 5(12%)

Age

21-30 1 0 1(3%)

31-40 9 2 11(28%)

41-50 9 4 13(32%)

51-60 10 0 10(25%)

61-70 4 1 5(12%)

Civil

Status

Single 0 3 3(8%)

Married 33 4 37(92%)

Occupation

Employed 33 3 36(90%)

Unemployed 0 4 4(10%)

Years of Service as

Health Provider

2-5 6

N/A

6(18%)

6-10 12 12(36%)

>10 14 15(46%)

No. of Treatment

Course

Defaulted

Once

N/A

4 4(57%)

Twice 2 2(29%)

> Twice 1 1(14%)

Barriers to Success of DOTS in Zamboanga City

This section tried to identify barriers to implementation of the DOTS program

which are grouped under the following category: Health system barriers, Barriers related

to interpersonal relationship between the health providers and patients and Barriers

associated to patient’s characteristic and behavior. The findings in the health system

barriers have been subcategorized under the following: Knowledge and perception on the

program, TB detection, Enrolment and declaring patients cured, Care delivery,

Government support, Health personnel, Drug supply, Health services and Data recording

and reporting. The result of this paper is presented according to different stakeholders’

perspectives. The interviews gathered by the researcher showed a variety of perspectives

from stakeholders and defaulters from the health districts with high and low TB cure

rates. To draw wider information, a survey was likewise conducted among the health

providers and subsequently presented here.

TB Administrator

A. Health System Barriers

The TB administrator was asked if DOTS in Zamboanga city is successful and he

confidently answered successful, since the detection rate increased from an initial 82% to

96% and the cure rate increased from 82 to 84% as evidenced in the 2007 record of the

Zamboanga City Health Office. He asserted that majority of the TB cases in the city are

being implemented with DOTS. He believed that the challenge now is how to reach the

target for cure rate which is 85%.

a. Knowledge and Perception about the DOTS Program

The TB administrator asserted that the health providers are with updated

knowledge on TB and DOTS as seminars or large group lecture were conducted

whenever there are changes in the manual of procedure of the National

Tuberculosis program. He said that the TB coordinator of the City health office is

in-charged of the training and updates on DOTS for the nurses, midwives and

even health workers.

b. TB Detection, Enrollment and Declaring Cured Patients

The TB administrator asserted that sputum microscopy centers available

are even more than enough for detecting TB cases for all the health districts of

Zamboanga city. The problem, however, is in the follow-up sputum examination

after the 6th

month course of treatment. Failure to follow-up patients after 6

months treatment can stand as a barrier because this step is required to establish

cure. The problem is not the microscopy service as claimed lacking but with the

inability of health workers in-charged to follow-up the patients for sputum exam

which is an important end of the course requirements for tuberculosis treatment.

He emphasized the need for assigning health worker to every sputum positive

individual so that follow-up will definitely be done.

c. Care Delivery

The TB administrator believed that treatment should be given to those

permanent residents of Zamboanga. Non-residents of Zamboanga should be

referred back to their provinces of origin. Only those patients who agreed to stay

for the duration of the treatment will be given medicine to prevent spurious

default recording. This unfortunately can be a barrier to implementation of DOTS

as the referral system in our city for TB treatment is still in question. There is a

need to re-enforce and strengthen the referral system so that problems or

continuity of health care delivery can be addressed. Zamboanga is known to be a

destination of forced migration by people coming from the nearby islands. Most

of the migrants stay in Zamboanga as transients. Reasons for migration ranged

from the peace and order situation to working conditions. If patients from other

areas will be deprived of medication in the city, the untreated TB cases will

eventually increase. But the reason given by the DOTS implementers also share a

good reason to consider for if treatment were started with non-residents, the

treatment may end incomplete as the latter might migrate forward, leaving behind

a tract record of spurious defaulters.

d. Government Support on the DOTS Program

The National Tuberculosis Program (NTP) of the Philippines is the

Government’s response in addressing the TB problem of the country. The

Philippine Department of Health has been giving high priority for this public

health program (Osorio, 2002). The TB administrator believed that the local

government of Zamboanga has likewise been supportive of TB program in terms

of augmenting drug supply. It even created the Zamboanga Hermosa TB council

to institutionalize further and unify the work of all TB DOT centers with other

NGOs in the city. The TB Administrator also asserted that BHWs are provided

some financial assistance. Transportation expenses are being shouldered by the

RHU while the additional honorarium for the BHWs is also provided by the city

government. They also have existing donation boxes placed in the RHU where

they can also draw for their transportation expenses.

d. Health Personnel

The TB administrator believes there is no shortage of health providers in

the communities. Selected midwives are also trained in sputum microscopy. The

TB administrator believed that the problem is with some health providers who are

not able to work efficiently and effectively because of being lazy.

e. Drug Supply

Uninterrupted drug supply is also one of the DOTS’ strategies. The TB

administrator said there are enough oral drugs for the TB patients in Zamboanga

but admitted that the patients in PTB Category II are not provided with

Streptomycin because of shortage. This study revealed that anti-TB drug supply

becomes a barrier for the treatment success of PTB Category II patients who

require Streptomycin injection.

g. Health Services

The TB administrator reiterated that health services for DOTS

implementation are adequate and good practices should be maintained. However,

policies regarding health providers’ role for following up patients should be

properly implemented for better treatment outcome. He admitted that the policies

released regarding DOTS implementation in the city are still not being properly

followed by health providers, thus, becoming a barrier for a better DOTS

program.

In relation to health services, having a separate room for DOTS patients

had been one of the issues brought out from the discussions among different

stakeholders and defaulters. Separate room was described by the respondents of

this study as a room separate from where the non-TB patients go for consultation

in the health center. The TB administrator, however, has a different view on the

issue of separate room for every health districts or for barangay health stations.

He believes that having separate rooms specifically for DOTS patients will only

re-enforce stigma attached to TB.

Another issue brought out was about the microscopy services. The TB

administrator repeatedly emphasized there are now 17 microscopy centers for 15

health districts. It is more than enough for all health districts of Zamboanga

which he said accounts for the increase in detection and cure rate for the year

2007.

Health Providers

A. Health System Barriers

a. Knowledge and Perception about the DOTS Program

All of health provider respondents were able to attend educational sessions

on TB detection and treatment and all of them likewise answered in the survey

questionnaire that they are oriented with the DOTS objectives. However, when

asked about the DOTS objective, only 15(45%) got the correct answer. The

survey likewise showed that 31(94%) of the health providers believed that

“treatment completion” is enough basis for declaring DOTS success. This finding

is critical because it is the “cure rate” which is the basis for declaring DOTS

success while treatment completion is not. It requires a negative sputum follow-

up result to declare the patient as cured. Completing the course of treatment alone

does not mean “cure”.

Table 2. Knowledge and Perception of the Health Providers on the Program Health Provider Respondents’

Knowledge and Perception

on the Program

Responses Frequency

(N=33)

Percentage

(%)

Attended Educational Session

regarding TB detection and treatment

Yes 33 100

No 0 0

Oriented about the DOTS Objectives Yes 33 100

No 0 0

Knows the DOTS Objectives

Yes 15 45

No 18 55

Treatment Completion is already

enough basis for DOTS Success

Yes 31 94

No 2 6

Although in the interviews done with the health providers, some were able

to answer correctly the objective of DOTS, only the barangay health worker

(BHW) who incidentally are the treatment partners of patients and are in direct

contact with them, failed to explicitly say what the exact target goals of DOTS for

case detection and cure rate. For health workers, DOTS simply means “to know”

if the barangay has TB cases then to treat these cases accordingly. Poor or

insufficient knowledge about the program can become a barrier for the

implementation of DOTS. Health providers are implementers of DOTS in the

district and barangay level. Their actions are dictated by what they know. If they

do not know the meat of the program, then, target goals may not be met at all.

Success in any program or strategy implementation requires that all stakeholders

be aware of the objectives and target goals of the program.

b. TB Detection, Enrollment and Declaring Cured Patients

In the survey done among the health providers, 31(94%) answered they

require sputum examination before starting treatment. This study also observed

that result of chest x-ray is still used as a basis for treatment of TB cases. Sixteen

(48%) answered they require chest radiography before starting treatment. This

issue on what is required before starting treatment becomes a barrier to the

implementation of DOTS program in two reasons. First, chest x-ray is not the

ideal diagnostic modality for tuberculosis detection. In cases where sputum

microscopy is negative, chest x-rays are only used to support symptomatic suspect

of tuberculosis. Not all patients should be required with chest x-ray prior to

treatment. Secondly, not all patients will be able to comply with the chest

radiography requirement because of economic cost.

Table 3. Health Provider Respondents’ Perception on Barriers Related to

Detection and Enrolment of Patients to the DOTS Program Health Provider Respondents

on Detection and Enrollment

of Patients to the DOTS

Program

Responses Frequency

(N=33)

Percentage

(%)

Require Sputum Exam to all

patients before starting

treatment

Yes 31 94

No 2 6

Require Chest X-Ray to all

patients Before starting

treatment

Yes 16 48

No 17 52

Actions taken when someone

in the community is suspected

of having symptoms of TB

I will wait for him

him/her to consult.

3 9

I will immediately advise

sputum examination

28 85

I will start TB treatment

2 6

BHW respondents claim to be watchful in detecting possible PTB patients

in their communities. They asserted that they are in constant surveillance of

people with symptoms of chronic cough, weight loss and loss of appetite. If they

find people with these symptoms, they immediately advise them to go to the

health center for sputum examination. If the result is positive, the patient will be

considered the health worker’s partner. It is good that BHWs know their role in

detection of TB cases but most patients interviewed claimed they were not

recruited by BHWs, instead, they went to the nearest hospital or private clinic and

presented their health problems there and was only subsequently referred to the

health center. This issue of TB case-findings in the districts and barangays

becomes a barrier because BHWs must put into practice what they know about

TB detection and should not only rely to patients presenting themselves to the

health centers. Being able to recognize TB cases in the localities is important as

part of the case-finding activities of DOTS and is important to be able to start

treatment.

c. Care Delivery

Among the 33 health provider respondents, 24(73%) of them believed

they should give treatment only to certified residents of the barangay to assure

completion of treatment. They asserted that completion is not assured when the

patients is not a permanent resident of the barangay. They believe that as long as

the patient stays in the barangay, they will not have any reasons to fail from

completing the treatment. In addition to this, some health providers also claimed

that the reason for the increase of TB cases despite massive anti-TB campaign is

because of the continuous migration of people from the nearby areas and islands

to Zamboanga. This is supported by a research done by Fabian(2004) that the

increase in growth rate in Zamboanga city during the first half of the decade can

be attributed to the net migration rate. This has brought about both positive and

negative results affecting service delivery, resource mobilization and social

concerns in the city. This continuous influx of transient migrants into the city can

therefore become a barrier to DOTS implementation. Ten to 15 other more

residents of the city will be infected in a year if even 1 infected non-resident will

not be treated. But if implementers chose to start treatment with them,

consequence will be increase of defaulters should the patient migrate further. In

addition, incomplete treatment can result to risk of multi-drug resistant.

Most [20(61%)] of the health providers also believe that all patients

should come to the health center regardless of their distance to the center. This

becomes another barrier to implementation of DOTS. It is a prerequisite that

health providers should not only make health care available but also accessible to

the users. Considering the cost of transportation, there is a need to device a

scheme where medication could be made accessible for the patients distant from

the center.

Table 4. Health Provider Respondents’ Perception on Barriers Related to

Care Process

Health Provider Respondents

on the Care process

Responses Frequency

(N=33)

Percentage

(%)

Only certified residents of the barangay

should be given treatment

Yes 24 73

No 9 27

All PTB patients should come to the

health center regardless of their

distance to the health center

Yes 20 61

No 13 39

d. Government Support on the DOTS Program

The health provider respondents affirmed the testimony of the TB

administrator that the government has been very supportive of the DOTS program

by giving large fund for drugs and microscopy services. Twenty-six (79%) of

them answered there was no institutional shortcomings in the DOTS

implementation. But these health providers were also concerned that no financial

assistance is provided to them for transportation expenses in following up

patients. Two thirds of them or 61% answered there is a need that they be given

transportation stipend. The current stipend received by barangay health workers,

according to them, is not enough to sustain activities even for the DOTS program

alone. This concern becomes a barrier since patient will not have enough sources

for transportation expenses, there is a risk that health providers will not be able to

do DOT or even follow-up patients’ progress.

Table 5. Health Provider Respondents’ Perception on the Barriers Related to

Government Support for the DOTS Program Health Provider Respondents

on the Government Support

for the DOTS Program

Responses Frequency

Percentage

(%)

Need for Stipend

(N=33)

Yes 20 61

No 13 39

Receive Stipend

(N=33)

Yes 0 0

No 33 100

e. Health Personnel

Only 8 or roughly ! of the health provider respondents believed there is

lack of manpower in their barangay health center. From this, 5(63%) believed

that house visits to patients who fail to come to the center is not done due to

shortage of manpower. Lack of manpower becomes a barrier because it is critical

to the implementation of DOTS in terms of treatment with supervision as it is also

one of the 5 mainstays of the DOTS strategy needed to assure patient’s

compliance.

Table 6. Health Provider Respondents’ Perception on Barriers Related to

Health Personnel Barriers Related to

Health Personnel

Responses Frequency

Percentage

Lack of Manpower

(N=33)

Yes 8 24

No 25 76

If yes, what is not

accomplished due to

lack of manpower

(N=7)

Daily recording of treatment 1 12

Supervision of the daily intake

of medicine

2 25

House visits to patients who fail

to go to the center

5 63

f. Drug Supply

All of the health provider respondents answered there was enough anti-TB

oral drugs for their patients in the health center and 29(88%) of them do not

charge anything for these drugs. The remaining 4(12%) of respondents claim they

charge for anti-TB drugs perhaps in the form of donation. Unfortunately, this

practice of soliciting for donation in place of anti-TB drugs can stand as a barrier

to the implementation of DOTS program because some patients will not be able to

afford the cost of medicine even if it comes in the form of donation.

Table 7. Health Provider Respondents’ Perception on Barriers Related to Anti-

TB Drug Supply Health Provider Respondents on

Anti-TB Drug Supply

Responses Frequency

(N=33)

Percentage

(%)

There is enough anti-TB drugs Yes 33 100

No 0 0

Charge patients for anti-TB drugs Yes 4 12

No 29 88

g. Health Services

Health provider respondents suggested the need for improvement of the

health services provided by the center for a better implementation of DOTS

program. Fourteen(43%) responded there should be improvement in the sputum

microscopy follow-up, 10(30%) responded there should be improvement in the

separate room for DOTS patients, 5(15%) responded there is a need to increase

manpower, 3(9%) responded other improvements like funding for transportation

expenses for health providers, and only 1(3%) answered that drug supply should

be improved. Among the suggested improvement, it is the follow-up sputum

microscopy which can stand as a big barrier because its result dictates the

treatment outcome of each patient and as well define the success of the DOTS

program. Patients’ condition can be evaluated and cure rates will be verified if

sputum microscopy follow-up is done well.

Table 8. Health Provider Respondents’ Perception on Barriers Related to

Health Services Health Provider

Respondents on Health

Services

Responses Frequency

(N=33)

Percentage

(%)

Needs improvement for the

success of DOTS

Manpower 5 15

Separate room for DOTS patients 10 30

Sputum follow-up 14 43

Anti-TB drugs 1 3

Funding for transportation

expenses of health providers

3 9

Need for a separate room Yes 32 97

No 1 3

Presence of Separate room

in their center

Yes 28 85

No 5 15

Separate room will decrease

stigma for PTB patients

Yes 24 73

No 9 27

h. Data Recording and Reporting

Data recording and reporting from the district to barangay level are

questionable. The researcher noted some discrepancies between the CHO

treatment outcome reports and the data given by the district nurse and midwives

during the interviews especially in terms of the number of defaulters. However,

the source of error in the recording system was not traced in this study.

Discrepancy in the recording and reporting of treatment outcome stands as a

barrier because systematic monitoring and evaluation is also one of the strategic

components of DOTS. If not met, this will also hinder the success of the

program.

B. Barriers Associated to Health Provider - Patient Interpersonal Relationship

Effective treatment can only be achieved where there is an effective patient-provider

partnership (Walpole,2007). Effective interpersonal communication between health care

provider and patient is an important element for improving patient’s satisfaction, treatment

compliance, and health outcomes. In this study, it revealed that most of the health provider

respondents believed that to convince patients to complete treatment and to convey their

concern for patients, they need to befriend [19(958%)] and threaten patients as to the

consequences of not taking medicine [11(33%)]. All of them answered that if their patients

failed to take medication, they will talk to the patient and try to find out the reason for not

taking the medication. Threatening patients as to the consequences can stand as a barrier

because it loses patient’s autonomy of the treatment regimen. It will also result to

intimidation, thus, patients will have a difficulty in communicating their problems regarding

the treatment.

Table 9. Health Provider Respondents’ Perception Regarding Interpersonal

Relationship with the Patient

Health Provider Respondents

on Interpersonal Relationship

with the Patient

Responses Frequency

(N=33)

Percentage

(%)

How to Convince Patients to

Complete Treatment

Scold 2 6

Befriend 19 58

Give incentives 1 3

Threaten patients as to

the consequences of

not taking medicine

11

33

Others 0 0

What to do when patient failed

to take Medicine

Scold 0 0

Find out the reason

why

33 100

Don’t Mind at all 0 0

Others 0 0

C. Barriers Associated to Patient’s Characteristic, Behavior and Reasons for

Default

Similar to Russia’s study in 2002, behavioral characteristics were identified as an

important barrier to effective care and treatment of tuberculosis, this study also likewise

proves that patients’ behavior can be a barrier to implementation of DOTS. Making

health care and medication more accessible to patients will not mean a complete success.

It needs that the patient should also accept the medicine and help in the procedure of the

treatment course. Health provider respondents believed that patients who are most likely

not to comply with treatment are those who are lazy [18(55%)] and those who are with

poor self-motivation [13(39%)].

Table 10. Health Provider Respondents’ Perception on Patient’s Characteristic

Health Provider

Respondents on Patient’s

Characteristic

Responses Frequency

(N=33)

Percentage

(%)

Characteristic of Patient

who are most likely not to

comply with treatment

Lazy 18 55

Poor Self-Motivation 13 39

Others (No Means for

transportation &

Allergic to Drugs)

2

6

Among the health provider respondents, 13(39%) admitted they

encountered defaulter under their DOTS care. Most of who encountered

defaulters responded patients’ default was due to transportation cost [6(46%)] and

improvement of symptoms [5(38%)].

Table 11. Health Provider Respondents’ Perception on Patient’s Reasons

for Defaulting Health Provider

Respondents on Why

Patient’s Default

Responses Frequency

(N=33)

Percentage

(%)

Health Provider

Respondents Who

Encountered Defaulter

Under Her DOTS Care

Yes 13 39

No 20 61

If yes, Reason Why Most

Patients Default

Long Course of Treatment 1 8

Improvement of Symptoms 5 38

Adverse Reactions of Drugs 1 8

Problems Regarding Health

Center Services

0 0

Transportation Cost 6 46

Stigma 0 0

Defaulters

A. Health System Barriers

a. Knowledge and Perception about the DOTS Program

The defaulter respondents were also found to have limited knowledge of

what the DOTS program is all about including its goals. When asked on what

they know and can say about the DOTS program, mostly answered it is merely

about free medicine given for 6 months. Lack of knowledge can serve as a barrier

to implementation of DOTS among patients. Prior to becoming a part of the

program, patients should know the mechanism of the program and should be able

to understand it so that it will be easy for them to accept and follow the program.

c. TB Detection, Enrollment and Declaring Cured Patients

The defaulter respondents found it difficult to comply with the request for

chest x-ray. According to them, health providers would require chest x-ray even

during the follow-up examination which they think was costly. This requirement

can post as a barrier because patient will not want to come even for sputum exam

to establish cure when they know they would probably be asked for chest x-ray

which they cannot afford. When defaulters were also asked about how they

became involved in the DOTS activity, all of them answered that they had their

check-up because of the worsening of their symptoms or that they were required

to submit themselves to physical examination for employment health certification

and not because of the health workers advising them to do so as claimed by the

latter. They went to the Barangay health center through the referrals from the

City health office or from the hospitals where they first had their consultation.

Making health care available is not enough for the implementation of DOTS.

Patients should be aware of its existence and offered services.

f. Care Delivery

Some defaulters admitted they are not originally from the district and they

stopped treatment because they had to go back to their former residence to be with

families or due to job deployment to other areas. This residential movement has

affected their treatment course. This migratory movement may post as a barrier

because treatment can be interrupted. It is necessary that the patients stay where

the health provider can locate them.

d. Government Support on the DOTS Program

All of the defaulters admitted that the government has been supportive of

the TB program in terms of giving free medication and microscopy services. But

still, they are not able to comply with the DOTS treatment regimen because of

many reasons especially when it comes with financing transportation expenses to

visit the center. This implies that government support for DOTS program is

already enough but there is still other existing external factor like poverty which

can make patients susceptible to default and which the government should also

address.

e. Drug Supply

Most of the defaulters interviewed also shared the same view with the TB

administrator and health provider respondents that there were always available

anti-TB medications in the health centers. Although most of them admitted that

these drugs were given for free, still some complained about being charged in the

form of donations for the drugs they claim in the health center. They also

complained about the side effects of the drugs which made them stop medication.

There is no problem with drug supply but charging patients even in the form of

donation and untoward effect of the drugs can become a barrier to DOTS

implementation because patients opted to stop medication because of the cost and

when they experience undesirable effects of these drugs.

B. Barriers Associated to Health Provider - Patient Interpersonal Relationship

Most of the defaulters interviewed were under the care of a barangay health

worker. They responded that their treatment partners were friendly and kind. Some

claimed their treatment partners were firm but they understand why health providers

would relate to them that way. Most of them also responded they are being convinced by

their treatment partners to complete treatment by giving advises but if they fail to go to

the health center, their treatment partner will either get mad or would not mind them at

all. Even patients understand the firmness of their treatment partners, this kind of patient-

provider relationship will still stand as a barrier because most of them are hesitant to

consult their treatment partners whenever they are facing problems regarding their

treatment. Patients are hesitant to communicate with their health providers regarding

their reasons for defaulting. They also seem not to be interested with the mechanics of

the treatment regimen. Communication and partnership are deterred, leaving patients

unable to understand the nature of their illness which led them to eventually default.

C. Barriers Associated to Patient’s Characteristic, Behavior and Reasons for

Default

Defaulters, in the interviews, also admitted that there is a problem with

compliance because of their characteristic and behavior. Most of them admitted that they

are hard-headed and lazy to go the health center for medication and follow-up. They also

agreed that it’s a personal choice to be cured and that alone will motivate them to follow

the treatment regimen. Interviews with them also confirmed the reasons for default given

by the health providers. They also added other reasons for defaulting like stigma,

preference to traditional healers and substance abuse.

Transportation Cost

One of the determinants of defaulting appear to be structural

barriers related to physical access, cost and ability of the patient to reach a

treatment centre (Shargie,2007). One defaulter in the interview

responded, “Magastos.. Wala na ngang pera, mamasahe ka pa papunta

doon.” (It’s costly. There’s no money anymore, yet you still need to pay

for transportation fee in going there.)

Improvement of Symptoms

Among various reasons for defaulting, indifference due to

improvement of symptoms was also identified in this study. Similar study

done in India also identified this factors and reason for defaulting

tuberculosis treatment (Chatterjee, et.al., 2002). As one defaulter

responded regarding his reason for defaulting, “Kung maramdaman kong

magaling na ako at makatrabaho na ako uli, hindi na ako iinom ng

gamot.” (If I feel that I am already well and able to work again, I don’t

drink medicine anymore.)

Adverse Reactions of Drugs

Adverse reaction or side effect of drugs is another reason of

defaulting. Some patients think the side effects of drugs aggravate their

symptoms and as a result, some will decide to default than to continue

medication. Another patient testified about her reason for defaulting,

“Sumasama ang pakiramdam ko, nanghihina at di makalakad kapag

nakakainom ako ng gamot.” (I don’t feel well, I feel weak and unable to

walk if I drink the medicine.)

Long Course of Treatment

TB treatment is perceived as long, agonizing and burdensome.

Long course of treatment can cause patients’ drop-out from the therapy.

Patients tend to look for shorter duration and faster resolution of their

health problems than wait for the 6-8 months regimen. As one defaulter

reasoned, “Ang tagal kasi ng 6 months at ang daming requirements.

Nakakatamad, gusto ko ng gamot pang-1 week lang.” (Six months is too

long and requirements are too many. It is tiring, I want a medication for1

week only.)

Stigma

TB is not just a public health problem (A Deadly Stigma, 2007). It

is a social problem and some patients are still stigmatized and isolated

from society despite social mobilization to break the myth behind

Tuberculosis. Testimony from a defaulter interviewed proved that stigma

attached to TB is still present in Zamboanga City. “Kung pumapasok ako,

naiibahan ako sa ibang pasyente. Feeling ko, natatakot silang makuha

ang TB ko.” (If go in, I feel uncomfortable. I feel like they are afraid to

be infected by my TB.)

Preference to Traditional Healers

Some patients considered traditional treatment as a valid

alternative to modern treatment and believed it to be as effective and much

shorter. Only after symptoms persist for some time and or the suspect’s

health deteriorates, are modern health services consulted (Liefooghe,R.

et.al.,1997). This is strongly influenced by cultural norms and values.

Within ethnic groups, an individual's cultural beliefs and practices often

provide an underlying structure for decision making during illness that is

not always concordant with the biomedical model (Tuberculosis, 1999).

As part of accessibility to health care, traditional healers are preferred

because they are more accessible in communities than the health centers.

One patient confirmed about her preference for traditional healers when

she said, “Naniniwala ako sa mga kababalaghan. Humingi ako ng gamot

sa mananambal. Noon, hindi ako makalakad ng isang taon pero ngayon

noong uminom ako ng binigay ng mananambal, naging mabuti na ang

pakiramdam ko. Paano mo ‘yon ipapaliwanag sa akin?” (I believe in the

mysteries. I asked for a cure from a quack doctor. Before, I am unable to

walk for 1 year but now when I took the medicine given to me by the

quack doctor, I felt better. How can you explain that to me?)

Substance Abuse

Another reason given by a defaulter during interview was

substance abuse. He was a “shabu” or illegal drug user and believes that

as long as he is addicted to illegal drugs, no amount of medication for TB

will work for him. “User din kasi ako dati. Kaya iniisip ko kahit iinom

ako ng gamot, kung magdrugs parin ako, hindi rin ako gagaling. Minsan,

mag-drugs parin ako.” (I was a user before. that is why I thought that

even I drink my medication for TB but will still continue doing drugs, I

will still not get well. Sometimes I still do drugs.)

Comparison of the Perceptions of the DOTS Stakeholders and Defaulters

Issues under health system barriers can be linked to the 5 components of the

DOTS program. First is regarding the barriers relating to the political and administrative

commitment which involves financing and education. The local government of

Zamboanga city has been supportive of the DOTS program in terms of augmentation for

the drug supply according to the TB administrator. The health providers and the

defaulters agreed with this view of the TB administrator but also believed that the

government failed to support for the transportation expenses of the health providers in

following up the patients. Another issue under political and administrative commitment

is about education. Health providers are unaware of the target goals and systematic

components of the program. The patients on the other hand, are also unaware of the

program’s mechanism. Another issue is about the absence of separate rooms in some

DOTS centers. The health provider and the defaulters commented that there is a need for

separate rooms exclusively for the DOTS enrolled patients wherein they would go for

consultations, claim their drugs, and do sputum examinations. This is, according to them,

for the protection of the non-TB patients and also to protect patients from the stigma

attached to TB. The TB administrator has a different view regarding this. He believes

that separate rooms will only re-enforce stigma. Treating TB patients separately from

other patients with other diseases will give a notion that TB is something to be ashamed

of, a disease different from any other common diseases.

The second health system barrier is related to the good quality diagnosis

component of DOTS. The TB administrator asserted that there are more than enough

sputum microscopy centers for all the health districts of Zamboanga. The defaulters,

however, claimed that these microscopy centers are still not accessible. In relation to

case-findings, this study found out that most of the defaulters interviewed had their

consultation in the city health office or private clinics and was only referred to the health

center after being diagnosed with Tuberculosis. This is contrary to the health providers’

claim that most of the patients have been found out through their vigilance in the

community, looking for TB suspects and advising them to consult the health center.

Another issue under this barrier is about the use of chest x-ray to establish diagnosis for

all patients. The 48% of the health providers believed there is a need of chest x-ray for

all patients before starting therapy. The defaulters on the other hand, believed that this is

too costly and not accessible.

The third health system barrier is related to the uninterrupted supply of anti-TB

drugs. Stakeholders of the DOTS program including the defaulters asserted that there

were enough oral drug supply but there was a shortage of the streptomycin drug intended

for the relapse patients. Another issue raised was also about health providers charging

patients in place of drugs in terms of donation. Patients claimed that they cannot afford

the cost even it comes in donation form.

The fourth health system barrier is related to the systematic monitoring and

evaluation component of the DOTS program. The first issue under this barrier is the lack

of sputum follow-up at the end of treatment course. The health providers reasoned that

there is no sputum follow-up at the end of the treatment course because the patients do

not go to the health center after 6 months treatment. The defaulters on the other hand,

believe there is no need for sputum follow-up when they already feel well. Another issue

with regards to this component is the discrepancy in the recording of the number of

defaulters. The data (no. of defaulters) given by the district nurses during the interviews

do not match with the CHO record treatment out record for 2006. The source of error,

however, was not traced in this study. The health system barriers also included barriers

related to drug regimens administered under direct supervision component of the DOTS

program. According to the TB administrator, there was already an issued policy that

BHW should be assigned to every sputum-positive enrolled patient but the health

providers complained about their problem regarding transportation cost to do patient

follow-up. The TB administrator also believed that health providers are lazy to do house

visits and daily treatment with supervision. Health providers required patients to come to

the health center daily regardless of their distance to the health center but patients also

complained about the transportation cost. Another issue under this component is about

the place of residence of patients. The TB administrator also issued a policy that only

permanent residents of the community should be given treatment. The health providers

on the other hand, have poor screening skills for patients as to their place of residents and

tend to enroll non-residents of their district to the program. The health providers believed

that migration increases the TB cases in the community. The defaulters, on the other

hand, believed increase migration as transients is expected because of the peace and order

situation and working conditions.

Table 12. Comparison of Perception of DOTS Stakeholders and Defaulters

Regarding Health System Barriers Health System

Barriers to DOTS

Implementation

5 Components of

DOTS

TB Administrator Health Providers

(Nurses, Midwives,

BHWs)

Patients

(Defaulters)

Health System

Barriers

1.)Political and

Administrative

Commitment

(Financing &

Education)

-Local Gov’t is

augmenting for TB

drug supply.

-Gov’t added to the

monthly stipend of

BHWs given by

Brgy. Officials.

-------

-Separate room will

re-enforce stigma.

-------

-Stipend received by

BHWs is not enough

for transportation

expenses.

-BHWs are unaware

of the target goals

and systematic

components of the

program.

-There is a need for

separate room for

DOTS patients.

-------

-------

-Patients are

unaware of the

program’s

mechanism.

-Patients believe

separate room

protects them from

stigma.

2.)Good Quality

Diagnosis

-Sputum Microscopy

Centers are more

than enough to detect

TB cases

- Case Detection is

96%

-------

-------

-------

-BHWs have poor

skills in detecting TB

cases in the

community

-48% of health

providers believe

chest x-ray is

needed before

starting therapy.

-Sputum microscopy

should be available

in the local centers -

- to be more

accessible

-Patients consult

directly to hospitals

or private doctors.

Patients cannot

afford chest x-rays

Health System

Barriers to DOTS

Implementation

5 Components of

DOTS

TB Administrator Health Providers

(Nurses, Midwives,

BHWs)

Patients

(Defaulters)

Health System

Barriers

3.)Uninterrupted

Supply of

Chemotherapy Drugs

-There is enough oral

drugs but with

shortage of

Streptomycin.

-There is enough oral

drugs but with

shortage of

Streptomycin.

-Some health

providers charge

patients for drugs in

the form of

donations

-There is enough oral

drugs but with

shortage of

Streptomycin.

-Some patients

cannot afford to give

even donations

4.)Systematic

monitoring and

evaluation

-There is lack of

sputum follow-up at

the end treatment

course. The target

cure rate is still not

reached (84%).

-Reports given by

district nurses should

be accurate because

the TB coordinator is

constantly

monitoring them.

-The patients do not

follow-up at the

health center.

-Data (no. of

defaulters) given by

the district nurses

during the interviews

do not match with

the CHO record.

-When patients feel

they are well, they

believe there’s no

need for follow-up.

------

5.)Drug regimens

administered under

direct supervision

-Issued policy that

BHW should be

assigned to every

sputum (+) enrolled

patients

-HP are lazy to do

house visits and

daily treatment with

supervision

-Issued policy that

only permanent

residents of the

community should

be given treatment

- We have problem

with transportation

cost.

-Require patients to

come to the health

center daily

regardless of their

distance to the health

center

- There is poor

screening of patients

as to their place of

residency

-Because of

migration, there will

be increase TB cases

in the community

-------

-Patients cannot go

to health center daily

due to transportation

costs

-Increase migration

(as transients) of

people from nearby

islands & provinces

is expected because

of work or peace &

order situation.

Barriers associated to interpersonal relationship between health providers and

patients can be related to the drug regimens administered under direct supervision

component. It is in this component that provider-patient partnership is established. This

study found out that there is a poor interpersonal communication between the patients

and their health providers. Although most providers are aware of the need to find out

why patients default and are aware of the need to address these problems by constantly

advising patients to continue medication, they still fail to give clear and accurate

information of what their patients need. The patients, on the other hand, fail to express

their concerns and expectations about the treatment. This kind of interpersonal

relationship can stand as a barrier because partnership grows from good communication.

Another reason for this kind of relationship becoming a barrier to implementation of

DOTS is when providers will simply take treatment failure as only the fault of the

patients. On the other hand, the patients may likewise blame the providers’ unbecoming

behavior as the cause of default. It should be stressed that treatment failure is not only

the shortcoming of the patient but likewise the provider as shared responsibility exists

between them. The partnership requires mutual respect and understanding. Each party

should respect the other’s perspective, priorities and other external factors that affect the

treatment course. The provider should be sensitive of the patient’s beliefs and culture and

on the other hand, the patient should be able to understand and appreciate that the goal of

the provider is to help them.

Table 13. Comparison of Perceptions of DOTS Stakeholders and Defaulters on

Barriers Associated to Interpersonal Relationship Between Health Providers and Patients Major Barriers to

Success of DOTS

Components of

DOTS

TB Administrator Health Providers

(Nurses, Midwives,

BHWs)

Patients

(Defaulters)

Barriers associated

to Interpersonal

Relationship

Between Health

Providers and

Patients

5.)Drug regimens

administered under

direct supervision

----- -Health providers

believe threatening

patients can

convince them to

complete treatment.

- Failure to give

clear and accurate

information of what

the patient needs.

-Failure to address

the reasons of

patients for

defaulting.

- Health providers

are harsh but patients

understand their

reactions.

- Failure to express

their concerns &

expectations

regarding the

treatment regimen.

The last barrier identified in this study was barriers associated to patient’s

characteristic and behavior. It is important to understand patients’ characteristic and

behavior to be able to understand why they default and to be able to address their problems.

The health providers believed that patients who are most likely to default are those who are

lazy and lack self motivation. Defaulters confirmed they are really lazy and poorly self-

motivated but this has come out because of the other issues they are facing in life. They

asserted that they are lazy because the health centers are too far from where they stay. They

also asserted that their default is due to difficulty in transportation, undesirable effects of the

drugs, or improvement of symptoms.

Table 14. Comparison of the Perceptions of DOTS Stakeholders and Defaulters

to Barriers Associated to Patients’ Behavior and Characteristics Major Barriers to

Success of DOTS

Components of

DOTS

TB Administrator Health Providers

(Nurses, Midwives,

BHWs)

Patients

(Defaulters)

Barriers Associated

to Patients’

Behavior and

Characteristics

---- ----- - Health providers

claim some patients

are lazy and poorly

self-motivated.

- Patients admitted

they are lazy and

lack self motivation

but asserted that their

behavior have to do

with other issues.

Through the comparison of the perceptions of the different stakeholders of the DOTS

program, this study identified specific barriers to implementation of the program. In the table

below, it showed the specific barriers identified from the health system barriers, barriers

associated to interpersonal relationship between health providers and patients, and barriers

associated to patient’s characteristics and behavior.

Table 15. Summary of the Barriers to Implementation of DOTS

in Zamboanga City

3 Major Barriers to Success of DOTS Specific Barriers Identified

Health System Barriers -Insufficient financial Assistance for transportation expenses

-Absence of separate room for DOTS patients

-Lack of awareness on the mechanics of the DOTS program among

health providers and patients

-Poor diagnostic skills of the health provider

-Shortage of Streptomycin drugs

-Charging patients for drugs

-Poor sputum microscopy follow-up at the end of treatment course

-Questionable recording and reporting of treatment outcome

-Continuous migration(transients)

Barriers Associated to Interpersonal

Relationship Between Health

Providers & Patients

-Poor interpersonal communication between health providers and

patients

-Problem in pursuing patients who failed to take medication or who

have failed to follow-up

Barriers Associated to Patient’s

Characteristics & Behavior

-Patients’ behavior (lazy and lack self-ion have to do with other

issues.

CHAPTER IV

CONCLUSION AND RECOMMENDATION

Although TB cure rates of Zamboanga city have been increasing in the past years,

identifying barriers to implementation of DOTS from the perspective of the DOTS

stakeholders and defaulters is still important for better actions in the implementation of

this existing program. Success of DOTS is not only dependent on the health services

made available. It is not merely dependent on any rise in the statistical value. It is

dependent on the interaction between the implementers, other stakeholders and patients.

Truly, barriers would mean structural and social factors. This study identified three major

barriers to success of DOTS in Zamboanga city: health system barriers, barriers

associated to patient’s characteristics and behavior, and barriers associated to

interpersonal relationship between health providers and patient. Specific barriers under

the health system barriers were identified and were found to be related to the 5

components of the DOTS strategy. These are: Insufficient financial assistance for

transportation expenses, Absence of separate room for DOTS patients, Lack of awareness

on the mechanics of the DOTS program among health providers and patients, Poor

diagnostic skills of the health providers, Shortage of streptomycin drugs, Charging

patients for drugs, Poor sputum microscopy follow-up at the end of treatment course,

Questionable recording and reporting of treatment outcome, and Continuous migration as

transients. Barriers associated to interpersonal relationship between health providers and

patients revealed that there is poor interpersonal communication between health providers

and patients. Among the five systematic strategies under DOTS program, it is the

standardized treatment with supervision which met many lapses during implementation.

Problems arise because of poor interpersonal communication and inadequate attitudes of

health providers coupled with the lack of attention and support to patients’ account.

Patients on the other hand, tend to have behavioral barriers that need to be recognized and

understood in order to be addressed. Barriers associated to patient’s characteristics and

behavior revealed that patients who are most likely not to adhere in the treatment regimen

are those who are lazy and lack self-motivation. In conclusion, the results of this study

gave us an understanding that tuberculosis is not simply a biological problem. It

transcends a merely medical approach. It is a social disease entailing socio-cultural

approach in order to improve the existing DOTS program in Zamboanga city. The DOTS

program should include in its strategy on how to deal with the behavioral and social

factors involved in the treatment of tuberculosis.

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APPENDIX A

INTERVIEW GUIDES

Interview Guide for Health Providers

1. How many years have you been handling the DOTS program?

2. What is the objective of the DOTS program?

3. What are the major strategies of DOTS?

4. What is your assessment of the existing DOTS program?

5. What are the barriers to success of DOTS?

6. Why do some patients default?

7. What can you do to increase the accomplishment of DOTS?

8. What can you say about the government’s support on the DOTS program?

9. In your opinion, what is still lacking or can be improved in the program?

Interview Guide for Health Providers

1. How many years have you been handling the DOTS program?

2. What is the objective of the DOTS program?

3. What are the major strategies of DOTS?

How do you get your cases?

How do you monitor patients?

How do you encourage patients to complete treatment?

How do you know patient is cured?

4. What are the barriers to success of DOTS?

5. Why do some patients default?

6. What can you do to increase the accomplishment of DOTS?

7. What can you say about the government’s support on the DOTS program?

8. In your opinion, what is still lacking or can be improved in the program?

Interview Guide for Defaulters

1. How did you become involve in the DOTS activity?

2. What do you know about DOTS?

3. How do you assess the government support in the DOTS program?

4. What can you say about the supply of medicine?

5. What can you say about your treatment partner?

6. What is the reason why you default?

7. In your opinion, what is still lacking or should be improved in the program?

APPENDIX B

TRANSCRIPTIONS

Respondent: TB Administrator from Zamboanga City Health Office

Interviewer: The Researcher

---------------------------------------------------------------------------------------------------------------------------------

Interviewer: Good afternoon, doc! Thank you for this time you are giving me to interview you regarding

the TB DOTS program in Zamboanga City.

Respondent: Why do you have to ask me questions, diba, I asked you already to attend the symposium in

ATOA regarding DOTS of Zamboanga? Hahaaa..

Interviewer: I’ll have some different questions for you today, doc.

Respondent: Okey.

Interviewer: How many years have you been handling the TB program?

Respondent: Only, ah, 1 year.

Interviewer: 1 year, so, ano po’ng mga components ng DOTS na alam ninyo?

Respondent: Components of DOTS, 5 components yan siya. It needs political commitment, that’s 1.

Second, it needs quality-assurance by examining mga microscopy centers, quality microscopy services ba.

Three is standardized, ah, three is, the treatment should be DOTS. The fourth one is, the drug supply

should be complete in the entire course of management. And the fifth one, the last one is standardized

recording and reporting system. If kumpleto yung five na ‘yan, you are actually doing good DOTS.

Interviewer: Sa tingin niyo, doc, yung DOTS ng Zamboanga, what has ano, yung mga naging

accomplishment niya?

Respondent: When it comes to accomplishment sa DOTS, ah, kasi diba sinasabi natin, sa third component

of DOTS must be directly observed with social support. So it’s the health workers who will give the

management in front of them. They should observe patient swallowing the medicine. Something like that.

So, majority of the cases in Zamboanga City is implemented, in terms of taking the medicine, is

implemented with DOTS. Although some are modified DOTS by tapping family members or any mga

neighbors or teachers as their TB treatment partners but, ah, in general, I can assure that the TB DOTS or

the DOTS strategy is, indeed, working in Zamboanga City.

Interviewer: Pero nung seminar sa ATOA po, sinasabi ninyong successful ang DOTS ng Zamboanga?

Respondent: Yes. Yes..

Interviewer: In terms of?

Respondent: Ahh.. kung meron man sa 5 components ang medyo hindi masyadong nagawa sa ngayon, is

yung the presence of medicines na, diba sinabi natin na dapat kumpleto yung medicines? But the

streptomycin, wala ang streptomycin. The streptomycin is supposed to be supplied by the DOH. But until

now, wala pang supply na narereceive. So, as far as treatment is concerned, the category II treatment is

affected. But this category II, mostly are those patients, ah, who had treatment of TB before. Kasi

nagrelapse sila, so kaya naging Cat II. They can just wait for streptomycin because negative naman sila sa

sputum. Especially negative sila sa sputum, so, it means to say, they are not contagious. So they can just

wait for their management. Symptomatic na lang tayo. So, yun lang ang nakita kong problema. Second,

sa DOTS, ah, although the report says that it’s ok pero we cannot deny that some of the health workers

might be during the time, are lazy or meron naman silang ginagawa so, hindi natutukan yung DOTS. These

are the things that we can speculate but it’s possible that it happen also.

Interviewer: Pero diba doc, dun sa ano, sa program sa ATOA, sinabi dun na from 85, naging 90…?

Respondent: Yeah.. from 82% naging 96, ang case detection rate.

Interviewer: Cure rate po?

Respondent: Ang cure rate niya from 82 to 84%

Interviewer: From 2006-2007?

Respondent: Oo. So, the target is 85.

Interviewer: Opo.

Respondent: So, kulang pa ng isa. But if we try to include private data, diba?

Interviewer: Opo?

Respondent: We could have reached 85 or more than that. That’s why we have this another initiative

trying to strengthen partnerships with private physician in order to accommodate their data and include that

as computation for cure rate.

Interviewer: Sa private?

Respondent: Yes, sa private.

Interviewer: Anong masasabi niyo doc? Kasi may mga health center kasi, sabi nila na gusto nila daw doc

ano, gusto nila na permanent residents lang nila ang bigyan nila ng DOTS o i-start nila ng DOTS. Kunwari

from Tawi-tawi, or from other places..

Respondent: Yes, that’s correct! Kasi how can we implement DOTS when they are in Tawi-tawi? So, we

are computing our targets based on the population of Zamboanga City.

Interviewer: Opo.

Respondent: So.. and we presume that all provinces and cities are also doing DOTS. So, if we happened to

have patients coming from Tawi-tawi and we know that they will really go home, so, we opted not to start.

Kasi high risk doon na baka hindi nila ma-continue. So, ang gagawin na lang is to refer them to their

appropriate province or provincial health office. Like sa Tawi-tawi, so that the provincial health office of

Tawi-tawi will be the one enrolling them and implement the DOTS kasi dapat doon. So that the

accomplishment also will be included sa accomplishments ng province.

Interviewer: Have you addressed this problem sa provinces like sa Tawi-tawi?

Respondent: Yeah, we actually have. We are planning this referral system pero hindi pa siya na carry out

pero logically, if we give referral note to the province, they should follow it. Kasi ang sa amin is better not

to treat the patient than to treat them incompletely or with incomplete treatment. So, they will just develop

resistance. So, especially for negative sputum. Positive nga siya, positive TB pero negative sputum. So,

there are two ways naman to treat. One is to treat the patient. Second is to prevent transmission. So if we

can assure that transmission is less, dahil hindi naman siya positive sputum at ma-aasure namin that this

person will really go home, so, paano natin siya ma-DOTS kasi ang DOTS is everyday. So, hindi kame..

ang protocol namin is…

Interviewer: hindi talaga? Lahat ng barangays ng Zamboanga hindi mag-start ng DOTS kapag hindi

certified resident ng barangay?

Respondent: We can start as long as we can assure that the patient will stay for the entire course of

management, mga 6 months or 8 months.

Interviewer: In connection with this doc, yung mga estimatations, Diba, nag-eestimate kayo ng mga

detection rate? Paano niyo ginagawa yun?

Respondent: There’s a standard computation for that. Ah, I don’t have the formula but there’s a standard

computation as to the estimates of possible cases of TB in a year based on the NSO population. Ah, the one

of disadvantage naman… ah, going back to the question, one of the disadvantage of giving medicines to a

potential.. ahm, patient who is potentially ah, or sabihin natin na uuwi din sa area nila, is default. The

default will increase. So, kaya nga yun, stick kame sa policy na if we cannot assure that the patient will

stay the entire treatment, so better not to start or not to start but to refer the patient to the corresponding

province.

Interviewer: In terms of constitutional shortcomings sa system ng DOTS or sa program, meron ba kayong

nakikitang mga pagkukulang.? Like sa organization niyo, sa mga tao?

Respondent: Yeah. Ahm, sa organization wala. Pero sa pag-carry out ng ano, like for instance, how will

you expect DOTS will be implemented for patients who are working sa basnig? They will be staying sa

dagat for about for 4 months, 6 months. Eh, sinong magbibigay ng gamot? Can you assure na ma-iinom

nila yung gamot? So, papahinto mo rin sila sa trabaho? Sino naman ang magbibigay ng pagkain sa pamilya

nila? So, eto yung mga one specific problems na na-encounter namin on how to deal with this problem ba.

Interviewer: Ah, yes doc, kasi may nabasa ako na kahit ano daw, na taga mountains daw ang pasyente mo,

you have to assure na DOTS talaga ang pag-inom ng gamot for at least 2 months.

Respondent: Tama! Lalo na sa intensive. Sa mountains, puwede relative or barangay officials ang maging

DOTS partner mo. Not necessarily health worker. Sa bagong MOP o manual of procedures, puwede

health worker, ‘pag hindi puwede siya, family member, teacher, barangay officials, puwede yun siya. Ah,

just to avoid yung tinatawag nating SAT management or self-administered treatment. Kasi, nakakalimutan

talaga.

Interviewer: Pero pag non-health worker, doc, kailangan pa ba silang i-train?

Respondent: Ah, yes, they should be trained. Parang, it’s a short ano lang, ganito magpa-inom, dapat

ganitong oras, ganyan. So, they should be trained. Pero most of the patients naman, BHW talaga ang

treatment partner kasi yung BHW, karamihan sa bundok man yan. Every purok, there should always be a

BHW na naka-assign.

Interviewer: How do you assure that health providers are being updated with regards to knowledge of TB

and DOTS?

Respondent: Actually ma’am jo bue is in charged of training nurses and midwives and even health

workers. She udpdate them whenever there are new MOP for tuberculosis treatment and if ever she is

unable to go train BHWs, it’s the districts nurses’s or midwives’ responsibility to train health workers. I

also do training. We schedule seminars. Even the NGOs do their independent interventions sa mga

community in line with DOTS program. So, ganun yun.

Interviewer: So far, doc, kayo man ang TB manager. Bale, ano’ng ginawa niyong mga visits doc? Ah,

how do you do mga visits sa mga barangays with DOTS program?

Respondent: Not necessarily ako ang mag-visit. But we have this protocol kung paano i-visit. All districts

have their own district nurses. And these district nurses are the ones visiting the BHS. Ganun lang. And all

the midwives in the BHS are the ones responsible in managing their BHW or reminding them or enhancing

them on how to do DOTS. So, constant yun. And ofcourse, yung mga collection ng follow-up sputum

examination should be also ahmn, so ang ano namin is ganon. A regular schedule with DOH visiting the

microscopy centers just to assure that the microscopy services are quality. Ah, quality and accessible and

standardized ba.

Interviewer: Doc, yung about sa microscopy, kumpleto na ba ito para sa mga districts ng Zamboanga?

Respondent: yeah, yeah.. We have 15 districts and we have 15 ah, we have 17 microscopy centers.

Interviewer: enough na ba yun sa tingin niyo, doc?

Respondent: Yeah, kung sa detection, enough na siya because the target of detection is 70% but we

reached 96% because of the existence of these microscopy centers. The challenge is how to reach the 85 for

the cure rate. Kahit ngayon 84 palang, kulang na lang ng isa. So, one policy na nilabas ko is number 1,

there should be BHWs assigned to positive sputum individuals. So, they have to plot in their schedule what

time and when they will go their house to collect the specimen for the follow-ups. Ganun. Kasi, the cure

rate, we can only say that the patient is cured if the patient completed the treatment regimen for the entire

course with sputum follow-up.

Interviewer: na negative na po?

Respondent: na negative na! na may conversion na. But if the patient improved because of the taking, na

completed naman ang taking but never submitted sputum exams for follow-up or follow-up sputum exam,

so we cannot consider it cured even the manifestations are already gone. We can only consider it as

completed. So that, completed plus the cured will now, result to success rate. Pero hindi man ang success

rate ang kinukuha. Ang cure rate man. Other countries’ success rate of 85 ang kinukuha pero sa

Philippines, cure rate talaga ang gusto natin makuha. So, para mas matutukan talaga yung paggamot..

Interviewer: How about the local government’s support,doc, sa mga programs niyo for TB?

Respondent: Ah, yeah! The local government support is very… Ahh.. The local government of

Zamboanga is very supportive, allotting 1.3M per year for medicines. Yan, meron ng supply sa DOH but

we are still doing augmentation.

Interviewer: Ah, nag-a-add pa sila for the supply?

Respondent: Yeah, and the local government unit also created the Hermosa TB council to unify all

existing non-government agencies in Zamboanga working for TB para ma-unify, ma-harmonize yung

work. Kasi dati, kanya-kanya silang work, eh. Diba?

Interviewer: Yes.

Respondent: Kanya-kanyang work. Kanya- kanyang, individual ba. Individualistic, ah, competition,

waste of resources. So, because of these reasons, nag-create ng council para tutukan sila. So, “TB link,

hindi mo na puwedeng gawin yan, kasi ginagawa na ng kuwan.. Nadu-duplicate na ang efforts.“Global

funds, hindi ka na puwede sa Tumaga kasi anjan na yung ano, kailangan sa ibang area ka naman.”

Interviewer: Doc, marami mang NGO’s supporting TB treatment diba? Meron pa ngang TB ano po ba

yun? Task force TB . Connected ba yang mga agencies na yan sa inyo, doc?

Respondent: Yes. Lahat sila. Kaya nandiyan si Hermosa TB council. One is social mobilization on TB.

They are organizing TB task force to be treatment partners in selected areas lang. Then we have also,

under Global funds yun. Then we have also PhilCat, trying to organize partnership with, among private and

public sectors, the PPMD. Then we have also the Zamboanga Coalition against Tuberculosis. And all of

these sectors are under one executive, masasabi natin na, puwede nating masabing legal council ang

Hermosa TB Council because it was created through an executive order and supported by an ordinance. So

because of that, masasabi mo na inoobserbahan ng government yung mga surroundings. Kung sino yung

mga taong nagwowork sa TB at gusto nilang maharmonize yung activities, for one goal. Kasi kahit ano pa

diyan, ang iba-ibang approach niyo. whether community-based, whether technical, whether curative,

preventive, isa lang ang goal niyan eh. It’s to reduce the prevalence at morbidity of TB by 50% in year

2015.Pare-pareho lang ang mission nun. So, why work individually, diba? so, mag-organize na lang tapos

magdefine na lang. “Ikaw sa community, kame dito sa technical, kame dito sa private.” Ganun.

Interviewer: Pero what determines, doc, na kailangan mong lagyan ng TB task force ang isang district?

Like sa Talon-talon, meron sila.

Respondent: Oo, it’s actually the NGO, the Global fund who will identify the areas na gusto nila. Then

pag-identified na nila, titingnan ng TB council kung ok.

Interviewer: opo.

Respondent: So kung wala namang ibang NGOs na existing dun at hindi maduduplicate yung trabaho then

go sila as long as they will coordinate with the Hermosa TB council.

Interviewer: so, yung mga program nila, kelangang naka-pattern parin sa inyo?

Respondent: Yes, naka-pattern parin siya. As to the mission and vision, it should be the same. The

strategies and the activities na lang ang iba.

Interviewer: Bale, anong ginagawa niyo, doc, kunwari may mga low-performing districts?

Respondent: Ah, yun na! Sa mga low-performing districts, tinitingnan ng cure rate. Di ba? Case detection

rate nila ok, cure rate nila mababa. So, titingnan namin kung ano yung problema bakit mababa. Like sa

Manicahan, meron silang microscopy center pero bakit mababa ang cure rate? Baka walang sputum follow-

up. So, sinasabi kasi hindi pumupunta yung pasyente sa health center para magdala ng sputum, wala

naman silang plan B na dapat ang BHW ang pumunta sa bahay. So, sinabihan na namin ngayon, ngayon

meron na kaming protocol na for those low-performing, that you should assure that you should get sample

or sputum samples in an identified or specific time for sputum follow-ups whether, the patient will come to

the RHU to submit it or you, BHW, will go to the residence to collect it. Basta ganun. So that, pagdating, at

the end of the day na tapos na siya, magaling na siya, we can say that, that individual can contribute in the

cure rate not just in completion, ah yung completed treatment.

Interviewer: Pero talking about mga stipend nila, like for pamasahe? Paano yun? Saan sila kukuha para

dun?

Respondent: Stipend, ahm para sa pamasahe, puwede lang.

Interviewer: Puwede ba yun, puwede galling sa inyo?

Respondent: Puwede pa, tsaka nagrereceive naman sila ng honorarium from the city government and

barangay.

Interviewer: Pero sabi nila, it’s not enough daw po kung sakaling kailangan pang habulin nila ang mga

pasyente.

Respondent: Before, they are just receiving honorarium from the barangay and they are saying it’s not

enough. Now it’s added from the honorarium coming from the city government, sasabihin na naman nila

yan, it’s not enough. So, wala bang satisfaction ang tao. But rest assured that the transportation will be

shouldered by their RHU. Kasi, may mga donation boxes naman yan sila. So, they can just be given. Kasi

ginagawa naman yun every 2 months, 4 months or 6 months. So not everyday. In just 3 consecutive visits

for one patient, hindi naman impossible yun. So, yun lang naman ang ano namin. Hindi mo madedeny na

kahit sino naman, kahit anong profession, meron talagang tamad, meron talagang madaldal, meron talagang

reklamador. So, given na yan.

Interviewer: Sa side naman ng defaulter doc, there are some defauters who are complaining of lack of

separate room wherein they can be entertained kasi daw, if they enter the same room as the other patients

na walang TB, nahihiya sila.

Respondent: Nahihiya sila…

Interviewer: Anong masasabi niyo about that? Is there a need for separate room?

Respondent: Yeah, may point sila na ganun kasi but if we tolerate that, we are tolerating stigma. We are

tolerating that TB is something that should be isolated from the general population.

Interviewer: Yes, po.

Doc: Pero trying to make a message that TB is not different from any other disease, message sa iba na hindi

dapat ikakahiya, na hindi dapat ikakatakot, managing TB infront of general population is a good strategy to

eliminate stigma. Pero kanya-kanya kasi yan, eh. Pero some RHUs, meron silang separate rooms for TB

patients. Actually, meron yan sa mga TB DOTS centers, meron talagang separate room for intake of

medicine. Pero para sa mga BHS level, wala. Sa RHU, sigurado akong meron.

Interviewer: In terms of ano naman, doc, laws and regulation, kasi sa mga ibang countries, meron silang

sanction if the patient failed to take their medication.

Respondent: yeah.

Interviewer: Sa inyo, doc, naisip niyo na ba yang mga ganitong klaseng strategy?

Respondent: hmmn.. We are in a democratic country. Taking medicines or forcing patients to take

medicines hindi rin yun ano… eh. Ang maganda dun ay ibigay mo ang disadvantage of not taking the

medicine and let them absorb so ang pagtake nila ng medicine is not by force. Para sa akin, hindi yun

tama. Ahhh.. if there are criminal grounds like, uubuhan ko for example, si Noreen ng harap-harapan

because I want her to get my TB infection, puwede yun.

Interviewer: Puwede na yun i-sanction, doc?

Respondent: Puwede na. Pero hindi naman yung hulihin.

Interviewer: Pero mayroon na bang law na ganun, doc?

Respondent: Siguro sa mga socialist pati mga communist, puwede yan gawin pero pag sa democratic, nah,

pang human rights yan, nah! So, naisip namin. Pero nakita namin it’s not proper. It’s not proper. So, sige

lang. Ang ano lang doon is try to identify the reasons, the specific reasons why they don’t want to take the

medicine.

Interviewer: And address this problem?

Respondent: … If the problem is stigma, then target the stigma. If the problem is ano, then… ganun na

lang.

Interviewer: Diba doc, kasama rin yun sa mga principles ng implementation na you should do mga cohort

analysis?

Respondent: Yeah! Cohort analysis is always done every year.

Interviewer: Tapos yung mga ganun, doc, mga identifying factors ginagawa niyo rin ba yun, doc, kung

bakit hindi umiinom ng gamot ang mga patient?

Respondent: Yeah, ginagawa namin yan katulad ng sabi ko sayo yung cure rate, bakit mababa? Sa

microscopy center ba, wala kayong microscope? Hindi naman yun ang reason. So, hindi ang solution ang

dagdagan ang microscope, diba?

Interviewer: Yung capacity ng tao para magdetect.

Respondent: Oo, ang tao naman pala ang hindi pumupunta. So, it’s not adding the microscope is the

solution. The solution there is how to get the specimen for sputum follow-up. So, gagawa ka ng policy

naman. Nah, walang katapusang policy.

Interviewer: Oh, lastly, doc. Ano naman yung plans niyo..?

Respondent: Magresign!

Interviewer: hahahaa..! Hindi po, activity-wise to improve or to maintain yung status niyo ngayon and

achievements in TB program?

Respondent: Ofcourse, we have to maintain all best practices and ,ah to formulate initiatives from lessons

learned na mali. Yun lang naman. Basic! As to the specific, so, mahaba yun. So, kung ano yung maganda,

i-maintain. Ano yung lessons learned katulad ng hindi nag-i-increase ang cure rate dahil walang sputum

follow-up, nah, so magbibigay kame ng policy dun na kailangang mag-apoint kayo ng BHW para mtutukan

yung pasyente. Nah wala siyang ibang trabaho kundi hanapin yung positive na patient nay un. Anyway,

yung address, nandun man.

Interviewer: Opo.

Respondent: Example, ngayon, meron akong pasyente. March 10, positive. So, magcount na ako ng 2

months. Diba? March, April, May, dapat may specific date for follow-up yun. Or tapos ida-dot ko na yan sa

calendar. Para pagdating ng day na yun, “Uy! Hindi siya pumunta dito, ako ang pupunta.” So, puntahan na

niya yun. Siguro in a day, ahmn, in a month siguro isa o dalawa lang ang pupuntahan niya. Hindi naman

marami ang sputum positive, eh. It’s just less than 20 or less than 10 per district. So, hindi siya mahirap.

Kaya nga sabi ko, with that initiative plus the initiative of partnership with private will really increase the

ano, ako ina-anticipate ko na mag-iincrease ang cure rate of more than 85% by next year.

Interviewer: Okey. Thank you, dokie.

Respondent: Okey, bye-bye.

~ End of Interview with the TB Administrator ~

Respondent: Manicahan Nurse & Midwife

Interviewer: Researcher

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Interviewer: Good afternoon pala ulit. Ako po uli si Aisa Presas, ma’am. So ang research paper ko is about

barriers ng DOTS sa Zamboanga City. Gusto kong malaman sana kung bakit hindi successful ang DOTS in

some barangays like Manicahan. Kasi di ba ang basis natin po ay yung detection rate and cure rate? Tapos

ang Manicahan, diba, you are aware naman na it’s the lowest cure rate in terms of TB treatment?

Ilang years na ba ang DOTS sa barangay niyo?

Respondent: mga 2 years… 4 years ago.

Interviewer: 4 years po?

Respondent: Siguro 3-4 years kasi 2 years na ako dito. Before that nag-DOTS naman dito.

Interviewer: Kayo, ma’am, ilang years na kayo nagwo-work dito?

Respondent: 15.

Interviewer: Matagal na pala talaga. Beterana na kayo dito sa Manicahan. Siguro Ma’am tinuruan na rin

kayo kung ano ang mga goals ng DOTS. Anong alam nyo sa goals, objectives ng DOTS?

Respondent 1: At least to complete the treatment and do follow-up.

Respondent 2: It’s not only completing the treatment kailangan confirmed cured. To declare a patient

cured dapat mayroon syang 2nd

sputum and 6 months follow-up. Iyong follow-up kasi ang problema

naming kasi usually pag pafollow-up sa maintainance stage, mahirap man papuntahin ang mga pasyente

dito. Sometimes, nandito ang microscopist, ang patient naman ang wala. So nagkaroon kami ng problema

kasi nag-shift man from yong Medtech talaga na pumupunta dito to trained midwife sa microscopy. ‘Yon

ang bago microscopist

Interviewer: Ano po ba ang naging problema dun sa dating microscopist?

Respondent: Hindi. Pareho lang man din kaso noon, mahirap din ‘yong mga pasyente ipa-schedule.

Magschedule ang medtech pero minsan hindi siya makapunta. Minsan naman, ang pasyente ang wala.

Respondent 2: Usually every Friday man yun sya nandito, tapos every first Friday of the month nandito

sya, tapos every third Friday sa Sangali. Scheduled lang ba sya, tapos usually pag schedule nya either

conference namin, so wala.

Interviewer: So, ito na ba ang main problem ng DOTS sa Manicahan, yung detection pati yung pag-

declare na cured ang pasyente kasi dahil sa follow-up?

Respondent 1: Yun talaga pero ngayon kasi meron na kami regular na microscopist kaya magiging okey

na siguro ‘yan..

Respondent 2: Tulad kanina schedule namin sa mga pasyente, nandito rin ang microscopist. Tumutugma

sya.

Interviewer: Si Doc Ric po ilang beses ba pumupunta si isang linggo dito?

Respondent 1: Every Tuesday ang consultation day niya.

Respondent 2: Pero ‘yong dating CESO din sya mas mahirap din kasi ang schedule niya sometimes

parang wala din ba siyang time…

Interviewer: Ganun po ba. Sa tingin nyo ba naging successful ang DOTS sa pag-treat ng TB Sa

Zamboanga?

Respondent 1: Mas okay naman ang DOTS kasi hawak namin ang mga pasyente kaysa ‘yong dati.

Respondent 2: Kasi pumupunta sila dito except lang holiday, Saturday and Sunday.

Interviewer: Pero kailan lang ban a ganyan na ang way ng gamutan dito?

Respondent: Noong nag-training sila sa amin about mga 4 years ago. Pero before sa DOTS, once a week

sila pumupunta dito sa health center pero ngayon everyday na.

Interviewer: Sino po ang mga treatment partner ngayon?

Respondent: Mga BHWs kung malapit lang sa BHW. Pero usually kung malayo na talaga, ‘yong family

member. Pero rare man dito kasi DOTS talaga sya. Iyong intensive phase, dito talaga sa center.

Interviewer: Marami kayong defaulters dito?

Respondent: Meron din, mga 2 lang. si Melvin ayaw daw, mag-private na lang daw. Ayaw daw sa Nurse

namin.

Interviewer: Bakit daw?

Respondent: Ewan namin, makulit man ang nanay nya. Ang nanay man nya ang nagpapunta dito nagpa-

register tapos positive man talaga. Tapos noong nagpagamot na, ayaw na. 1 week lang ata sya pumunta

ditto.

Interviewer: Ano po ang dahilan bakit sila nagde-default ang mga pasyente ditto?

Respondent 1: One is siguro kahit na mag-health teaching ka na, iba ba talaga ang attitude kasi pag okey

na di, na sila umuubo, okay na daw yon. Kahit na mag-health teaching ka na, kasi before ka mag-treat may

health teaching man talaga.

Respondent 2: Individual counseling talaga. Pero part of that attitude problem talaga, isa pa, pamasahe,

financial. Isa pa yong mag-shift na lang daw sa gamot galing private kasi sumasakit daw ang sikmura

kapag yong meds natin, iba daw ang epekto. Sabi ko nga “ hindi nyo ba alam na yong isang box na ganyan

5 thousand plus binibigay ng gobyerno para lang sa inyo tapos ganyan lang ang attitude ninyo?”

Interviewer: So sa palagay nyo Ma’am ang government talaga is really working para mawala ang TB?

Respondent: On their part okay din kasi imagine ha 90% of ‘yong budget ng DOH sa… narinig ko lang

‘yan sa TV…90% daw of allocation para sa TB treatment tapos 10% para sa vitamins… so imagine mo

yon.

Interviewer: So sa tingin ninyo ang kulang talaga ay ang response ng tao?

Respondent: Kulang ba talaga… pero meron ding kusa talagang pumupunta ditto.

Interviewer: In terms of facilities, anong kulang sa health center niyo para sa DOTS program?

Respondent: Wala naman. Kaya lang ‘yong smearing room namin, papalitan daw ‘yan. Pero okay naman.

Sa medicine okay naman.

Interviewer: Hindi naman po kayo nauubusan ng medicine?

Respondent: Hindi naman nag-a-out of stock. Tama lang talaga for patient, hindi nakukulangan doon.

Interviewer: Pero expected na ngayon mas magiging okay na ang data collection nyo.

Respondent: Saka mayroon ng mga nag-smear sa amin, na-train sila for smearing…

Interviewer: Kasi ang Mercedes, mayron din silang microscopy.

Respondent: Lahat ng district meron na.

Interviewer: So, bale wala na kayong gustong i-improve kumbaga program?

Respondent 1: Depende na lang sa MOP. Meron kasi before we started everything may training naman

kami lahat. Noong nag-change din ng MOP, ung manual, may training din kami as a whole.

Respondent 2: Noong nag-change ng manual nito lang July, last year lang mga July or August. Siyempre

kung magchange ng MOP, may mga kakailnganin na naman.

Interviewer: Sa whole barangay, may large group educational session ba kayo?

Respondent: Basta World TB Day, usually August yan, sometimes symposium or bench conferences.

Interviewer: So nagbibigay din kayo ng lecture sa kanila?

Respondent: Dito na lang sa health center.

Interviewer: Iyon lang, ma’am, salamat. po… Ma’am, ‘yong study ko po will also include’yong mga

pasyente sana. Habulin ko sana ‘yong mga defaulters. Marami ba? 2 man kayo dito ano?

Respondent: Defaulters? Hala saan mo ba mahahanap si Melvin? Akala mo ano, walking na ano. Positive

na positive tapos 1 week lang pumunta dito tapos na-default. Pinuntahan namin sa bahay ayaw nya.

Interviewer: Magpasama na lang ako sa isang BHW nyo.

Respondent: Kay Wali man ‘yon. Nag-default na tapos bumalik na naman ulit. Noong una category 2

injection ng streptomycin. Tapos after a month nawala sya nag follow-up ako sa bahay pagdating ko sa

bahay sabi ng daughter- in-law nya di daw TB ang sakit ng nanay nya ano daw, ano ba ‘yon? Sa labas,

‘yong mga naengkanto daw ba.

Interviewer: Ah? So sa quack doctor na nagpagamot?

Respondent 1: Yes, kasi Muslim man din.

Respondent 2: Sabi ko okay lng ‘yon nirerespeto ko ‘yong mga belief, mga desisyon nila. Ayaw niya,

wala akong magawa. Pero sabi ko tingnan din sa x-ray result nila. Kasi hindi daw pwede ang magpadalos-

dalos daw. Tapos bumalik na naman kanina, ah kahapon. Mag 1 year ngayon kasi January sya nagstart,

balik nanaman sya kanina nandito magpa sputum tapos ‘yong anak parang galit pa parang ang tingin niya,

kami ang ayaw mag gamot sa kanila, pero pinallow- up ko ‘yon sa bahay. Last Tuesday nandito si doctor,

si doctor ang nag-explain sa kanya.

Interviewer: Subukan ko na lang sila kausapin, ma’am.

Respondent 1: Ewan ko sa kanila? Yan lang ang mga defaulters namin. ‘Yan pinafollow-up talaga namin

kasi gusto naming silang gumaling.

Respondent 2: Kasi ayaw ng libre. Kahit yung mga mayayaman health center pa rin. Pero sila ayaw, ayaw

nila yung free service.

Interviewer: Ma’am ha salamat sa time. So distorbohin ko lang kayo ulit by next week.

~ End of Interview with Manicahan Nurse & Midwife ~

Respondent: Manicahan BHWs

Interviewer: Researcher

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Interviewer: Ang mga katanungan ko sa inyo ay tungkol sa barriers to success ng DOTS Program sa

Zamboanga City. Gusto ko lang po alamin yung mga bagay kung bakit hindi nagiging successful ang

DOTS sa isang barangay o community. First question ko po, kailan nag-start ang DOTS dito sa

Manicahan?

Respondent: 19… 2000?

Interviewer: 2000 ano po?

Respondent 1: Nakalimutan ko na po kasi matagal na.

Respondent2: Opo, matagal na kami kasi ang doctor po namin dito ang in-charge sa DOTS noon. Si Dr.

Natividad.

Interviewer: So sa palagay ninyo, marami ba talagang TB patient dito sa Manicahan?

Respondent 1: Marami po talaga. Normal man po ‘yan sya kasi most of the population, kasi po kadalasan

maski may ubo na sila, ayaw pa talaga nila magpacheck-up kahit pinagsasabihan na namin pumunta sila sa

health center. Nahihiya sila. Parang nahihiya sila na may ganoong klase ng sakit sila maski sinasabihan na

namin sila na “huwag kayo mag alala kasi libre naman ang mga gamot na ibibigay namin sa inyo pero sa

unang 2 buwan punta kayo sa center para direct oral treatment po ang ibibigay namin, para sa oras na

magbibigay kami ng gamot sa inyo, ‘yan po talaga ang oras na iinom po kayo”.

Respondent2: Kasi po paminsan-minsan kung malayo ang pinanggagalingan nila, kung wala silang pera

hindi sila pupunta. So nahihiya po sila. Sa tingin ko nahihiya po talaga sila.

Interviewer: Saan po dito sa Manicahan ang may pinakamaraming may TB cases?

Respondent 1: Ang lugar talaga na mas marami sa Aplaya po kasi po malapit na ‘yun sa dagat.

Respondent 2: Manicahan. Aplaya talaga po. Kung may panahon, maski sinasabi po namin “kung

umuubo po kayo, huwag dumura kahit saan.” May panahon po na hindi sila naniniwala sa amin. Kung

darating na po ang month of Ramadhan hindi po sila lumulunok ng ano nila, dura sila ng dura. Wala silang

ingat.

Interviewer: Ma’am ‘yong ilang taon na ang dumaan, ano po ba ang performance ng Manicahan in terms

of TB treatment? Alam niyo po ba kung ano ang performance ng Manicahan? Mababa rin kahit nung dati

pa o mas maganda noon? Kasi ang data po sa CHO, nagsasabi na ang Manicahan ang pinakamababa in

terms of cure rate po ng TB.

Respondent: Kung ngayon po mas marami naman pong cases kumpara dati na konti lang kaya madali mo

lang silang gamutin pero ngayon mahirap na. Maski umuubo na sila, hindi nila tayo pinakikinggan

especially ‘yong mga brothers natin dyan. Mabuti lang ‘yong mga nakakaintindi kasi naiintindihan nila.

Ang mahirap lang po ‘yong mga hindi nakakaintindi.

Interviewer: Ibig sabihin mga uneducated po?

Respondent: Opo.

Interviewer: Ano po ang alam niyo tungkol sa DOTS?

Respondent: Direct oral treatment po ‘yan. Dito sila umiinom ng gamot tapos ang oras talaga 1 hour after

kumain Kaya po sinasabi namin sa kanila “7AM kain na po kayo ng agahan para 8 AM dito na po kayo sa

center, magbukas kami, painumin namin kayo ng gamot.” Sinisigurado namin na umiinom talaga sila ng

gamot.

Interviewer: Araw-araw talaga ‘yon?

Respondent: Opo. Except lang po kung holidays. Pero dati, BHW ang nagbibigay ng DOTS. Noong mga

2003, doon pumupunta sa akin sa bahay everyday maski holiday kasi po nandoon lang ako sa bahay.

Pumupunta sila doon sa akin. Ngayon may bagong policy na po na dito po talaga sa health center dapat.

Interviewer: Maski Saturdays and Sundays, dito lang talaga?

Respondent: Hindi po. Friday pa lang binibigay na namin para sa dalawang araw. Kung holiday po bukas,

bigyan po sila para bukas.

Interviewer: Para sa inyo, paano ninyo masasabi na cured na ang pasyente? Di ba meron naman yan kung

ilang buwan dapat umiinom at may proseso para malaman?

Respondent 1: Kung nagpa-follow up, for example kung umabot na ng 2 months i-che-check na ulit ang

sputum. Kung positive sya dati tapos nag-negative na ngayon bibigyan na lang sya ng maintenance for 4

months. After 4 months magpa-check ulit, magpa-x-ray ulit.

Respondent 2: Opo kasi ang plema po ay chini-check up po parang every 2 months.

Interviewer: Kung, for example po, sinasabi natin na tapos na sila ng 6 months na pag-inom ng gamot,

cured na ba sila o kailangan pa kayong ipagawa sa kanilang exam?

Respondent: Opo. Kailangan talaga i-check ang plema nila tapos magpa-x-ray sila ulit.

Interviewer: Ano po ba ang role ninyo sa DOTS bilang Barangay Health Workers?

Respondent: Follow-up lang, ma’am. For example, may isang pasyente na hindi pumunta dito, kami ang

mag-follow up. Pupuntahan namin sila at alamin namin kung bakit hindi sila pumunta?

Interviewer: Kasi kayo naman po ang partner di ba?

Respondent: Opo, partner-partner kami noon, pero ngayon hindi naman puwede ang BHW ang pupunta.

Kailangan talaga dito ang DOTS.

Interviewer: Pero dito, sino po talaga ang nagbibigay ng gamot?

Respondent: Ang Midwife.

Interviewer: So hindi na kayo?

Respondent: Pero minsan kung nandito kami sinasabi ng Midwife na “ibigay mo na sa kanya ang gamot

nya.”

Interviewer: Nag-eeducate ba kayo sa pasyente tungkol sa TB o nagbibigay ng mga advises?

Respondent: Hindi Ma’am. Pumupunta lang naman po sila dito para kunin ang mga gamot nila.

Pumupunta lang sila dito para mag-register. Pag nakikita sila ng Midwife namin, ini-educate na talaga sila

kaagad. “ So ito po ang dapat ninyong gawin…Ikaw may ganito kang klaseng TB. Dapat mag-ingat kaya

hindi ka dapat dumura kung saan-saan. Ang plato at baso mo, kung pwede ikaw mismo ang maghugas ng

tubig na mainit. ” Ganoon ang sinasabi sa kanila ng Midwife. Kami nire-remind na lang namin. “Alam

naman po ninyo kung anong dapat gawin kung magsasalita po kayo, dapat takpan ang bibig ninyo para sa

mga anak ninyo kasi madali lang ‘yan makahawa kung positibo ang mga laway ninyo. Kasi nandyan lang

ang mga mikrobyo.” Ganyan po ang sinasabi namin sa kanila. “Maski nandito po kayo kung pwede pag

kinakausap namin kayo, makinig na lang kayo, huwag na masyado magsalita kasi puwde din kami

mahawa.”

Interviewer: So, ilang linggo po sila dapat na uminom ng gamot para puwde niyong sabihin na hindi na

sila makahawa ng TB?

Respondent 1: Meron po nagsasabing after 3 weeks pa para masabing hindi na makahawa. Pero ako hindi

po naniniwala pero depende kung nagpa-sputum exam na sila tapos negative na. That’s the time na

sasabihin kong safe na talaga.

Respondent 2: Sa amin noong nag-training kami sa DOTS sinabi nga sa amin na sa loob ng isang taon

pwede kayong makahawa ng 12 tao. Dyan sa 12 tao pwedeng 2 dyan ang maging positibo. Ganyan ang

sinabi sa amin noong nasa City Health kami. Iyon din ang sinasabi namin sa mga pasyente. Pwede daw ang

mga anak ninyo, parents ninyo, relatives at mga kapitbahay. Kaya mag-ingat daw sa mga laway. Huwag

dumura kahit saan. Kung mayroon arinola doon lang dumura tapos ibuhos lang sa CR.

Interviewer: Anu-ano ba ang mga strategy ng DOTS na alam ninyo, ma’am?

Respondent: Kailangan po talaga uminom araw-araw sa tamang oras.

Interviewer: Paano ninyo sila ini-encourage na kailangan nilang uminom ng gamot ng 6 na buwan?

Respondent: Sinasabi ko “kailangan talagang inumin ito, magpasensya lang po kayo at libre lang po ang

gamot. Ang ibang mga sakit mahal ang gamot. Maski ito mahal ang gamot pero binibigay ng gobyerno. Sa

inyo ‘yon lang, panahon niyo lang talaga. Gawin niyo lang talaga ang part ninyo para gumaling kayo.”

Interviewer: Ilang taon na po kayong BHW dito sa Manicahan?

Respondent 1: Anong taon ba ako pumasok dito?

Respondent 2: Ako Ma’am 19 na. 19 na po ako ngayong September. 1988 pa ako. Siguro 1998 ka

(referring to respondent 1)

Interviewer: anu-ano na ang mga accomplishments ng DOTS dito? Noong wala pang DOTS, ano ang

sitwasyon ng mga TB patients? Mas dumadami ba o pareho pa rin kahit may DOTS marami pa rin?

Respondent 1: Pareho pa rin.

Respondent 2: Matigas kasi ang ulo.

Respondent 3: Hindi man matigas ang ulo pero hindi ko nga alam kung bakit. Kami nga mismo maayos

naman ang pagbibigay namin ng gamot, nasa oras naman ang pag-inom ng gamot. Nakikita naman namin

ang pag-inom ng gamot. Kami nga mismo, kami-kami hindi namin alam kung bakit. Bakit, saan ang failure

natin. Bakit?

Interviewer: May laboratory ba kayo dito sa Manicahan?

Respondent: Opo Ma’am.

Interviewer: Tuwing kailan ba kayo nagko-collect ng sputum? Every Friday ba kayo nagko-collect ng

sputum? Tapos sino ang nagbabasa ng result?

Respondent: Iyon lang talaga. Hindi naman namin masiguro. Ano ba? Kasi may panahon ‘yong ibang

mga health center dinadala lang nila dito ang sputum. Hindi ko alam kung inano na ba nila ‘yon. Pero

‘yong dito sa amin direct talaga kinukuha. Pagkatapos kunin, ‘yon na.

Interviewer: Bale sino ang nagbabasa ng sputum? Meron ba kayong Med Tech or ano?

Respondent 1: Hindi sa Cabaluay yata dinadala.

Respondent 2: Hindi. Dinadala talaga ‘yan sa City Health.

Interviewer: A,h sa City Health pa? Sila ang nagbabasa, resulta na lang ang dinadala dito? So, wala

kayong laboratory dito?

Respondent: Noon, ma’am, may Medtech kami dito.

Interviewer: Kailan po ‘yong may laboratory kayo dito? Anong year po ‘yon?

Respondent: 2000 lang siguro ‘yon. 2000-200_? Ano na ba tayo ngayon? 8 na ba tayo? 2007 po. 2008

lang naman tayo walang laboratory. Kasi nagtrain sila ng mga midwives sa microscopy.

Interviewer: Sa tingin nyo ba may problema kung Midwife na ang nagbabasa ng sputum kumpara sa Med

Tech?

Respondent: Iba talaga. Kung sa akin lang ha? Iba talaga ‘yong Med Tech.

Interviewer: Paano kayo nagre-recruit ng pasyente sa purok ninyo or sa barangay ninyo?

Respondent: Sabi ko “ilang araw na ang ubo mo?” Sabi nila “ 2 weeks na ito”. “ Siguro mas maganda

magpa-x-ray ka na lang para ‘yong gamot tama para sa iyo.” Ganyan lang ang sinasabi ko.

Interviewer: Naging problema ba ang x-ray sa kanila kasi mahal daw ang x-ray diba?

Respondent: 150 ata. Mahal kaya hindi din sila makapag-x-ray.

Interviewer: Kailangan pa bang may x-ray before mag-enroll for treatment dito?

Respondent: X-ray talaga pati sputum.

Interviewer: Ang sputum exam, libre lang ba?

Respondent: Libre lang.

Interviewer: Iyong gamot dito Ma’am regular ba ‘yan? Nauubusan ba kayo ng gamot dito o hindi

naman?

Respondent: Sa City Health man ‘yan galing. For example, ako ang pasyente tapos may sakit ako ng

ganyan, TB, dinadala na lang namin dito ang x-ray result so, naghihiram lang naman kami sa mga pasyente

na sobra ang gamot. Hindi ibig sabihin na sobra talaga kundi hindi pa nila naiinom. So ’yong hindi pa nila

nainom, pinangti-treat namin ‘yon kaagad para kung darating ‘yong gamot nya, kasi dadalhin pa naman sa

City Health tapos kunin ang gamot, so para hindi maghintay ang pasyente, kuha muna kami ng gamot sa

ibang pasyente para ibigay namin sa kanya tapos ipalit na lang para pag dumating ang gamot ng bagong

pasyente, palitan na lang ang nakuha nyang gamot.

Interviewer: Maganda rin naman ‘yong ganoon.

Respondent: Opo kasi nakakaawa din naman ang mga tao minsan kasi gusto na nila magstart ng gamot.

Interviewer: Paano ba ‘yong para sa cases ng pasyente ninyo, dito ba sila talaga nagpa-check up o galing

pa sila sa hospital tapos ni-refer lang dito?

Respondent 1: Opo. Karamihan man, galling pa sa hospital ksi doon man sila deretso pag masama

pakiramdam nila tapos magrefer lang sa amin para sa medisina.

Respondent 2: Meron dito sa amin, ma’am, meron siyang complaint… nandito naman si doctor sa clinic.

So ang complaint nya back pain, chest pain tapos more than 2 weeks na ang ubo nya kaya sinabihan sya ni

doctor na magpa-x-ray. Noong nagpa-x-ray sya, sa town na ‘yon. Kung meron ng result, dalhin dito sa

amin ulit.

Interviewer: Sa tingin nyo, ma’am ano pa ba yong kulang o kailangan i-improve dito sa health center

ninyo para maging successful ang DOTS?

Respondent: May binibigay namang information sa kanila. Sa tingin ko minsan financial ang problema.

Interviewer: Ano man tungkol sa financial?

Respondent: Sila, ang maga pasyente, walang pera para pumunta dito.

Interviewer: Ah, transportation po ba?

Respondent: Opo. Minsan ang mga pasyente weak na, so mayroong alalay plus pasahe pa ‘yun sa kanila.

Interviewer: So, mas makakabuti ba kaya na ibigay na lang ang gamot sa kanila para sa bahay na lang?

Respondent 1: Hindi ko sinasabi ‘yon. Kung ganun kasi baka hindi lang nila inumin.

Respondent 2: Sa tingin ko ang problema talaga ay sa pasyente. Depende talaga sa pasyente kung gusto

talaga niyang gumaling o ayaw nyang gumaling.

Respondent 3: Pero may pasyente naming pumupunta talaga dito para iinom ng gamot nila.

Interviewer: Pero sa tingin nyo ba ang gobyerno ginagawa ay nagging supportive sa TB program?

Respondent 1: Oo naman po kasi libre na nga ang gamot. Hindi lang gobyerno, kami din nga po BHW,

supportive.

Respondent 2: Si Dr. Natividad ang supportive kasi sya talaga ang nagsabi na mag-training.

Interviewer: Kailan ba ‘yong training na iyon, ma’am?

Respondent: Una nag-training kami sa Red Cross, yong doon sa hall ng Red Cross noong 2000. May 18.

Interviewer: Tapos ang next training?

Respondent: ‘Yong nagkaroon na ng failures dito na naman ‘yan sa amin mag effort si doctor kasi nandito

lang man sya. Siguro mga June o May 2007?

Interviewer: Si Dr. Natividad parin ba hanggang ngayon?

Respondent: Di na ngayon.

Interviewer: Sino na ang doctor dito?

Respondent: Si Dr. Angeles.

Interviewer: Ay, Si Doc Ric? ilang years na si Doc Ric dito?

Respondent: Bago lang. Iyong nag-retire na si Dr. Natividad. May or August? August 2007. Ngayon pa

lang August mag 1 year pero sabi ngayon aalis na naman sya.

Interviewer: Sa tingin niyo bam as maayos kung kayo ang treatment partner?

Respondent: Opo, Kasi kung doctor ka, nurse o midwife ba, ang feeling ng mga tao mababa na talaga sila

habang kami ganito, nakakapag-relate sila. Mas open sila sa amin.

Interviewer: Sabi niyo kanina, nahihiya ang mga pasyente kapag nalaman nila may TB sila. Bakit po

kaya?

Respondent: Nahihiya na sila kasi may TB sila kasi hindi sila nag-iingat maski sa kanilang pamilya. Iyon

ang nakikita ko. Kasi ayaw nilang malaman ng mga pamilya nila na may TB sila.

Respondent 2: Iyon na nga daw nakakahawa. Alam nila na nakakahawa. For example ako, may TB ako,

hindi ko sasabihin kasi mandidiri yung iba sa akin. Hindi na nya ako kakaibiganin. Ganyan sila.

Respondent 3: Ang sinasabi ko nga sa kanila, mas maganda pa na may TB kayo kasi libre pa ang gamot

galing sa gobyerno while kung mayron kayong diabetes o may cancer kayo, mahal ang gamot.

Interviewer: Tama naman po ‘yon.

Respondent: Dati, ma’am, 1 year po ang treatment ng TB.

Interviewer: Thank you sa inyo dahil pumunta kayo dito ngayon.

-End of Interview with Manicahan BHWs -

Respondent: Manicahan Defaulter 1

Interviewer: Researcher

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Interviewer: Kailan po ninyo nalaman na may TB kayo?

Respondent: May 28, 2007 siguro yun.

Interviewer: Bago dumating ang May 28, 2007, ano yung mga naramdaman mo?

Respondent: Parang nilalagnat ako.

Interviewer: Ilang araw po kayo nilagnat?

Respondent: Matagal na. Siguro may 1 buwan. Pagtapos nagpa-check up ako.

Interviewer: Nag-ubo, wala?

Respondent: Merong ubo.

Interviewer: Pero hindi ba kayo umubo na may dugo?

Respondent: Wala. Pero paminsan, tulad noong huli akong nagpa-check up, may sumama na parang pula

o brown kasama ng plema ko kapag umuubo ako pero….

Interviewer: Parang mantsa na dugo? Mukha kayong maputla. Nilalagnat kayo sa gabi o sa hapon na?

Respondent: Opo. Lagnat? Mayroong gabi, mayroong hapon.

Interviewer: So, pumunta kayo sa health center o City Health kaagad?

Respondent: Sa City Health, nagpa-sputum ba ‘yon?

Interviewer: Tapos nagpa-x-ray kayo o wala?

Respondent: Nagpa-x-ray po.

Interviewer: Ano ang sinabi sa inyo?

Respondent: Pus daw po.

Interviewer: Sa baga ninyo? Ano ang sinabi nila doon sa CHO?

Respondent: Noong nagpa-sputum ako mayroon daw ano, positive daw ako.

Interviewer: Pagkatapos sinabi nila na pumunta kayo kaagad sa health center ng Manicahan o paano?

Respondent: Humingi ako sa kanila ng gamot at sinabi ko “pwede po ba doon na lang sa health center sa

amin?”. Binigyan nila ako ng referral kaya sa center na ako nagpagamot.

Interviewer: May bayad ba ang gamot na kunukuha niyo para sa TB doon sa health center?

Respondent: Donation tawag nila pero humihingi sila ng P10 kapalit ng gamot. Magastos na nga sa

pamasahe tapos may P10 pa kailangan ibigay bago makuha ang gamot.

Interviewer: Ano ang masasabi ninyo, Sir, sa TB Program natin, ‘yong partner-partner, o kaya mayroon

ba kayong treatment partner na nagbabantay talaga sa inyo kung umiinom talaga kayo ng gamot o wala

lang? Binigay lang ba sa inyo ang gamot for 1 week pagkatapos inumin nyo na lang na mag-isa?

Respondent: Ang alam ko sa program ng TB ay ‘yong libre ang gamot sa center hanggang 6 months.

Yung gamot ko, pang-araw-araw ang binibigay sa akin sa health center.

Interviewer: Anong masasabi niyo tungkol sa supply ng gamot?

Respondent: Lagi man may gamot nung kumukuha pa ako sa center. Wala man problema sa supply.

Interviewer: So, kailangan kayong pumunta sa health center araw-araw?

Respondent: Opo. Pero alam nyo naman po kung magkano ang pamasahe.

Interviewer: Pamasahe? Ano pa po ang ibang problema na na-e-encounter niyo sa inyong gamutan?

Respondent: ‘Yon din ang problema ko,e.

Interviewer: Iyong sinabi niyo kanina tungkol sa gamot ninyo?

Respondent: Tini-take ko po. Kapag umiinom po ako, 3 po ‘yon sa isang inom ko lang sa morning, parang

naghihina ako.

Interviewer: Iyon lang po ang binibigay sa inyo, 3 tablets per day po? So once a day lang po? Nanghihina

kayo? Ano pa ang nararamdaman mo?

Respondent: Parang nawawalan ng gana kumain. Parang malansa ang pagkain.

Interviewer: Makati ba? Kumakati ba ang katawan nyo? Nagkalagnat ba kayo dahil sa gamot?

Respondent: Hindi naman po. Binigyan po ako ng gamot para sa lagnat, bumuti naman.

Interviewer: So mga ilang buwan na kayo umiinom ng gamot ng health center?

Respondent: Bale naka-3 lang.

Interviewer: 3 days lang Sir? Hindi umabot ng 1 buwan?

Respondent: User din kasi ako dati, ma’am. Kaya iniisip ko kahit inom ako ng gamot kung magdrugs

parin ako, hindi rin ako gagaling. Minsan, mag-drugs parin ako pero hindi man palagi.

Interviewer: Ganun ba, sir? Dapat po tulungan niyo po ang sarili niyo. I-prioritize po kung ano sana ang

makakabuti sa inyo.

Respondent: Nahihiya din kasi talaga ako pumasok doon.

Interviewer: nahihiya kayo dahil may TB kayo? May stigma kayo sa sakit na TB? Parang nahihiya kayo

na malaman ng mga tao na may sakit kayo na ganito?

Respondent: Oo, nahihiya talaga ako.

Interviewer: Pero sa tingin nyo ba ang gobyerno natin ginagawa ba nila ang kanilang parte para gamutin

talaga ang TB? Ano ba ang alam ninyo sa ginagawa ng gobyerno natin ngayon?

Respondent: Wala namang problema sa mga effort ng gobyerno para sa TB. Okay naman.

Interviewer: Nasaan po kaya ang problema, sa pasyente ba o sa nagbibigay ng gamot?

Respondent: Sa patient siguro ang problema. Parang tamad kasi.

Interviewer: Ano kaya sa tingin ninyo ang dapat gawin ng patient para matapos niya ang treatment niya?

Respondent: Siguro kung sila na lang ang pupunta dito o bibigyan na lang nila kame ng gamot every week.

Interviewer: So, bibigyan kayo ng gamot para inumin niyo every week?

Respondent: Opo, para sa weekly na inuman na if okey yun.

Interviewer: Sa tingin po ba ninyo kapag ginawa nila ‘yon makukumpleto talaga ninyo ang gamutan?

Respondent: Opo.

Interviewer: Pero paano kung walang magsasabi sa inyo, walang titingin kung iniinom ninyo talaga ang

gamot, kaya ninyo bang maging responsible para sa sarili ninyo?

Respondent: Sa akin, kaya ko ‘yon.

Interviewer: Ano ang masasabi ninyo sa mga tao sa health center, matataray ba sila? Pinapagalitan ba

kayo?

Respondent: Minsan mataray talaga sila dahi siguro pagod pero okay lang sa akin.

Interviewer: Maayos naman po ba sa inyo? Wala naman kayong problema doon na takot kayo at hindi na

pupunta sa kanila?

Respondent: Maayos naman sila sa akin. Minsan nagagalit sila pero kasalanan ko naman kasi hindi ako

parati pumupunta sa center.

Interviewer: So, ano po talaga yung problema?

Respondent: Nahihiya lang po ako.

Interviewer: Nahihiya ka lang sa mga tao doon baka malaman nilang may TB kayo?

Respondent: Opo. Kung pumapasok ako kung saan pumapasok yung ibang pasyente, naiibahan ako.

Feeling ko, natatakot silang makuha nila ang TB ko.

Interviewer: Pero alam naman dapat ng lahat na kapag nagpagamot na ang pasyente for some time, hindi

na siya makakahawa.

Respondent: Alam ko po, sinabi ng midwife sa akin pero sa tingin ko kailangan parin may separate na

room para sa mga pasyente na katulad ko para makakuha kame ng gamot

Interviewer: Kung kayo ay bibigyan ng pagkakataon para turuan ang ibang patient, ano ang sasabihin mo

sa kanila?

Respondent: na uminom po sila ng gamot.

Interviewer: Pero paano po ninyo sila ma-convince? May balak pa po ba kayong bumalik sa health center

para magpa-check-up at ituloy ang gamutan?

Respondent: Parang ano po Ma’am, nahihiya na po ako.

Interviewer: Nahihiya kayo, ayaw nyo ng pumunta? Pero paano kayo gagaling niyan, sir?

Respondent: Malala na siguro ito.

Interviewer: Hindi naman po sa ganun pero mas maagapan ang komplikasyon kung i-continue ninyo agad

ang gamot ninyo.

Respondent: Susubukan ko na lang po bumalik next week.

Interviewer: Kasi ‘yong nakita sa inyo noong May 2007, sabi may spot na kayo sa baga. Baka mamaya

hindi na lang spot. Sana magpacheck-up na po kayo uli at i-continue na ang gamot ninyo.

Respondent: Thank you po sa concern ninyo. Mabuti pa kayo, pinupuntahan niyo ang mga pasyente para

malaman ang problema. Kasi hindi naman sila pumupunta sa akin dito kapag hindi ako pumupunta sa

health center.

Interviewer: Hindi po sa ganun, sir. Marami rin po kasing ibang pasyente. Dapat po, magtulungan po

tayo. Nasa inyo din po ‘yan. Salamat po sa oras, sir. Babalik na lang po ako kung may mga additional

questions pa ako.

Respondent: Sige po, ma’am.

~ End of Interview with Manicahan Defaulter 1 ~

Interviewer: Aisa Presas

Respondent: Manicahan Defaulter 2

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Interviewer: Kailan po ninyo nalaman na may TB kayo? Ilang taon na po?

Respondent: 4 or 5 years na nung una akong nagka-TB.

Interviewer: Ilang beses na po kayo nagpagamot sa healtth center?

Respondent: Dalawang beses lang.

Interviewer: So, ito na yung ika-3rd

time?

Respondent: Hindi, 2nd

time palang ito. Sa Tumaga ako nagpagamot noon.

Interviewer: Anong naramdaman niyo bago kayo nagpacheck-up?

Respondent: May dugo pag umuuno ako.

Interviewer: Humina ba katawan ninyo. Nagbawas ang timbang?

Respondent: Ayoko lang kumain.

Interviewer: Ubo? Ilang taon na kayo may ubo?

Respondent: Mga 4 years.

Interviewer: Kumati ba katawan niyo?

Respondent: Oo, kumakati.

Interviewer: Sumakit ba katawan niyo?

Respondent: Oo.

Interviewer: May ibang tao sa bahay niyo na may TB?

Respondent: Wala.

Interviewer: Ikaw lang? Paano po yung asawa niyo? Ma’am noon po, sinabi niyong 5 years ago, saan

kayo pumunta? Sa hospital? Health center?

Respondent: sa doctor.

Interviewer: Sa private? Pagkatapos, ano daw ang gagawin niyo?

Respondent: Sputum, x-ray rin.

Interviewer: Pina-x-ray niya kayo. Itong x-ray niyo po, bago lang ba ito kinuha? Yung 5 years ago,

pinagawa rin ba nila kayo nito?

Respondent: Oo.

Interviewer: Noon, saan kayo nagpagamot 5 years ago?

Respondent: Doon sa health center pero ang gamot ko, putol-putol.

Interviewer: Hindi kayo nakatapos ng 6 months? Ilang buwan lang kayo nagpagamot?

Respondent: Mga 3 months lang tapos mag-stop na naman.

Interviewer: Pag bumuti pakiramdam niyo, magstop na kayo? Ilang beses na kayo nagpagamot?

Respondent: 4 beses na ako nagpa-x-ray. 4 beses narin ako nagpagamot. Nagpa-x-ray ako uli last year

nung humina talaga ako para mabigyan na nila ako ng injection at gamot kasi may sipon ako.

Interviewer: may asthma po ba kayo? Ano ang mga epekto ng gamot niyo?

Respondent: May ubo din. Masama pakiramdam ko, ayaw kong kumain.

Interviewer: Ah, may side effects?

Respondent: Oo. Mas lalo akong nanghina at hindi makalakad.

Interviewer: anong gamot ang binigay nila sa iyo?

Respondent: Binigyan ako ng 16 injectables. Nag-stop ako kasi sabi ng mga anak ko huminto na ako.

Tapos, nagging mapayat talaga ako, humingi ako ng gamot sa mananambal. Sabi niya sakit pambabae daw

ito. Umiinom ako ng gamot. Naniniwala ako sa mga kababalaghan. Noon, hindi ako makalakad ng isang

taon pero nung pumunta ako sa mananambal, naging mabuti pakiramdam ko.

Interviewer: Sa palagay niyo, pinagaling kayo ng mananambal? Wala ba kayong plano magpagamot uli

sa health center?

Respondent: Magpapagamot din ako doon kasi sabi ng mananambal na okey lang naman pumunta sa

health enter at ituloy ang gamot.

Interviewer: So ngayon naniniwala kayo na bumuti ang pakiramdam niyo dahil sa mananambal at hindi

dahil sa gamot na bigay ng health center?

Respondent: Opo. Noon, hindi ako makapagsalita pero ngayon okey na. Makakain na ako ng madami

ngayon nang hindi ako nasusuka. Sinabi ng mananambal sa akin na nanggaling itong sakit ko mula sa

sumpa galling sa ninuno sa libingan. Hindi raw ito basta-basta mapapagaling ng gamot galling sa health

center.

Interviewer: So, nagpapagamot kayo sa health center at sa albularyo ng sabay para gumaling? Babalik po

ba kayo sa health center at dadalhin ang x-ray?

Respondent: oo, babalik ako.

Interviewer: tatapusin niyo ba ang 6-months treatment? Matatapos niyo ba yun?

Respondent: Oo, tatapusin ko.

Interviewer: Kung hindi matapos ng pasyente ang 6-month gamutan, kanino pong kasalanan iyon?

Respondent: Sa pasyente.

Interviewer: Bakit, tinatamad ba kayo?

Respondent: Oo, tinatamad ako magpagamot.

Interviewer: May problema ba kayo sa transportasyon o gastos pamasahe?

Respondent: Oo.

Interviewer: Nung una, paano ninyo ininom ang gamot niyo? Pumupunta ba kayo sa health center araw-

araw?

Respondent: Oo, araw-araw.

Interviewer: Araw-araw?

Respondent: Araw-araw kasama yung injection. Nung gamutan, nawalan ako ng gana kumain. Hindi rin

ako makatulog. Nasusuka ako lagi kahit wala akong maisuka. May ubo rin ako.

Interviewer: Pero naniniwala ba kayo makakahawa kayo ng ibang tao kung hindi niyo tatapusin ang

gamutan? Kahit kame, mga kausap niyo, puwede kaming mahawa.

Respondent: Ang sabi ng mananambal sa akin, maghintay lang ako dahil may mga mabubuiti raw na

darating. Kaya nagihintay lang ako. Habang naghihintay, magpapagamot din ako.

Interviewer: Sa tingin niyo ba ginagawa ng gobyerno ang parte nila para mawala ang TB?

Respondent: Opo.

Interviewer: Pero ito ba yung pasyente na tamad?

Respondent: Oo. Lagi akong tinatamad kasi masama pakiramdam ko. Hindi ako makalakad para pumunta

sa health center.

Interviewer: Hindi ba sila nagbibigay na gamot para sa isang lingo kung mahina ang pasyente para pumnta

ng health center?

Respondent: Hindi.

Interviewer: Pero sa ugali ng mga tao sa health center, okey ba sila sa inyo? Negatibo ba ang ugali nila o

tama lang?

Respondent: Okey lang. Kahit si Ma’am Ging, galling ditto nung isang araw, tinanong niya ako bakit ako

nag-stop.

Interviewer: Hindi ka niya pinagalitan?

Respondent: Hindi. Sinabi ko lang sa kanya na masama pakiramdam ko. Sinabihan niya lang ako na

natatakot siya kasi baka mamatay ako kung hindi ako magpagamot, so dapat pag-isipan ko. Sinabihan ko

siya na huminto ako dahil sa paniniowala namin. Magpapagamot ako sa mananambal dahil sabi niya may

kailangan akong gawin. Pero pagkatapos noon, babalik na ko sa health center para magpagamot. Sinabi ko

rin sa kanya na tatapusin ko lang yung gamot ko sa mananambal. Pero noong nagpagamot na ako sa

mananambal, nakakalakad na ako sa 2 buwan lang na paggagamot.

Interviewer: Pero babalik po ba kayo sa health center?

Respondent: Babalik ako.

Interviewer: Pinapapunta kayo ni Ma’am Ging-Ging sa health center sa lalong madaling panahon pag

nagka-oras kayo dahil kailngan raw po niya kayong Makita.

Respondent: Hiningi ni Ma’am Ging-Ging ang cell number ko para kung sakaling pupunta sila ditto.

Naghihintay ako kahapon pa pero di naman sila nagtext.

Interviewer: Pero sigurado ba kayo na matatapos niyo ang 6-months na gamutan kung babalik kayo?

Respondent: Oo, makukumpleto ko.

Interviewer: So okey na ngayon?

Respondent: Oo, magpapagamot ako sa health center pati sa mananambal nang sabay.

Interviewer: Sa tingin niyo po ban a ang TB program ng Pilipinas ay epektibo sa inyo? Pipiliin niyo po

bang pumunt sa health center araw-araw o hihingi na lang kayo na gamot na pang 1 week?

Respondent: Oo, mas mabuti para makatipid sa pamasahe.

Interviewer: Ayaw niyo bang pumunta sa health center araw-araw?

Respondent: Oo, mas makakabuti ‘yon pero wala akong sapat na pera para sa transportasyon.

Interviewer: Puwede niyo silang kausapim tungkol ditto dahil ang pagagamot naman ay case-to-case basis.

Respondent: Mahirap kasi wala akong pera

Interviewer: kailangan talaga niya ng injection para sa TB niya kasi nakapagpagamot na siya ng dalawang

beses. Mas seryoso na ito ngayon. Yun lang po. Maraming salamat sa inyo. Importanteng matapos niyo

ang gamutan sa healthy center. Thank you, ma’am.

Respondent: Salamat din.

~ End of Interview with Manicahan Defaulter 2 ~

Respondent: Canelar Nurse and Midwife

Interviewer: Researcher

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Interviewer: Ang paper ko, ma’am, ay tungkol sa barriers to success ng DOTS. So, basically and question

talaga dito is why hindi successful and DOTS in some of the barangays in Zamboanga. Then, nalaman that

Canelar ay isa sa mga barangays na may lowest cured cases.

Respondent: Iyong mga nag-migrate dito and they got TB, they will come to us to enroll and they will be

staying in Canelar for how many months and they will not go home to their hometown unless treated. But

kung wala na sila, hindi na pinapa-follow up.

Interviewer: Were you trained on the procedures of DOTS, ma’am? If so, who trained you?

Respondent: Yes. It’s the CHO who trained us.

Interviewer: What are the objectives of the DOTS program that you know, ma’am?

Respondent: The objective really is to increase detection and cure rates of TB.

Interviewer: In terms of defaulters Ma’am, marami bang defaulters sa Canelar for 2007 or 2006?

Respondent: Meron pero ano naman kasi 73 ang cure rate namin.

Interviewer: Pero marami po ang nagko-complete pero yong cured konti na lang?

Respondent: Yong cured, kasi hindi naman pwede tawagin na cured unless they will follow kasi may

requirements man yan. Dapat with 3 sputum follow ups. But then if they finish their medicines, even on

time, but then only 2 sputum follow ups submitted to us, treated lang sila; complete treatment lang sya.

Interviewer: How many years na kayo nagwowork sa Canelar Ma’am?

Respondent: Since 1989.

Interviewer: Si Ma’am po?

Respondent: Since 1993.

Interviewer: Ang DOTS po sa Canelar how many years na po?

Respondent: 5 years na siguro ‘yan.

Interviewer: How do you do the recruitment of patients at pag-treat sa kanila?

Respondent: All symptomatic patients should have sputum examination.

Interviewer: You follow pa rin po na kahit na magpacheck-up sila sa City Health tapos with referral dito

pa rin sila iti-treat as long as they belong to Barangay Canelar? Ano lang po ang alam nyo na goals ng

DOTS or objectives?

Respondent: Goal namin sa DOTS?

Interviewer: Opo.

Respondent: Yong sa compliance sa medication para masigurado talaga na umiinom sila ng medicine.

Interviewer: Paano ang procedures ng DOTS dito, ma’am, kasi sa ibang barangays ang ginagawa nila

ay…

Respondent: Daily therapy.

Interviewer: So pumupunta talaga ang patients dito? Kailan lang po kayo nag-start ng ganyan Ma’am?

Respondent: 5 years ago.

Interviewer: Ah kasi Ma’am meron yong nagsimula sila yong BHW’s… Di ba per zone man yang

BHW’s natin Ma’am ano? Tapos sila ang nagfa-follow up sa patients house-to-house.

Respondent: Wala pang BHW’s syempre kami ang una and then kami ang nag-train sa BHW’s on DOTS.

Interviewer: So hanggang ngayon ditto ang mga pasyente pumupunta para sa gamutan nila araw-araw?

Respondent: Case to case basis. Kung mayroong trained BHW malapit doon, sya na ang treatment partner

para magbigay ng medicine.

Interviewer: May changes ba sa cure rates niyo kumpara nung wala pa pong DOTS? Bumaba ba ang

kaso ng TB?

Respondent: Actually, tumaas pa ang kaso ng TB. Kahit mag-cure kame ng pasyente, marami parin ang

lumalabas. Naniniwala talaga ako na ang mga tao na ito ay hindi galing dito sa city.

Interviewer: You mean galing sila sa ibang lugar, ma’am?

Respondent: Oo. Pumupunta sila ditto dahil sa mga rason na wala tao sa health center o walang gamot sa

kanila.

Interviewer: Saan sila karamihan galling, ma’am?

Respondent: From nearby islands like Jolo, Taw-tawi and the like.

Interviewer: Do you start treatment with these people dito sa inyong center, ma’am?

Respondent: Yes, but I have to assure that they will stay here for the duration of the treatment. Pero hindi

talaga natin ma-control ang mga tao, meron uuwi talaga sa lugar nila kahit hindi pa sila pinapauwi.

Matigas ang mga ulo. So, we really have to stick on the protocol ang mga pasyente should be properly

screened as to their residence para sigurado ang compliance.

Interviewer: Ano ang mga ibang rason bakit hindi kinukumpleto ng mga pasyente ang treatment nila?

Respondent: Yun man talaga ang problema, yung residence. Mga Muslim man karamihan sa kanila.

Meron din yung mga may side effects ang gamot sa kanila, nangangati o nahihilo ba. Meron din yung mga

akala nila magaling na sila because the symptoms are decreasing.

Interviewer: Anong masasabi niyo tungkol sa government’s support for the TB program?

Respondent: Full support ang gobyerno sa TB program. Kumpleto and gamot naming. Hindi pa kame

naka-experience makulangan ng gamot para sa TB since DOTS started.

Interviewer: Sa opinion niyo po, anong characteristic dapat meron ang pasyente para ma-complete niya

ang treatment?

Respondent: Dapat willing to be cured ang pasyente and also determined. Dapat feeling responsible like

for example, “Ayaw kong makahawa ng ibang tao o kaya pamilya ko ba.” Yung tamang konsensiya.

Dapat tulungan nila kame para matanggal ang TB.

Interviewer: Ano pa po ba kaya ang kulang dito sa health center niyo na makakatulong talaga sa TB

program?

Respondent: Ang kulang talaga ay yung separate room to receive our PTB patients. Maliit kasi masyado

and center.

Interviewer: Sa microscopy po?

Respondent: Mayroon naman kame niyan. Dito rin pinapagawa ung mga sputum exam ng Camino Nuevo

kasi ito ang sentro ng district.

Interviewer: Regular po ba si doctor dito, ma’am?

Respondent: Once a week siya dito. Nire-refer namin sa kanya yung mga pasyente for follow-up.

Interviewer: Sino ang nagpa-follow-up sa mga pasyente, ma’am?

Respondent: Ang mga BHW ang nagpa-follow-up. Pero yung mga pasyenteng nakatira malapit sa center

ay required pumunta dito daily para sa gamot nila. Kame ang responsible sa recordings and reporting.

Interviewer: Last na, ma’am, how do you convince patients to complete their treatment?

Respondent: Kailangan talaga namin to follow-up patients because along the way, nagiging tamad at

nawawalan ng interest sa treatment nila. Sinasabihan naming sila tungkol sa consequences ng hindi

pagkumpleto ng treatment.

Interviewer: Thank sa time niyo, ma’am. Sana makabalik ako and para magtanong ng mga questions na

baka nakalimutan ko tanungin.

Respondent: Okey lang basta hindi kami busy Thank you din.

~ End of Interview with Canelar Nurse & Midwife ~

Respondent: Canelar BHWs

Interviewer: Researcher

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Interviewer: Good morning sa inyo. Ako pop ala si Aisa Presas galling sa Ateneo de Zamboanga

University-School of Medicine. Graduate po ako ng Medicine, tapos na kame nag-internship, kame ni

Allen Mabano ay tapos ng na-internship. Ngayon, nagma-masters in public health dahil kailangan din ito

bago kame makapag-take ng board exam.

So ngayon ang study ko tungkol sa … Bisaya ba tayo dito?

Respondent: Okay lang kahit anong dialect Ma’am.

Interviewer: kasi ano, hindi rin ako masyado expert mag-bisaya, pero kahit papaano.. mag-mix dialect na

lang.

So, ang study ko ay tungkol sa DOTS Program. Bakit hindi successful ang DOTS Program sa Barangay

Canelar at sa iba pang barangays sa Zamboanga City? Dahil sabi nila successful daw ang DOTS sa

Zamboanga pero kung titingnan natin sa barangays marami parin ang hindi successful ang TB program.

Tanungin natin si Ma’am Josephine? Ma’am ilang taon na po kayo dito sa barangay as BHW?

Respondent: Since 1989 si Ma’am Adelyn dito, so nag-function ako dito as BHW since 1989 kasi sa 3rd

son ko sya ang nagpa-anak. Siya ang assigned.

Interviewer: So bale ikaw po?

Respondent: Nag-function ako dito as BHW sabihin na lang natin, Ma’am, since 1993.

Interviewer: Si Ma’am Isabel po?

Respondent: Bago lang ako, Ma’am.

Interviewer: Ilang taon na po?

Respondent: 1 year… 2 years na.

Interviewer: Si Ma’am Nena?

Respondent: 11 years

Interviewer: Si Ma’am Dina?

Respondent: 1990… 17 years.

Interviewer: Si Ma’am Maria Flor?

Respondent: Since 1984.

Interviewer: Matagal na pala ano? Si Ma’am Adelina?

Respondent: 1984 rin.

Interviewer: Wow! Beterana si Ma’am Carolina?

Respondent: 13 years.

Interviewer: Matagal na pala lahat no? So lahat kayo involved sa DOTS Program?

Respondent: Yes, Ma’am.

Interviewer: So ilang taon na ang DOTS sa Barangay Canelar?

Respondent: 1998 kasi nag-start tayo sa Tutok Gamuta. 1998 ang seminar natin.

Interviewer: So nag-start ang DOTS Program sa Barangay Canelar 1998?

Respondent: Sa aming BHW. Pero noon pa ‘yan.

Interviewer: Pero noong official nyo na ini-implement ang DOTS?

Respondent: 1998.

Interviewer: Bale anong masasabi nyo sa TB noong wala pa ang DOTS? Mas marami ba ang may TB?

Respondent: Marami, matanda, bata.

Interviewer: Noong wala pa ang DOTS? Pero ngayong meron ng DOTS?

Respondent: Parehas lang, mas marami pa.

Interviewer: So dumami ang may TB?

Respondent: Oo.

Interviewer: Dumami kasi ma-detect na ninyo ang TB o ano?

Respondent: Kasi di ba kapag mayroon ang isa, mag-examination tayo so another na naman. Halimbawa

ako na, tapos meron ang anak ko so ‘yon na kasi sa isang bahay lang naman kami.

Respondent 2: Ang sa una kasi Ma’am natatakot ang mga tao. Nahihiya sila so nagtatago-tago sila. Tapos

kapag i-house-to-house na namin dyan na namin i-encourage. Parang kulang ba ng information

dissemination na hindi dapat ikahiya ang TB, hindi dapat katakutan ang TB kasi ma-cure naman sya, may

medisina naman sa health center. Katulad sabi noong isang may TB “makahiya man Ma’am, hindi na lang

kami ganyan ganyan… Nakakahiya naman uminom ng gamot araw-araw”

Interviewer: So, ganito ba ang pagkaintindi ko? Dumami ang may TB kasi alam na nila, lumabas na sila.

Dati konti lang kasi nahihiya sila, natatakot sila. Tama ba ‘yon?

Respondent: Correct Ma’am.

Interviewer: So, ano ba ‘yong alam nyo about DOTS? Isa-isahin natin simula dito. Ano ba ang DOTS,

ano ang alam nyo?

Respondent: Sa DOTS kami ang, kung malaman namin na may symptoms ang tao, may sakit na TB, kami

na ang magpapunta dito. Tapos gawa na sila ng check-up, ganon ganon, ng screening para malaman kung

ilang months sila mag-take, kung anong category sila kasi by category man ang TB. Tapos dyan na makita.

Sa una mag-assist kami sa kanila kasi ang iba hindi umiinom kasi may side effects, parang maiba na ang

pag-take nila sa gamot. Mayron silang ibang mga nararamdaman sa katawan.

Interviewer: Pero ano ba talaga ang DOTS para sa inyo? Kapag marinig nyo ang DOTS, ano para sa iyo

ang DOTS?

Respondent 1: Direct ano Ma’am…

Respondent 2: “Tutok Gamutan”

Interviewer: Ganon? ‘Yon ang sayo? Sa’yo Ma’am ang DOTS ano sya?

Respondent: Parehas lang.

Interviewer: Kailangan bantayan mo ang pasyente mo, ganon ba ‘yon?

Respondent 1: Hindi naman kailangan talaga naming bantayan, halimbawa, first treatment niya, araw-

araw naming ibigay ang meds. Hindi naman talaga sabihinh bantayan talaga ang pasyente. Atleast, kukuha

siya ng gamot araw-araw.

Respondent 2: ‘Yan ‘yong ngayon. Pero noon, iba ‘yong noon.

Respondent 1: Kasi DOTS man ‘yan.

Respondent 2: ‘Yon na nga. Ngayon ‘yan nga ang bagong…(unclear audio). Kasi ‘yon ang practice

ngayon, sila ang magpunta dito sa health center kasi nga noon, ‘yong mga pasyenteng merong ganyan,

hindi sila magpunta sa health center. So ang ginagawa sa DOTS noon, ‘yong mga treatment partner na

BHW, sya ang magpunta sa bahay, magpapainom ng gamot sa pasyente

Interviewer: Kailan ‘yong noon, anong year?

Respondent 1: 1998 kasi ‘yan man ang ano.

Respondent 2: ‘Yong tutok gamutan dyan na-implement.

Interviewer: ‘Yong sinasabi nyong pupunta sa health center, anong year lang sya nag-start?

Respondent: Bago lang, ngayon lang.

Interviewer: Itong year lang na ito?

Respondent 1: Oo kasi bago lang ang DOTS na-kuwan dito.

Respondent 2: Kasi Ma’am parang hindi, wala daw epekto.

Interviewer: Walang epekto ‘yong dati, mas maigi na daw ‘yong ngayon…?

Respondent: ‘Yong BHW na ang nagbibigay para makita talaga kung umiinom sya. I have patient at

talagang ako ang magbigay ng gamot sa kanya. Pasensya talaga sya magpunta dito daily.

Interviewer: So bale ‘yong DOTS sino ba ang nagturo sa inyo ng DOTS? Sinong nag-introduce ng DOTS

dito sa ano?

Respondent 1: Ang DOH.

Respondent 2: Ang CHO, City Health Office.

Interviewer: Pumunta sila dito o kayo ang pumunta sa kanila para magseminar?

Respondent: Nagseminar ang mga nurse at midwife, tapos sila ang naturo sa amin.

Interviewer: Kailan po ‘yon?

Respondent: “Tutok Gamutan”? March…July 1998. Kasi Ma’am until July 2003 man ang tutok gamutan,

July 2, 2003.

Interviewer: So ‘yong first seminar nyo on DOTS was July 1998. So, hindi pa sya naulit?

Respondent: Hindi pa. sa ngayon wala pa.

Respondent 2: Hindi. Meron na kasi nagpalit na ng gamot. Kapag magpalit ng gamot, nagkakaroon din

kami ng orientation.

Interviewer: After 1998, kailan ulit ‘yong seminar ninyo?

Respondent: 2003

Interviewer: After 2003?

Respondent: Kapag may seminar kaming mga BHW, sinasama na ‘yon pati maternal care.

Interviewer: Nag-lecture sila?

Respondent: Opo, nag-lecture.

Respondent 2: 2005. Noong 2005 nag-seminar sa amin under World Vision.

Noong 2005, kasama na rin ang mga bata kasi dati mga matatanda lang. Meron na kami para sa mga bata

para ma-cure naman ang mga bata.

Interviewer: So ibig sabihin nung 2005 ‘yon na ang latest upgrade ng DOTS? So sa inyo Ma’am ano ba

yang TB? Anong klaseng sakit ‘yan?

Respondent: Sakit na nakakahawa. Contaminated. Kasi ‘yang sakit na ‘yan sumasama lang sa hangin. For

example ako may sakit na ganyan, gusto kong gumaling, tutulungan ako ng gobyerno para gumaling para

hindi na ako makakhawa sa iba. Example, sa mga anak ko, sa asawa ko. Bakit? Kasi example, sa pagdura,

kailangan meron talaga tayong duraan, proper place para ilagay mo ang saliva. Pag nakalagay na doon,

matabunan na sya, hindi na sya makakahawa kasi covered. Hindi ako dapat maging kumpyansa maski

umiinom ako ng gamot. Ayaw mo na mismo ang pamilya mo mahawahan mo.

Ayusin mo ang mga gamit mo at maging maingat ka sa mga gamit mo para hindi magamit ng kung sinu-

sino.

Respondent 2: Hindi man. Ikaw mismo dapat mag-ingat para hindi ka makahawa. Kung ako ang may sakit

na ganyan, ako mismo i-isolate ko ang sarili ko sa kanila kasi ayaw kong ma-contaminate ang kapamilya

ko.

Interviewer: Kailangan ba na iba ang plato ng pasyente?

Respondent 1: Hindi na kailangan.

Respondent 2: Pero ngayon Ma’am hindi na kailangan ihiwalay, i-isolate, i-sterilize. Ang mga ganyang

klase hindi na kailangan. Bigyan kita ng example, si Manong Ramon. Sabi ng anak nya “tingnan mo ang

tatay ko, kung makita nya kami na gumagamit ng gamit nya, sinasabi kaagad ng tatay namin “huwag ‘yan

huwag sa akin ‘yan”. Ganon talaga ang reaction ng tatay ko”

Respondent 3: Opo, pwede naman po ‘yan. Depende na sa atin. Pero paminsan-minsan din ‘yong mga may

sakit nagtatampo rin, nagtatanong kung bakit hinihiwalay ang mga gamit nila. Nakakadiri na ba daw sa

sila?

Respondent 4: Oo nga.

Interviewer: Bale ilang linggo bago mo masabi na hindi na sya makakahawa?

Respondent 1: Basta nag-take ka na ng gamot. Mga 1 week pwede na.

Respondent 2: Pero hindi naman ibig sabihin na ganon na lang. Kailangan ang mga gamit mo hugasan

mo mabuti. Tapos i-sterilize lahat ng gamit.

Interviewer: Paano ‘yong mga mag-asawa? First day pa lang sya nag-take ng medicine?

Respondent 1: For example ako merong sakit na ganon, tapos ang asawa ko gustong makipag-ano. First

day akong uminom ng gamot, syempre i-prevent ko ‘yong asawa ko na huwag muna mag ganyan ganyan or

something ganyan.

Respondent 2: Hindi mo alam kung ano khit ngayon umiinom tayo ng gamot. Maski umiinom tayo ng

gamot tapos hindi naman tayo kumakain ng sapat, inaabuso pa rin natin ang katawan natin, pareho lang.

kailangan regular taking of medicine, rest, kailangan mayron talagang rest at kumain ng masustansyang

pagkain.

Interviewer: Ano ang role ninyo sa DOTS? Anong pagkakaintindi ninyo? Mag-start tayo sa ’yo, ma’am.

Ano ba ang role mo sa DOTS?

Respondent: Ang role ko mag-monitor ako sa pasyente ko tapos mag-remind ako sa kanya kasi nangyari

na ‘yan, ang pasyente ko matigas ang ulo kaya namatay pa rin. Kasi hindi nya natapos ang treatment nya,

useless lang daw kasi gutom din naman sya. Pupunta ako doon sa kanya tapos tinatanong ko kung kumain

na sya. Dinadalhan ko sya ng pagkain, dinadalhan ko sya ng mga saging. Nagdadala talaga ako sa kanya ng

pagkain.

Noong sinabi nya sa akin na “hindi na ako iinom”, nireport ko sa health center “Ma’am hindi na daw sya

iinom ng gamot”. Wala naman tayo magawa kasi ang pasyente na talaga ang nagsabi na ayaw na nya

uminom. So wala, nag-stop na.

Kapag long run, sabihin nya na naman “magpagamot na naman ako kasi masama na naman ang

pakiramdam ko”. Sabi naming, “punta ka na lang sa Camino Nuevo kasi ayaw ng tumanggap ng Canelar

ngayon.”

Respondent 2: Mag-monitor ako, mag-advise ako.

Interviewer: Anong advice?

Respondent 2: Ang advice ko sa kanya, ituloy lang ang pag-inom ng gamot mo kasi gagaling naman ang

sakit mo. Tapos huwag ka ng magpuyat o matagal matulog. Kasi maglala talaga, lalo na walang pagkain at

walang nag-aasikaso sa kanya. Parang inabandona na sya ng pamilya nya.

Kung gusto nya ng magandang outcome, alagaan nya ang sarili nya. Maski iinom ka ng gamot kung hindi

mo rin naman aalagaan ang sarili mo, useless lang.

So ina-advice namin na ang TB madali lang gamutin. Kailangan lang alagaan mo ang saili mo para

gumaling ka.

Interviewer: Si Nanay hindi ko pa narinig na nagsalita. Ikaw Nay, ano’ng role mo sa DOTS?

Respondent: Ako meron akong pasyente, pero matigas talaga ang ulo. Hanggang ngayon ayaw pumunta

dito kasi naniniwala sya na asthma lang ang sakit nya. Pinipilit nya na asthma lang talaga ang sakit nya.

Old patient sya sa Sto.Niño. pero ano naman ang mangyayari sa kanya kung ipagpilitan nya na hika lang

ang sakit nya kung hindi sya magpapa-check-up? Pero madalas kong sinasabi sa kanila na kapag asthmatic

kayo, prone sa sakit ang inyong mga lungs. Pati siguro nahihiya sila na malaman na may TB sila kaya

sinasabi na asthma lang ang sakit nila.

---technical interruption---

Interviewer: Sa tingin ninyo, supportive ba ang gobyerno natin sa pag-treat ng TB?

Respondent 1: Oo.

Respondent 2: Supportive, Ma’am. Kung hindi, wala ng gamot ngayon?

Interviewer: Bale nasaan kaya ang problema?

Respondent: Sa pasyente na ‘yan Ma’am.

Interviewer: Sa health center ninyo, mayroon pa bang kulang dito para sa TB Program katulad ng meron

ba kayong microscopy?

Respondent: Wala kami.

Interviewer: Iyong sputum examination ninyo, saan ‘yan dinadala?

Respondent: Sa City Health.

Interviewer: Bale mag-request kayo, tapos pupunta ang pasyente. Ganon ba ‘yon?

Respondent: Opo.

Interviewer: Tapos?

Respondent: Dala ang resulta pero dito na ang treatment.

Interviewer: So, ano pa ang mga requirements ng pasyente?

Respondent: X-ray, sputum, 3 times sputum.

Interviewer: So wala kayo ditong microscopy?

Respondent: Wala pa.

Interviewer: Sa City Health lahat. Iyong x-ray nila saan nila usually pinapagawa?

Respondent: Sa City Health.

Interviewer: Hindi kayo nauubusan ng gamot?

Respondent: Hindi nangyari sa amin. Sa pasyente lang talaga Ma’am kahit puntahan ninyo pa sa bahay.

Magagalit pa sila.

Interviewer: Meron ba kayong educational program on TB para sa mga tao?

Respondent: Dito lang sa center. Meron ding nagtuturo sa kanila na Nursing students galing WMSU.

Interviewer: Kapag mayroon kayong pasyente tinuturuan nyo talaga?

Respondent: Opo pati sa pamilya. Kung mayroong pasyente na pumunta sa ‘yo, automatic na ‘yan na

sinasabihan naming kung anong dapat nilang gawin.

Interviewer: Anong magagawa niyo para maso-solve ‘yong problema sa pasyente?

Respondent: Ngayon kung matigas ang ulo ng pasyente, hindi pwede i-solve. Kahit anong gawin mo, kahit

pupukin mo ang ulo hanggang mamatay na lang.

Respondent 2: Walang cooperation. For example, mayron nagsasabi na nahihiya sila. Mayroong pasyente

na pumupunta dito dini-deny nila na may TB sila kasi tinatanggi nila na nag-ubo sila ng dugo.

Interviewer: Kinoconclude niyo na hindi maganda ang cure rate Barangay Canelar kasi matitigas ang ulo

ng mga tao, ng mga pasyente ng TB?

Respondent 1: Yes. Correct.

Respondent 2: Walang kooperasyon. Mayroon akong nakita kanina dura ng dura. Tapos tinanong ko

“uminom ka na ba ng gamot?”. Sumagot sya “nahihiya ako kumuha ng gamot, ayaw ko.”

Respondent 3: Mayroong isang pasyente si Ma’am Win, tingnan mo ngayon gumaling talaga sya kasi

pumupunta talaga sya dito.

Interviewer: Anu-ano ang mga rason nila bakit ayaw nilang magpagamot o ikumpleto ang gamot?

Respondent: Isa Ma’am ang rason nila nahihiya. Pangalawa “Ay mataba na ako ngayon, magaling na ako.

Isang buwan na ako umiinom ng gamot. Next month hindi na ako iinom ng gamot”. Tapos, mayroong

nagsasabi na “hindi na ako umuubo.”

Interviewer: Marami silang reklamo sa gamot? Ayaw nila sa gamot or one of the reasons lang ‘yon? Ano

na ‘yong pinaka ano na reason nila, ang gamot talaga o tinatamad lang?

Respondent: Tamad lang talaga.

Interviewer: Ano ang advice niyo sa mga pasyente para mag-complete sila ng treatment? Paano ninyo sila

ini-encourage?

Respondent 1: Tulungan lang talaga, mag-advice lang sa kanila na kumain ng gulay, prutas, huwag

munang manigarilyo at huwag gawin ang bawal.

Respondent 2: Kailangan may prinsipyo sya sa pag-inom ng gamot kapag gusto nyang gumaling. Kapag

gumaling na sya kailangan hindi nya abusuhin ang katawan nya kasi ang mga ganyan Ma’am abuso naman

‘yan.

Interviewer: Last tanong ko na po sa inyo, sa tingin ninyo saan ang mas maganda, ‘yong may treatment

partner sa purok, o ‘yong pasyente talaga ang pupunta dito sa health center?

Respondent 1: Kailangan po sa first two months treatment siya ang pupunta dito.

Respondent 2: Mas maganda talaga ‘yong sila ang pupunta dito para ma-monitor talaga namin ‘yong

iniinom nilang gamot. So walang gamot na masasayang, walang gamot na makakalimutan kasi sila man

talaga ‘yong pumupunta dito.

Respondent 3: Kami nga po pumupunta pa kami sa bahay nila para gisingin sila. Inaaway pa kami. Kung

pwede lang sana pumili, bibigyan ko nalang ‘yong gustong uminom.

Interviewer: Pero hindi naman pwede ganun di po ba?

Respondent: Hindi po naman pwede. Dapat mo talaga silang i-treat.

Interviewer: So salamat pos a inyo. Galing sa interview ko sa inyo at sa ibang barangay, gagawa ako ng

survey questions. So babalik lang po ako dito ipasagot sa inyo ‘yon.

Respondent 1: Sige, salamat din, ma’am.

Respondent 2: Sabihan niyo lang kame, ma’am.

Interviewer:Thank you po uli.

~ End of Interview with Canelar BHWs ~

Respondent: Canelar Defaulter 1

Interviewer: Researcher

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Interviewer: Ano po ang alam ninyo about sa DOTS?

Respondent: ‘Yon sa TB program? Nagbibigay sila ng libreng gamot.

Interviewer: For ilang months po?

Respondent: For 6 months.

Interviewer: Bale paano kayo nag-start magpa-treat or paano nila nalaman na may sakit nga kayo?

Respondent: Nagpa-x-ray ako tapos may nakita sila sa x-ray ko.

Interviewer: sputum exam?

Respondent: Sa sputum exam negative pero ‘yong sa ano ba ‘yon?

Interviewer: Ah, skin test?

Respondent: Oo sa skin test positive.

Interviewer: Bale anong naramdaman ninyo, bakit kayo nagpacheck-up?

Respondent: Nagpacheck-up ako kasi required kasi para sa health certificate. So, coincidental finding daw

yung TB ko.

Interviewer: Ah, sa employment?

Respondent: Oo.

Interviewer: So, kailan lang po ninyo nalaman?

Respondent: Mga July.

Interviewer: Last year? Nagpa-check up kayo? Saang hospital?

Respondent: Sa City Health.

Interviewer: Nagpa-check up lang? Nagpa x-ray sa City Health?

Respondent: Check-up lang sa City Health.

Interviewer: So doon naggawa sila ng referral para sa barangay?

Respondent: Sa General.

Interviewer: Sa General?

Respondent: Kasi before lumabas ‘yong result ng x-ray ko, palaging sumasakit ‘yong likod ko. So ‘yon

nagpa-check up ako sa General tapos after a day nakuha ko ang result ng x-ray ko, doon ko na lang

nalaman ‘yong result.

Interviewer: Bale last year ‘yon?

Respondent: Oo.

Interviewer: Ano pang ibang naramdaman ninyo dati?

Respondent: None. ‘Yon lang sakit lang ng likod ko at breast ko.

Interviewer: Hindi ka inuubo?

Respondent: Before ako nagpa-x-ray nag-ubo ako ng more than 2 weeks.

Interviewer: Tapos nag-fever kayo sa hapon or sa gabi? Laging pinapawisan?

Respondent: Wala.

Interviewer: Fever lang talaga.

Respondent: Mga ilang araw?

Interviewer: Mga more than 2 weeks, on and off lang?

Respondent: Oo.

Interviewer: So bale sa General ang sabi nyo nagpa-x-ray kayo tapos?

Respondent: No. Hindi ako nagpa-x-ray sa General. Nagpa-check up lang ako sa General dahil sa sakit ng

breast ko.

Interviewer: Noong may resulta na ang x-ray?

Respondent: Noong may resulta na bumalik ako sa General para sabihin kay Dr. Barrera ‘yong tungkol sa

result. Tapos ni-refer nya ako kay Dr. Sabellina magpa-skin test. ‘Yong positive na may TB ako kaya ni-

refer na nila ako sa center para magstart ng gamot ko.

Interviewer: Nag-start na kayong magpa-treat dito sa barangay o wala?

Respondent: Nag-start na.

Interviewer: Kailan po ‘yon?

Respondent: Mga September.

Interviewer: 2007?

Respondent: Opo.

Interviewer: Wala naman kayo masabi sa supply ng gamot?

Respondent: Wala. Kasi everyday pumupunta dito sa bahay si Ma’am Miriam.

Interviewer: Pinapainom talaga kayo ng gamot?

Respondent: Oo.

Interviewer: Wala kayong masasabi sa service nila?

Respondent: Wala akong masasabi sa serbisyo ni nang Miriam. Okey talaga siya.

Interviewer: Pero ‘yong reaction ng drugs ninyo?

Respondent: Iyong initial na inom ko may nararamdaman ako na itchiness tapos may lumalabas na mga

rashes pero…

Interviewer: Sa paa lang?

Respondent: Sa paa.

Interviewer: Meron konti sa ano?

Respondent: Pero mas marami sa paa.

Interviewer: Hindi kayo nahihirapan huminga dahil sa gamot?

Respondent: Hindi man kasi tine-take ko sya before ako matulog, pero ano nagreklamo na ako kay

Ma’am Miriam. Sabi nya ganyan daw talaga basta initial daw na ano.

Interviewer: Ah si Ma’am Miriam ang BHW treatment partner niyo?

Respondent: After a week lang daw mawawala din daw yan, pero continue lang ako di ko pinapansin mga

kati-kati ganun. Tapos nagkasakit ako ng German Measles mas grabe na.

Interviewer: Ang reaction ng drug?

Respondent: Oo.

Interviewer: Nag-stop na kayo ilang buwan na po?

Respondent: Ah more than three months.

Interviewer: Nag-stop na kayo? Ano na nangyari?

Respondent: Nag-stop talaga ako, kasi grabe talaga ‘yong heart palpitations ko once na-take ko ‘yon.

Interviewer: Ano na ang gamot na iniinom ninyo ngayon?

Respondent: Ngayon nag-stop ako. Pumunta ako kay Dr. Hemarino. May mga gamot na binigay sa akin.

Pero mahal naman masyado.

Interviewer: Alam ninyo ano ang pangalan ng gamot?

Respondent: Iyon nga ‘yon, mga Levox.

Interviewer: Mahal masyado ang mga gamot nyo.

Respondent: High power na daw. ‘Yong Levox isa. ‘Yong una hindi ko alam. Binigyan rin ako for anti-

allergy.

Interviewer: Ganun po ba?

Respondent: Ito, hindi ito mawala sa mind ko, kaya gusto ko magheal talaga sya. Since allergic ako sa

gamot ng TB, nanghingi talaga ako gamot para gumaling.

Interviewer: Levox, Ciprofloxacin.

Respondent: Opo 1 year daw po ‘yan. After 3 months magpa-check ako ulit kaya lang hindi pa dumating

kasi itong gamot ko sa baba walang stock. Ito lang ang meron.

Interviewer: Pero in terms of health provider like si Ma’am Meriam, okay po ba ang serbisyo nila? Sa

tingin mo ano ba ang mas kailangan ng isang tao para matapos nya ang treatment? What will it take para

makatapos ka talaga ng treatment?

Respondent: Kailangan siguro mas matapang na gamot. Nakakadiri din inumin ‘yong apat na klase ng

gamot. Malalaki pa talaga. Tinitiis ko na lang.

Interviewer: So ang complain nyo talaga is about ‘yong medicine?

Respondent: Okay lang sa akin. Tinitiis ko nga. Iniinom ko talaga for six months kaya lang since lumabas

ang german measles ko, grabe talaga ang effect, ang reaction sa akin ng allergy.

Interviewer: Ano sa tingin mo ang mga reasons bakit ang mga pasyente hindi nakakapagkumpleto ng

treatment?

Respondent: Siguro may mga dahilan parehas sa akin, allergy. Siguro dahil din sa financial problem.

Mabuti na supportive ang gobyerno by giving medicine. Pero sa mga may allergies, walang alternative.

Interviewer: Importante ba sa inyo na ang treatment partner ninyo?

Respondent: Syempre. Si Nang Miriam talaga ang pumupunta dito sa akin. Kahit tulog ako ginigising nila

ako.

Interviewer: So ano yung suggestion niyo sa gobyerno para sa mga situation na tulad ng sa inyo, allergic

in drugs?

Respondent: Magprovide din sana sila ng regimen para sa mga allergic.

Interviewer: Salamat sa oras, ma’am. I am sorry ginising ko pa kayo.

Respondent: Okey lang, matutulog lang ako uli. Salamat din.

~ End of Interview with Canelar Defaulter 1 ~

Respondent: Canelar Defaulter 2

Interviewer: Researcher

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Interviewer: Ang study ko, Tay, is about DOTS. Ano ang pangalan mo, sir?

Respondent: Alejandro.

Interviewer: Alejandro? Pasulat ko pala ang pangalan mo, nakalimutan ko tuloy. So, Tay, tanong ko sayo

kung kailan mo nalaman na may sakit ka na TB?

Respondent: Bago lang.

Interviewer: Kailan po ‘yon? Anong taon lang ‘yon?

Respondent: 2006

Interviewer: Paano kayo na-enroll sa center o nagstart magpagamot?

Respondent: May ubo ako mga isang taon na siguro kaya nagpacheck-up ako sa city health kasi sabi ng

kapatid ko.

Interviewer: Isang taon ang ubo mo? Hindi ka pumayat, nawalan ng ganang kumain o nagkalagnat ba?

Respondent: Pumayat ako pero may gana man akong kumain at hindi naman nagka-lagnat

Interviewer: Anu-ano pa ang mga sintomas mo?

Respondent: Ubo lang tapos hinihika ako. ‘Yon bang nahihirapan ako maghinga.

Interviewer: Hindi ka nagtatrabaho ngayon? Kailan ka nagsimulang magpagamot?

Respondent: Nagtatrabaho ako ngayon sa construction, minsan lang. Nagpagamot ako siguro noong 2006.

Interviewer: Paano ka nakastart magpagamot sa center?

Respondent: Sa city health man ako nagapacheck-up tapos sabi nila sa canelar center ako magpagamot

kasi araw-araw daw ang pag-inom ko ng gamot. Binigyan nila ako ng referral kaya sa center na ako

nagpagamot.

Interviewer: Ilang buwan ka lang nagpagamot?

Respondent: Tumigil ako mga 2 months kasi hindi ako nakapunta sa City Health uli para magpa-sputum.

Interviewer: So dalawang buwan kayo nagpagamot?

Respondent: Oo. Kasi hindi daw sigurado kapag hindi ako magpa-sputum.

Interviewer: 2 months ka pa lang nagpagamot bakit hindi ka nagpa-sputum exam kaagad?

Respondent: Pinapunta man ako ng health center magpa-sputum doon sa city kasi wala man sa center

ganoon. Hindi ako nakapunta kaya tumigil ako nagpagamot.

Interviewer: 2006 ‘yon? Hanggang ngayon hindi ka pa nagpagamot uli?

Respondent: Hindi na kasi hindi rin ako makatrabaho pag magpunta na naman ako sa city.

Interviewer: May ibang rason pa ba kayo bakit hindi na kayo gustong magpatuloy?

Respondent: ‘Yon lang, sputum lang naman ang kulang kasi hindi man nila ako bigyan ng gamot kung

wala pa daw ‘yon.

Interviewer: Ngayon, wala kayong balak magpagamot ulit?

Respondent: May plano pa rin ako. Magpapagamot pa rin ako.

Interviewer: 2008 naman na po tayo ngayon. Kailan kayo mag-umpisa?

Respondent: Sabi kasi ni Miriam (Treatment Partner) noong two months na ako mag-take ng gamot,

kailangan daw ako uli magpa-X-Ray para bigyan nila ako ng gamot uli? Mas lalo na ako walang pera.

Wala nga pampamasahe. Sa City Health lang ang problema ko kasi kapag pupunta ka doon syempre

mamamasahe ka pa din.

Interviewer: Pero sabi naman nila, meron na daw dito sa Canelar para magcheck ng sputum.

Respondent: Ganoon ba? Hindi ko alam ‘yan pero ganu nparin, magpa-x-ray pa man daw uli.

Interviewer: Pero alam mo ang program ng gobyerno, ‘yong DOTS? May alam ka about sa DOTS?

Respondent: Wala akong alam tungkol sa DOTS. Ang alam ko 6 buwan magapagamot.

Interviewer: Ano masasabi mo sa programa ng gobyerno tungkol sa paggagamot sa TB?

Respondent: Okey man ang gobyerno kasi nagbibigay sila ng libreng gamot. May gamot man sa center,

hindi lang ako nakakuha kasi hindi pa ako nagpa-sputum exam.

Interviewer: Okay lang ang programa nila? Sa tingin niyo, ginawa na ba nila lahat para mag-treat ng TB?

Respondent: Oo.

Interviewer: Sa inyong opinion paano makumpleto ng pasyente ang pagpapagamot niya?

Respondent: Nasa tao kung ayaw magpagamot.

Interviewer: Pareho sa ‘yo kasi hindi ka na nag-follow up? Kailan mo balak pumunta sa City Health para

magpa-x-ray at magpa-sputum exam?

Respondent: Kapag mayroon na akong pera. Malalaman mo lang ‘yan, doktora, kasi magkapitbahay lang

kami ni Ma’am Miriam.

Interviewer: Ano ang masasabi mo sa mga BHW katulad ni Ma’am Miriam?

Respondent: Maganda naman ang pagtrato nila sa akin. Sa akin lang ang problema kasi hindi ako

sumunod. Hindi lang magbigay sa akin ng gamot kasi hindi pa ako nagpa-sputum exam.

Interviewer: Sa tingin mo hindi ka nakakumpleto ng gamutan kasi ikaw lang mismo ang may problema?

Respondent: Alam ko man ‘yon, minsan kasi, tinatamad narin ako, Kapag umiinom kasi ako ng gamot,

parang mas humihina man ako. Ganun ba talaga ‘yun?

Interviewer: Gusto niyo ba talagang matapos ang paggagamot niyo?

Respondent: Oo, kung nagpa-sputum ako, natapos ko na sana ngayon. Wala pa po kasi akong pera.

Interviewer: Ano pa ba ang sabi nila sa’yo sa center?

Respondent: Ipina-follow-up po ako. Syempre po maraming requirements. Pumunta po ako doon sa

General, x-ray, sputum. Pagkatapos BCG, marami na po ‘yon.

Interviewer: Kasi, sir, ang alam ko kahit nakainom ka na ng gamot ng isang buwan tapos okay na ang

pakiramdam mo, hindi ibig sabihin magaling ka na kasi kailangan anim na buwan. After 6 months magpa-

sputum exam kayo ulit para tingnan kung positive or negative. Kung negative, okay ka na. Kung positive, i-

extend pa nga ang gamutan

Respondent: Alam ko man ‘yon, doktora. Sabihan ko lang si Miriam kung magpagamot na ako uli.

Interviewer: Sige po, sana mapag-isipan niyong mabuti kasi mas lalaki po ang gagastusin natin kapag

magkaroon na n komplikasyon ang TB. Salamat, tay. Mauna na po ako. Sana nakatulong din ako sa ma-

convince kayo magpagamot uli.

Interviewer: Tay, tanong ko lang, ano ba ang kailangan i-improve sa programa ng paggamot ng TB?

Respondent: Wala naman siguro kung mayroon namang pagcheck-up ng sputum sa center. Mahirap lang

talaga kung sa city health pa tapos magpa-x-ray pa kasi walang pera.

Respondent: Sige lang, doc. Punta lang ako sa center.

~ End of Interview with Canelar Defaulter 2 ~

Respondent: Canelar Defaulter 3

Interviewer: Researcher

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Interviewer: Kailan po ninyo nalaman na may TB kayo, sir?

Respondent: noong December 2006 siguro ‘yon.

Interviewer: Paano po ninyo nalaman, sir?

Respondent: Nag-ubo kasi ako maga 1 month na sobra tapos minsan parang masikip maghinga…Nagpa-

check-up ako sa General, pina-sputum exam ako dalawa o tatlong beses ba tapos ang sabi ng doctor

positive daw. Sa health center na ako pinapunta para magpagamot kasi libre lang daw.

Interviewer: Ganun po ba. May alam po ba kayo tungkol sa DOTS?

Respondent: Nakita ko na ‘yan. Diba may DOTS center pa nga. ‘Yan nab a ang health center, ma’am?

Interviewer: ‘Yan po ang program ng gobyerno sa paggamot ng TB, sir.

Respondent: ah, ganun ba.

Interviewer: Opo. Noong nasa center na kayo, sir, maayos naman po ba ang mga tauhan ng center sa

inyo?

Respondent: Okey naman po sila. Medyo masungit lang ang nurse siguro yun, ma’am. Mataas man ang

boses ‘pag magsalita. Pero binigyan parin man anko ng gamot, okey man.

Interviewer: Sino po ang partner niyo sa gamutan, sir. I mean, sino po nagpafollow-up sa inyo?

Respondent: Si Miriam po.

Interviewer: Mabait naman po ba siy sa inyo?

Respondent: Oo, ma’am, araw-araw ‘yan magpunta sa akin sa bahay magcheck kung iniinom ko ang

gamot. Nag-aadvise siya kung anong bawal at kung ano’ng mabuti sa akin.

Interviewer: Pero diba huminto parin kayo? Ano po ba ang naging problema?

Respondent: Yung isang buwan na siguro ‘yun, ma’am, parang nanghihina man ako sa gamot. Parang

masikip lalo ang paghinga ko. Sabi ko sa kapatid ko, punta na lang kames a doctor sa pueblo. Sabi ng

doctor may pneumonia daw ako. Binigyan niya ako ng gamot, ininom ko yun mga 7 days, tatlong beses sa

isang araw. Okey naman ako, ma’am.

Interviewer: Pero hindi ba sinabi ng doctor sa inyo kailangan mo ring inumin yung gamot mo sa TB?

Respondent: Sinabi man niya, ma’am. Pero okey naman ako. Nakakapagtrabaho naman ako ngayon.

Hindi katulad noon, maluya lang palagi sa bahay.

Interviewer: Ano po ba ‘yung trabaho niyo?

Respondent: Sa factory ako, ma’am. Mabigat ang trabaho kaya siguro ako nagkasakit.

Interviewer: Hindi ba kayo pinayuhan ni nang Miriam kailangan tapusin ang gamot for 6 months?

Respondent: Pumunta man siya dito, tinanong niya ako kung bakit ayaw ko na mag-continue. Okey

naman ako, ma’am. Ayaw ko ‘yung gamot ng center, marami masyado tapos malaki. Mawalan ako ng

gana kumain minsan.

Interviewer: Pero, sir, kailangan po talaga sanang matapos niyo ‘yun kasi hindi pa namamatay ang TB

bacteria sa katawan niyo. Kailangan 6 months talaga ang gamutan. Malaki po yung gamot kasi

combination po ‘yun. Maraming klaseng antibiotic sa isang tableta o capsule. Mas magiging resistant o

malakas ang kagaw na nasa katawan niyo dahil hindi tuloy-tuloy yung gamot.

Respondent: Alam ko man ‘yun, ma’am. Kung anuman po, babalik rin ako sa center. Wala pa ding pera

ngayon.

Interviewer: Libre naman daw po yung, gamot, sir? At tungkol sa gamot, nauubusan ba kayo ng gamot

noon?

Respondent: Libre man po pero kailangan parin ng pera kung magpa-x-ray. Kasi yung pumunta ako doon

uli, pina-sputum exam nila ako. Negative man pero pina-x-ray pa ako. Wala ako pera, ma’am.

Interviewer: Pero kailangan po talaga matapos niyo yung gamot ninyo, sir.Mas malaki po ang gagastusin

niyo kung may komplikasyon na ang TB at mas dadami pa ang gamot niyo. Yung tungkol pos a supply ng

gamot, hindi ba sila nauubusan?

Respondent: hindi naman, ma’am. Kumpleto man ang gamot ko noon. Hindi man sila nauubusan.

Interviewer: Ano’ng masasabi niyo sa gobyerno tungkol doto sa programa nila para sa TB?

Respondent: Okey naman , ma’am. Libre man ang gamot kaya salamat sa gobyerno kaso ayaw ko lang

talaga ang lasa at epekto sa akin.

Interviewer: Ano po ba sa tingin niyo ang kailangan i-improve sa paggagamot ng TB?

Respondent: Wala man, ma’am. Siguro ‘yung sa gamot lang talaga. Dapat yung gamot, mas may gana

magkain ang pasyente. Ang laki din kasi masyado.

Interviewer: Ganun po ba. Sana, sir, mapag-isipan niyo yung pagbalik sa center. Sayang din yun. Atleast,

gagaling naman kayo.

Respondent: Sige lang, ma’am. Punta lang ako uli doon.

Interviewer: Sige po, sir. Mauna na ako. Salamat po sa oras ninyo at pasensiya narin sa istorbo.

!!End of Interview with Canelar Defaulter 3 !

Respondent: Talon-talon Nurse and Midwife

Interviewer: Researcher

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Interviewer: How many years na po ang DOTS dito sa Talon-Talon?

Respondent 1: Since the start of the program because one of the pilot areas of DOTS was Talon-Talon.

Interviewer: So mga estimated how many years?

Respondent 1: 5? I cannot remember the exact date. Basta what is in my mind is 5 to 6 years ago. As early

as 1995.

Interviewer: How many years ka na nag-work dito as a Nurse?

Respondent 1: I came in to the service in 1982.

Interviewer: Dito po sa Talon-Talon?

Respondent 1: I was assigned in Culianan Health Center, covering the areas of Lanzones, Guisao and

Tolosa (1982-1983). I came in to the next assignement in Mampang, I’ve stayed there for 13 years. From

there I was promoted to my very own community which is Talon-Talon and I’ve been here since 1997. So,

more than 10 years.

Interviewer: Kayo Ma’am, ilang years na kayo nag-wowork dito Ma’am?

Respondent 2: 12.

Interviewer: Matagal na rin pala po ano? So ano ang masasabi ninyo Ma’am sa TB treatment before the

DOTS came in? Siguro nandito naman na po kayo ano before the DOTS. Pero si nung si Ma’am Emma

nandito na, may DOTS na?

Respondent 2: Wala pa.

Interviewer: Ano ang masasabi ninyo about mga cases of PTB, treatment regarding PTB without the

DOTS Program pa?

Respondent: Treatment of PTB without the DOTS? Treatment compliance is one big question, bringing

down the cure rate of the patients and the barangay as a whole.

Interviewer: Before the DOTS?

Respondent: Treatment completion is in question because sometimes the patients may come unfinished in

taking of medicine. Then the medicine is taken by the patients themselves not as looking after the

medication.

Interviewer: So you’re just giving the drugs?

Respondent: Yes, we are giving the drugs and the patients are taking the drugs on their own at home. But

when DOTS came, we are forced to do the DOT in our health center facility and if the patients are residing

far from the health facility, there are assigned BHW’s to take over for the patients, the patients who are

really taking their drugs religiously.

Interviewer: So ‘yon ‘yong mga for the far flung patients? Kunwari ‘yong mga malalayo talaga na hindi

makapunta dito sa barangay health center or even those people are required to come here in the health

center everyday to take the drugs?

Respondent: It depends on the person, how far he is and the accessibility of transportation to the area. We

have one patient now. In fact, she was a defaulter, almost to be a defaulter during the Knockout Tigdas

because we left her in the care of the BHW’s. Since the BHW’s are going with us during the KOT, so we

gave the medicines to her. She’s on her own so their tendency was when she had no more money to, for the

fare, get the medicine here so wala na. On and off na ang mediation. Sometimes she missed 3 days, 2 days,

4 days, sometimes a week because she has no money for the fare,. So right now she’s almost finished. 1

month na lang and we are giving, she’s on SM category 2, so were giving pamasahe out of donation, were

giving fare allowance.

Interviewer: Ah that’s how you keep the patient to complete the treatment?

Respondent: Yes.

Interviewer: Even financially?

Respondent: Yes.

Interviewer: That’s from your own pocket?

Respondent: No. from the donation to the health center.

Interviewer: Pano ninyo kinukuha ‘yong donation Ma’am?

Respondent: Voluntary donation from the people, from the other services we give. Like for example EPI,

just like now, so we have donation. So those donations that we got from the EPI activity this morning it’s

not for the EPI program alone. For whatever activity or the needs, we can get from the donation.

Interviewer: Bale saan ninyo na-learn ang DOTS Ma’am? Sino nag-orient sa inyo ng DOTS?

Respondent: DOH. We have manual of procedures; we were trained from the DOH in coordination with

World Vision.

Interviewer: So na-train po kayo?

Respondent: Last year, with the new manual of procedures.

Interviewer: Ah so ‘yon na ‘yong update na po last year?

Respondent: Pero before it was mainly the DOH.

Interviewer: How do you train the BHW’s, dito lang po sa barangay health center?

Respondent: Right now the BHW will have a training on March 2008 for the new manual of procedures. It

is every year, every 2 years the manual of procedures of TB Program is changing. The protocol, the mode

of treatment keeps on changing.

So, in part, there will be an orientation again for the BHW’s but it will not be at the RHU level. It will be at

the CHO level. I don’t know who is the sponsor but last year it was the World Vision in coordination with

the CHO, DOH. We conducted it on our own at the RHU level. We were trained. All the staff, the

midwives, the nurses were trained at the Jolly Roy or we were trained in the office at CHO. Smaller na ang

funds sa kanila. Sa aming mga doctors and nurses different level kami sa training. Different ang orientation

sa mga doctors and nurses kaysa sa midwives level kasi kami more on reporting and recording, records and

report, sila on DOT talaga.

Interviewer: Ano po ang mga objectives ng DOTS na alam ninyo?

Respondent: For me DOT is a strategy in the TB Program in order to ensure the treatment compliance of

the patient to the treatment regimen that they are in. That is the main that I can see, that I can picture out.

Interviewer: Kung ano talaga ang DOTS? Sa inyo Ma’am ano po ‘yong?

Respondent: ‘Yon lang. Treatment compliance talaga. Kasi if you won’t exert effort to strengthen the

DOT, the patients won’t be cured.

Interviewer: In the recent year, ‘yong 2007, may changes ba in treatment? Kasi ang ibang barangays po

ang ginagawa nila, may BHW sila na pinapadala tapos sya ang responsible for watching out for their

patient in the zone. Tapos may barangay naman akong nainterview na maski anong zone ‘yan, you have to

go to health center and doon talaga sila mag-take ng drugs. Even at weekends may BHW who is in duty

para sa day na ‘yon to give the drugs sa patients.

Respondent: (interruption) Come again. Sorry for the intermission.

Interviewer: Sa 2007 may changes ba in the procedure on how to treat patient like house-to-house ba

mag-treat or patients should come talaga in the barangay health center as much as possible.

Respondent: For us, for me and my midwife, we don’t do that on Saturdays and Sundays. Ah we do on

Saturdays and Sundays but it is not necessary that they should come to the health center during Saturdays

and Sundays. We assign BHW to do the DOT here and asking the patient to report… (Interruption)

Interviewer: … protocol po ba?

Respondent: The protocol of the DOT Program is you stay within the area for the whole course of

treatment. So ngayon ang card na lang ang naiwan, wala na ang pasyente, wala na ang record.

Interviewer: Sa tingin po ninyo ano ang characteristic that a patient should have for him/her to complete

the 6-month therapy?

Respondent: The willingness to be cured.

Interviewer: In terms of financial problems, can that be compensated like can you still encourage these

people eventhough they have problems in terms of money, ganyan. Kasi like ‘yong sinabi mo pumupunta

pa rin kayo sa kanila at your own expense or from the donation.

Respondent: Yes they’re giving money. Sometimes the money is spent for fare but instead for fare, they

are buying 1 kilo of rice. Then we ask them nasaan na ang follow up examination result. Sasabihin nila

wala kasi they spent the money so we give again 20 pesos.

Interviewer: Ma’am what can you advice other barangays with low cure rate?

Respondent: What we are trying now to enroll in our TB ledger, in order to ensure treatment compliance

of cases who are still positive patients for them to complete the treatment, we are trying to screen them as

to their residence. So once they have a house here in our barangay we admit them to adhere to the DOT

Program. Once they are just renting, just working here, or just staying with their relatives, very strict ang

screening procedure ko ngayong 2008. That is my protocol even to them. Never register to me please,

screen very well the residence of the patients. Paikot-ikot ang question para you can catch if they are telling

a lie to ensure my cure rate.as much as possible I can get 100%. Pero never in the history of Talon-Talon

health facility to get… I wonder how Sangali got 100% cure rate when in fact Sangali has so many mobile

patients, transients coming in to the area. Pero I really question Jo, the TB Coordinator, how come pareho

lang ang status namin, pareho we are along the coastal line, how come she’s 100% cure rate and then me

above 90 lang, 80 lang. I started with 82, go to 85 and then I reached 89, then 91 and last year I was 94.

That is only the cure rate I have even me being very strict with the enrolling of patients in my TB Program.

‘Yong meeting namin dito di ba with the supervisors I was complaining already. What will you suggest like

now there’s a patient, she’s always here because her children are here but the residence is in Sangali. So

most of the time she’s here. If I won’t treat the patient, but she’s here. Sabi ko she’s spreading the bacilli in

my population. Instead I would treat only 1 patient, I will have to treat 10 patients or more. Ang comment

ni Jo, our TB Coordinator, was “never start treatment if you’ re not sure that she can comply with the

treatment”. Yes, okay. How about spreading the bacilli? “Never mind. Anyway the TB bacilli is just all

around.”Okay, amenable ako dyan. Now, this is the first patient I did not receive for DOT. I do not know if

she will go to Sangali. She will have to go to Sangali every now and then because the husband is here. That

is one problem. That’s why I told them please be strict even with them.

Interviewer: So ‘yon po ang mai-advice ninyo sa ibang barangays na ganon din po ang dapat nilang

gawin?

Respondent: Screen! Eh ang actual protocol is “never start treatment unless you are sure that they are

from your area and they are committed to complete, stay in the area to complete the treatment during the

whole course of treatment”. Kasi if you won’t be strict with registering TB patients to the DOT as to their

residency, maraming trans-out and the cure rate will be 75 just like that in Sta. Catalina. Sta. Catalina has

so many positive sputum patient and 75 lang ang cure rate nila. Second month pa lang wala na ang

pasyente. They are good only in starting the treatment. They never complete. Sayang ang effort ng…

Interviewer: Actually ‘yong study ko po sana doon ko gagawin kasi sila ang maraming reported cases of

TB according to the ZCMC tapos sabi ng …

Respondent: City Health?

Interviewer: General Hospital po. ‘Yon ang sabi nila kasi ang mga pasyente nila usually from Sta.

Catalina talaga. That’s why one of my mentors suggested to conduct the study there in Sta. Catalina pero

sabi ng panel mas maganda po kung gawin ang study para sa Zamboanga and study extreme barangays,

successful and low cure rate para ma-compare and what these people say.

Respondent: I told the World Vision 12 years na ako dito sa Talon-Talon and I have been exerting much

effort to the TB Program. Instead of lowering down the sputum positive cases to lowering it to the

positivity rate ba, lowering it. I do not know how to rate myself, am I a good implementor or what because

in terms of lowering the cases of TB. Kasi mas madami na ngayon.

Interviewer: Siguro mas aggressive na lang kayo ngayon in detecting kasi before di ba we don’t really

have good means on how to detect TB.?

Respondent: I don’t accept that because partly half of the issue is that perhaps I am more aggressive now

because I am aware that TB bacilli is in my community. But the second reason I think is that there so many

transients of the families here from the nearby provinces like Jolo, Basilan.

Do you know what are the comments of the patients from Jolo? Sabi nila sarado, walang nurse doon,

walang personnel. There are patients coming here. I throw them back where they came from. Why?

Tingnan ninyo marami na akong pasyente here and then you come here you are from other barangay. Buti

ang mga personnel doon walang trabaho.lax na doon. Kami dito over- burdened. Kasi nandito kayo, you’re

just taking treatment here from us and the moment you finished the treatment, cured na kayo, you are going

back where you came from. Tapos kapag nag-relapse, they come back here because they know every time

the services are available, accessible the whole days of the week while doon sarado. We cannot deny the

services because they are staying in my area. I am aware that if they stay there, they are spreading the

bacilli to my population. Instead of treating one patient in my area, I’ll be treating 10-20 persons a year or

more.

Interviewer: Lastly, ma’am, what improvements are you suggesting in order for the DOTS program to

become more effective?

Respondent: Actually, wala naman. Everything is already here. The government has been supportive in a

way that they are giving out free medicine. The BHWs here are also very efficient in their work. I am

happy they are really also concern. Microscopy service is available also. It’s just a matter of screening out

patients who will surely stay for the duration of the treatment. That’s really our main problem that is why I

wonder why Sangali got 100% cure rate last year. We have a similar setting wherein patients migrate from

the nearby islands coming here to our city. I really questioned ma’am Jo about that. As long as the patient

is here in the Talon-talon, he will really complete the treatment.

Interviewer: Ma’am, thank you for your time. I know you are also very busy.

Respondent:.Okey, you can interview the health workers now.

~ End of Interview with the Talon-talon Nurse & Midwife ~

Respondent: Talon-talon BHWs

Interviewer: Researcher

---------------------------------------------------------------------------------------------------------------------------------

Interviewer: Ang study ko is about barriers to success of DOTS Program. So ibig sabihin, pinag-aaralan

ko kung ano ang problema bakit hindi successful ang DOTS sa most of the barangays sa Zamboanga City.

Respondent: Opo. Minsan ang problema namin, ma’am, ang mga tao matitigas ang ulo.

Interviewer: First response naman talaga ‘yan? Mag-start muna tayo. Ilang years na ba ang DOTS sa

barangay Talon-Talon?

Respondent: Bago lang man ‘yan, ma’am. Dati meron na’yan pero hindi talaga tayo involved. Sila-sila

lang sa sarili nila ang naggagamot.

Interviewer: Mga ilang taon na talaga nag-start ang DOTS? Estimated mga ilang taon na noong i-norient

kayo about sa DOTS? ‘yong mga ilang taon na ‘yon? ‘Yong involved na talaga kayo sa DOTS?

Respondent: Noong July lang yata ‘yon.

Interviewer: 2007 po Ma’am doon na kayo na-orient na maging involved kayo sa DOTS? Before that ano

ang ginagawa ninyo dito? Involved pa rin kayo sa DOTS o hindi?

Respondent: Ganun na ata po. Wala man po. Kung example may nakikita kaming iba na ang itsura o

symptoms pinapupunta na namin kaagad dito. Tinitingnan namin kung ano ang resulta ng sputum exam o

kung pwede ng magbigay ng gamot.

Interviewer: Ginagamot ninyo na ba kaagad at binibigyan ng gamot?

Respondent: Opo, ginagamot namin kaagad at binibigyan namin ng gamot kung positive ang sputum

exam niya.

Interviewer: Mayroon po ba kayong mga treatment partners dito?

Respondent: Parang kami na po ang partner nila. Dati kasi wala naming ganyan.

Interviewer: Paano po ang procedure ninyo sa pasyente sa pagiging treatment partner? Kunwari may

nakita kayong pasyente tapos?

Respondent: Kung sa pa-inom ng gamot, pinupuntahan talaga namin sa bahay nila. Sinisiguro talaga

namin na umiinom sila. Kung kinakailangan kami talaga ang nagpapainom. Tapos pagdaan ng ilang sandali

papainumin na naman namin. Basta alam namin na iniinom talaga nila.

Interviewer: Sino po ang nag-orient sa inyo sa DOTS?

Respondent: City Health. Pero dati hindi pa kami member ng DOTS ginagawa ko na ‘yan kasi inutusan

ako ni Ma’am Dagalea noong time ni Ma’am Dagalea pa. Pumupunta na talaga ako sa bahay para tingnan

kung iniinom talaga nila.

Interviewer: Sa tingin ninyo nakatulong ba talaga ‘yong DOTS, yung mag-treatment partner para

makumpleto talaga ng pasyente ang kanilang gamutan or wala lang?

Respondent: Nakatulong talaga. Mas maganda talaga kasi nakikita ninyo talaga na umiinom sila kasi

pwede nyo talagang i-monitor. Kung sila lang ang iinom, sasabihin lang nila na mamaya na lang iinom.

Paminsan-minsan nakakalimutan na.

Interviewer: Dito sa health center ano pa po ang kulang o ano pa ang mga problema kung bakit hindi nila

kinukumpleto ang gamutan?

Respondent: Kung nagpapalit sila ng lugar at saka ‘yong mga matitigas talaga ng mga ulo na ayaw

tapusin ang gamutan. Mayron talaga silang rason, ma’am. Mayroon din nagsasabi katulad ng pasyente ko

na ubo daw sya ng ubo. Mas grabe daw kung umiinom sya ng gamot.

Interviewer: Sa barangay ninyo, anu-ano pa ng mga problema kung bakit hindi nakukumpleto ng mga

pasyente ang gamutan nila?

Respondent: Ang problema namin ang mga pasyente kasi hindi pumupunta at nakukulangan kami ng

gamot.

Interviewer: Nakukulangan ba kayo ng gamot?

Respondent: Oo, kulang minsan sa dami ng pasyente.

Interviewer: Pero ang sabi sa ibang center hindi raw sila nauubusan ng gamot. Sa inyo, ma’am, ano ang

mga problema ng mga pasyente natin?

Respondent: Sa amin, ma’am, meron na kapag umiinom sya ng gamot hinihimatay daw sya. Mayron din

hindi pumupunta kasi wala daw syang pamasahe. Ang isa naman nakumpleto na pero bumalik lang man

ulit ang TB niya kaya hindi niya rin kinukumpleto yung pinapacontinue sa kanya na gamot.

Interviewer: Nag-relapse? Pero nagkumpleto na sya?

Respondent: Opo.

Interviewer: Sa inyo, ma’am?

Respondent: Wala pa akong pasyente na hindi nagtapos ng gamot, ma’am.

Interviewer: Ah wala pa?

Respondent: Ako Ma’am ang problema ko sa brother ko talaga. Kasi ang brother ko meron siyang TB

noon. Pag nandito na ako sa health center, ako rin nagpainom ng gamot. Okay na sya ngayon. Naging

mataba na sya, kumpleto na ang gamot nya. Ang problema po pinapabayaan nya ang sarili nya. Umiinom

pa rin sya ng alak, nagpapahamog kaya bumalik na naman ulit. Ngayon, pinapa-sputum exam ko na naman

ulit.

Interviewer: ‘Yong sa inyo, ma’am, nakumpleto nya na ba ang gamutan?

Respondent: Yes, ma’am, nakumpleto nya. Tumaba talaga sya pero naging pabaya rin sya. Tapos

pinapapunta ko sya ditto pero makulit talaga. Ako talaga ang nag-aalaga sa kanya, ma’am.

Pinagpapasensyahan ko talaga. Ngayon pina-sputum exam ko na naman. Malalaman po ang result kay Sir

Bobby by Monday. Ako na naman ang mag-aalaga sa kanya, magpapasensya.

Interviewer: Sa ibang inyo, ma’am?

Respondent: Ako ang number 1 sa zone ko sa TB. Marami talaga sila pero nakumpleto nila.

Interviewer: Na-complete nila?

Respondent: Complete treatment sila. Ang problema ko ‘yong isa na lang kasi inuubo daw sya kapag

umiinom sya ng gamot kaya hinabol talaga namin kasi hindi pumupunta ditto minsan.

Interviewer: Sa inyo Ma’am?

Respondent: Continuous treatment naman. Kasi may 3 bago. Wala pa naming huminyo mag-inom ng

gamot.

Interviewer: Kayo, ma’am?

Respondent: Zero. Ako wala pa ring nag-default pero nag-oobserve ng kapitbahay. Meron doon dati hindi

sya umiinom kasi nag-aaral sya. Fourth year yata sa high shool. Hindi iniinom ang gamot nya kasi parang

kinukuha daw sya. Parang lumalala daw ang ubo nya. Tapos hindi nya tinuloy ang kanyang pag-inom pero

noong grabe na talaga sya, nagpa-check up sya. Ininom nya talaga ang mga gamot nya kaya okay na sya

ngayon. Vitamin na lang ang sa kanya.

Interviewer: Ano lang ang kailangan para ma-treat ang TB?

Respondent: Gamot talaga pati follow-up tapos alagaan talaga ang sarili.

Interviewer: Sa tingin ninyo ang barangay ninyo ginagawa talaga nila ang best nila para ma-treat ang TB?

Respondent: Ang problema dito Ma’am kung ang tao ay taga dito ba talaga. Ang problema lang po ang

mga tao dito sa Talon-Talon ay in and out.

Interviewer: Mga transients?

Respondent: Opo, ‘yan po talaga ang problema. Mayroong pumupunta dito 2 months or 3 months lang

tapos kung okay na ang pakiramdam nila alis din sila. Wala din. Minsan pupunta ‘yan dito manghihingi ng

2 linggong gamutan kasi pupunta daw ng Jolo, next week ang balik tapos hindi na babalik.

Interviewer: Naging problema din ba dito ‘yong nahihiya sila kasi may TB sila?

Respondent: Oo nahihiya sila kasi ang TB nakakahawa.

Interviewer: Ano pang mga problema nila? ‘Yong mga plato nila, utensils, naging problema rin ba ‘yon na

“ay ito plato ko ako lang ang pwedeng gumamit”

Respondent: Karamihan ganyan pa rin ang problema. Nag a-advice pa rin. syempre kailangan pa rin

ihiwalay ang plato, baso at utensils.

Interviewer: Pero kung treated na o negative na ’yong sputum hindi na ba kayo nag a-advice ng ganyan?

Respondent: Meron naman maski hindi mo sabihan alam na nila ‘yong etiketa, kung ano ang gagawin.

Interviewer: Paano ninyo ini-ensure na nagti-take sila ng gamot for 6 months? Paano ninyo kino-convince

ang pasyente na kailangan nilang tapusin ang 6 months? Ikaw Ma’am paano mo sinasabi?

Respondent: Kailangan talaga tapusin ang gamutan na 6 months para gagaling sya. Kung hindi, kung

laktaw-laktaw lalong dadami ang bacteria.

Interviewer: Sa inyo Ma’am paano ninyo kino-convince na ma-complete ang 6 months na gamutan?

Paano ninyo sinasabi sa pasyente ninyo na ‘yan kailangan mo talaga ikumpleto ng 6 mos?

Respondent: Ganyan lang oh. Sinasabi ko “Kailangan inumin mo talaga ang gamot sa loob ng 2 buwan,

itong pulang gamot, kasi malaki talaga ‘yang gamot. Hindi man ‘yan madaling pumasok sa lalamunan.

Kailangan isa-isa pero huwag mong sabihin na humihinto ka sa umaga, tanghali. Hindi. Sinasabi ko diretso

‘yan 5 minutes lang para papasok lang. 3 kasi ang iniinom. Kailangan kumpletuhin talaga ‘yan ng 2

months.

Tapos tinanong nya sa akin kung meron pa daw. Sabi ko meron pa. “huwag ka talagang tumigil kasi hindi

ka gagaling. “Kung pwede kayong uminom kahit hindi pa nag-aalmusal mas maganda kasi namamatay

talaga ang mikrobyo. Kung hindi talaga malunok, pagkatapos na lang kumain saka ka uminom ng gamot.”

Kasi umiinom sya dati umaga, tanghali, gabi. Sinabi ko sa kanya hindi ‘yon tama. Tapos ‘yon inulit ko na

naman. Tapos gusto nya na naman uminom kasi tuwing umaga ako man ang nagdadala. Sabi ko sa kanya

“sige inumin mo ‘yan.”

Interviewer: Paano po ang Saturday and Sunday Ma’am?

Respondent: Parang nagre-reserve na lang. Parang kukuha na lang dito para sa Saturday at Sunday tapos

kapag Monday balik na naman.

Interviewer: Kayo, ma’am, paano mo kino-convince ang patient?

Respondent: Basta ang mga pasyente na willing gumaling sinisikap talaga nilang uminom ng gamot. Pero

ang mga pasyenteng hindi willing, hindi rin talaga uminom ng gamot...

Interviewer: Kayo po?

Respondent: Sa akin naman wala akong problema kasi kung pinapaintindi mo na kailangan niya talagang

inumin sa 6 na buwan. Una, ito talagang pula inumin mo sa loob ng 2 buwan. Pagkatapos ng 2 buwan

papalitan ‘yan. Huwag magpuyat, piliting kumain. Maski maliit lang na isda, hindi naman kailangan na

mahal ang isda. Maski gumawa ka lang ng sabaw ng camote tops at saka malunggay, pwede ninyo na ‘yan

kainin. Totoo Ma’am ginagawa pala ‘yon ng kapitbahay namin. Ginagawa nya ‘yon sa kanyang anak kaya

tumaba po talaga.

Interviewer: Kayo po?

Respondent: Oo. Na-cure ko pero kailangan pasensya sa pagsabi Ma’am kasi ang mga pasyenteng ganyan

walang pasensya. Palagi silang wala sa mood kasi kapatid ko nga kaya alam ko talaga na wala sya sa mood.

Palaging mainitin ang ulo nila. Pero kung sakali may mga pasyente man ako na makita, sasabihin ko talaga

sa kanya na magsalita. Meron mga pilosopo. Merong ayaw nila. Kailangan step by step talaga.

Interviewer: Sa inyo po?

Respondent: Sa akin po Ma’am pinsan ko po kasi ‘yon. Umiinom na sya. Pagkatapos noon nagpa-sputum

na sya. Tinanong nya sa akin kung bakit iinom pa sya ng gamot sa loob ng 6 na buwan. Sabi ko sa kanya na

“ibibigay ‘yan namin para sa kabutihan mo din naman”. Tapos ako naman sinabi ko sa kanya “huwag kang

mag-alala tatanungin ko sila”. Pinaintindi ko sa kanya na kailangan niyang uminom kasi ‘yong mikrobyo

noong nagpa-sputum sya nanghina lang pero hindi pa namatay kaya kailangan nyang uminom.

Pero ngayon ang problema niya Ma’am noong pumunta ako sa kanya noong isang araw tinanong nya sa

akin bakit daw umiinom na sya ng gamot pero parang may plema pa rin daw. Hindi parin daw bumuti ang

pakiramdam niya. Bakit kaya ‘yon Ma’am?

Interviewer: Hindi naman po kasi agad-agad mawawala na ang sakit, ma’am. Kaya nga 6 months po ang

gamutan. Depende rin ‘yan sa resistansiya ng pasyente. Pero na-follow up nyo po ba siya? Ilang buwan na

po ba uminom?

Respondent: Ngayon pong May pangatlong buwan na.

Interviewer: Kasi di ba after 2 months mag-sputum follow up sya?

Respondent: Opo.

Interviewer: Ano po ang resulta? Mas dumami pa ba?

Respondent: Basta ang sinabi sa akin Ma’am negative naman daw.

Interviewer: Ganun naman pop ala, baka kailangan lang niya ng gamot para sa ubo kasi yung iniinom

niya, antibiotic naman po ‘yun. Ipa-konsulta narin po natin siya sa doctor dito para malaman kung ano po

ang ibang problema.

Respondent: Ganun na nga lang po siguro, ma’am.

Interviewer: Sa tingin niyo po, ang gobyerno ba ay supportive naman sa programa ng TB?

Respondent: Supportive naman po kasi ‘pag nagrequest ng gamot, nagbibigay naman din sila agad.

Respondent 2: Opo, okey naman ang gobyerno kasi pinaganda nila ang programa para magamot talaga

ang TB.

Interviewer: Ano pa po ba ang kulang ditto sa center para mas maging maayos ang paggamot sa TB?

Respondent: Wala naman po siguro. Ang pasyente lang man talaga ang problema. Kung gusto talaga nila

gumaling, susunod talaga sila sa pag-inom ng gamot.

Respondent 2: May sputum exam man kame dito, ma’am, doon sa likod may maliit na building doon.

Doon pumupunta ang mga TB patients namin

Respondent 3: May problema lang kame sa pamasahe, ma’am. Sariling pera namin ang ginagamit sa

pamasahe tapos yung allowance binigay ng gobyerno, hindi talaga makabawi sa gastos namin maghabol sa

pasyente.

Interviewer: Magkano po ba natatanggap niyo, ma’am?

Respondent: Naku, P600 po, ma’am. Okey naman yun , ma’am. Gracias nga kasi volunteer lang man

kame kaso sana yung sa pamasahe namin, sagutin narin nila.

Respondent 2: Kulang talaga ‘yun, ma’am. Minsan kapag may sobra sa mga donations galling sa

immunization naming, nakakuha din man kame pero minsan lang kasi hindi mo naman puwede pilitin ang

tao mag-donate, ma’am.

Interviewer: Salamat po talaga sa mga oras niyo. Kapag nagawa ko nap o yung survey questionnaire na

sinasabi ko, sana po masagutan niyo rin po ‘yun. Salamat po uli.

Respondent: Thank you din, doktora.

Respondent 2: Balik- balik ka lang dito, ma’am.

"

End of the interview with Talon-talon BHWs "

Respondent: Mercedes Midwives and Nurses

Interviewer: Researcher

------------------------------------------------------------------------------------------------------------

Interviewer: Ang study ko po ay tungkol sa barriers to success ng DOTS Program sa Zamboanga. Sabi sa

statistics na successful ang DOTS pero pag tingnan natin ang each barangays sa Zamboanga, marami ang

nakakaabot sa complete treatment lang at hindi nakakadagdag sa cure rate.

So, unang tanong kop o kalian nagsimula ang DOTS sa Barangay Mercedes? Ilang taon na po?

Respondent: Matagal naman ‘yan mga 2005 yata ‘yon nag-start pero previously meron na talaga kami..

pero hindi ‘yong talagang supplemented talaga. ‘yong previous matagal na talaga kaming ng nag-treat ng

…

Interviewer: ng TB?

Respondent: Oo.

Interviewer: Pero as in ‘yong DOTS talaga, ilang years na po?

Respondent: Nag-start kami dito mga 2006 pero dati, noong mga 2005, dati kasi doon kami sa.. Alam mo

ba kung saan ang lumang health center noon? Sa likuran ng church.

Interviewer: Opo.

Respondent: Pero actually, noon, hindi pa sya DOTS. Sosyal na ngayon, DOTS na. Pero noon category 1

pa, regimen A, regimen B, parang nag-change lang.

Interviewer: Pero ’yong “treatment partner” dati pa rin ‘yan?

Respondent: Oo.

Interviewer: So, estimated 5 years ago nag-start na ‘yang DOTS dito?

Respondent: Opo.

Interviewer: Sino ang nag-orient sa inyo Ma’am about DOTS?

Respondent: Ang City Coordinator namin sa CHO and DOH.

Interviewer: Noong nag-undergo po kayo ng training, ano po ang alam ninyo na objectives or goals ng

DOTS?

Respondent: Nag-increase talaga ang cure rate namin. Ang target namin is more or less 85%. Kailangan

pataas, so ‘yon talaga ang purpose ng DOTS, para ma-increase talaga ang cure rate namin.

Interviewer: So, kayo Ma’am, 2 years na kayo dito ano?

Respondent: 11 months lang ako. Sa February eksaktong 11 months.

Interviewer: Noong wala pa ang DOTS, ano ang masasabi ninyo sa cure rate dito in terms of TB

treatment? Mas mababa ba or walang nangyari kahit may DOTS na? Just the same?

Respondent: No. Kasi ang totoo talaga noong nag-DOTS na, nag-increase talaga ang cure rate gaya ng

Mercedes noong 2006 nga mataas na ang cure rate nila.

May mga instances na ang mga patients hindi na nag-DOTS kasi may rason din naman talaga sila. Hindi

naman talaga pinabayaan ng health center. May reason talaga kung bakit may default. Sometimes ang alam

namin dito sa Mercedes nakatira, tapos taga-Olutangga pala.

Interviewer: Residential ang problema po?

Respondent: Iyon ang isang dahilan. Meron din nag-transfer.

Interviewer: Ano pa po ang reason bakit may defaulters dito?

Respondent: Kasi ‘yong sa DOTS daily sila kumukuha dito at umiinom ng gamot. One reason is

accessibility, paglakad ba. Alam mo naman ang mga Pilipino tamad. Mas gusto kasi nila katulad noong dati

na BHW ang nagdadala ng gamot sa kanila.

Interviewer: So before ganon pala talaga ‘yon?

Respondent: Ang health worker talaga ang nagdadala sa bahay nila kaya nga may treatment partner sila.

Interviewer: Pero kailan lang ‘yong nag-change na dito na talaga sila dapat sa center?

Respondent: Itong year lang… No! 4 years ago.

Interviewer: Which is better, puntahan sila sa bahay o sila ang pupunta dito?

Respondent: Case to case basis din. For example, may mga patient na hindi nakakalakad, so definitely ang

BHW ang pupunta sa kanila. Pero kung walk-in lang ang client namin, so sila talaga.

Interviewer:Sa tingin ninyo ano pa ang kailagan ng health center? Alam niyo naman po na ang barangay

Mercedes is one of the barangays with high cure rate? Ano kayang meron ang Mercedes bakit sya

successful in terms of DOTS program?

Respondent: Importante talaga ang follow-up sa patient.

Interviewer: Do you scold patient para mag-complete sila ng treatment?

Respondent: Tinatakot namin.

Interviewer: In what way po?

Respondent: Gaya kanina, sabi namin “Gusto mo pa ba mabuhay ng matagal? Huwag ka makinig sa

advice namin. Kapag hindi ka uminom ng gamot, mamamatay ka. Nariyan pa ang asawa mo.” Sabi nya

iinom na daw talaga sya ng gamot.

Interviewer: Ano ang procedures nyo Ma’am sa pag-detect ng patient? Di ba sa community, meron ba

kayong mga barangay health workers? Are you training them how to detect for TB?

Respondent: Yes, alam nila. May training din naman sila how to identify symptomats tulad ng 2 weeks

cough, may weight loss, chest and back pain. Alam talaga nila. Kapag ano na, they refer to health center

and before din naming i-treat, i-interview-hin muna namin. Ang mga clinical signs and symptoms nila, si

Dr. Arceña na. Kaya ang schedule namin sa TB patients is Tuesday kasi nandito si Doctor, sya na ang

magsasabi kung ano ang gagawin nila, for x-ray, for sputum exam. Then, pinapabalik ni Doctor kung for

PPD na talaga.

Interviewer:Kelan na-train ang mga BHW’s po ninyo?

Respondent: Matagal na. Ngayon, updates na lang katulad ngayong February meron na naman silang

updating. Supposed to be last November pa pero dahil sa DOT na-move ang schedule nila.

Interviewer: In terms of facilities po like microscopy, buildings sa health center, ano po ba ang kulang o

kailangan mayroon sa health center para makumpleto ng pasyente ang gamutan? Sa medicines,

nagkukulang ba kayo?

Respondent: Hindi. Maraming supplies ang DOH.

Interviewer: Sa tingin ninyo po sa microscopy na mayroon tayo ngayon dito sa DOH, sa tingin ninyo po

ba it will further increase the cure rate para mas me-declare ninyo na cured na talaga ang patient?

Respondent: Oo.

Interviewer: Sa tingin nyo po ba ang government natin is doing their best o kulang pa rin ang effort nila?

Respondent: Wala naman yata like sa TB wala talaga kaming problema kasi ang DOH talaga ang nagma-

manage through Ma’am Jo, ‘yong TB Coordinator namin tapos may updates naman kami. So, wala talaga

kaming problema. Palagi kaming mino-monitor. Every now and then kahit during our conference nagmo-

monitor sila sa amin

Interviewer: Sa tingin ninyo walang pagkukulang sa side nila?

Respondent: Wala.

Interviewer: Sa tingin ninyo kung mayroong mga failure to complete treatment or defaulters, kanino may

problema?

Respondent: Sa pasyente talaga. Gaya kanina nag-enroll sya. Taga-Tabuk sya, separated sa wife nya, then

nawalan sya ng trabaho. May anak sya dito sa Doña Felisa. Married ang anak nya. Nakatira sya dyan then

late na ng nalaman nyang may TB sya. Ang problema nya kanina, paalisin sya sa bahay ng son-in-law nya

kasi may TB sya. Ang problema ngayon kung paalisin sya tapos nag-enroll naman sya sa Mercedes tapos

aalis naman sya sa Mercedes so, hindi na matatapos ang treatment dito.

Interviewer: So, residential po ang problema. Iyong mga stigma about TB na “ay hindi na lang ako

pupunta sa health center baka malaman ng mga tao na may TB ako”, meron pa rin po ba?

Respondent: Wala na. Alam kasi ng pasyente na once nag-enroll sila sa program, confidential naman

talaga ‘yan. Hindi ipapaalam sa mga tao na may TB sila. Kahit mga medicine nila, kailangan secured yan,

covered. Hindi namin pinapakita kung kani-kanino. Nahihiya din kasi ang pasyente kaya may separate na

cubicle para in case na may mga pasyente, nasasabi ko na “doon muna kayo maghintay”. So, alam na nila

kung saan ang place nila.

Interviewer: Ano talaga ang dapat na qualities ng pasyente para makumpleto nya ang treatment?

Respondent: One, kailangan matiyaga sya. Kailangan before mag-start ng treatment sa kanila, ma-

emphasize ang mga bagay na kailangan nilang gawin katulad ng pag nag-start sila uminom ng gamot,

kailangan religiously ma-take nila ‘yon para ma-complete ang treatment. Pangalawa, ang lifestyle nila.

Sabihin mo talaga na hindi sila pwedeng matulog ng late, kailangan early din. Then, sa pagkain nila, hindi

naman kailangang mag-beef or chicken lagi. Ang importante lang may fruits and vegetables, complete diet.

Pati ‘yong trabaho talaga nila.

Interviewer: ano po ang mai-a-advise nyo sa ibang health centers na low ang cure rate sa TB?

Respondent: Sometimes sa dami din siguro ng trabaho… ‘yong follow-up talaga. Alam naman ‘yan ng

mga health personnel sa ibang health centers kung ano ang dapat nilang gawin.

Interviewer: Do you have educational programs? Paano po ninyo ginagawa ang educational programs in

terms of TB?

Respondent: We have health teaching.

Interviewer: Bale individual counseling?

Respondent: Oo.

Interviewer: Mayrooon ba kayong guide how to counsel your patients? Tinuruan niyo din po ba ang mga

BHWs?

Respondent: Alam na nila dito sa health center ang individual counseling tapos ang discussion, kami lang

ang gumagawa.

Interviewer: Ang importance ng interpersonal relationship Ma’am; ‘yong kailangang magkaibigan kayo

with the patient para makumpleto nya ang treatment o kailangan talaga like “ako ang midwife, kailangan

sundin mo ako”?

Respondent: Hindi dapat ganon. Minsan binibiro namin. Pero ang impotante masabihan namin na

kailangan mag-take sila ng medicine religiously.

Interviewer: Thank you sa oras niyo, ma’am. Sana payag kayo ma-interview uli kung may mga

nakalimutan akong itanong. Thank you po.

Respondent: Welcome and salamat din.

~ End of Interview with Mercedes Nurse and Midwife ~

Respondent: Mercedes BHWs

Interviewer: Researcher

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Interviewer: Ang study ko po ay tungkol sa program sa TB treatment. Iyon po ang research ko. Pinag-

aaralan ko ngayon kung ano ang hadlang o barrier para maging successful ang program. Sabi kasi sa City

Health, ang Mercedes ang pinakamataas in terms of cure rate. Ibig sabihin, successful ang barangay ninyo

sa pag-treat ng TB. So, ngayon gusto naming malaman kung anu-ano ang mga hadlang kasi dati hindi

naman po dating mataas ang cure rate ninyo; nag-start naman siguro kayo sa mababa lang bago naging

successful. Ilang taon na kayo nag-handle ng TB Program?

Interviewer: Pero kayo na nag-serve as BHW ilang taon na?

Respondent: 3 years and DOTS… Since 1983 ako dito

Interviewer: So matagal na po kayo nag-start as BHW, pero nag-start ang TB program 3 years ago lang?

So, dati hindi pa ganito kaganda ang pag-treat ninyo sa TB?

Respondent: Hindi pa kami partners dati. Ang nakakaalam lang ay mga staff sa health center. Nag-start

lang kami noong nag-DOTS na.

Interviewer: So 3 years ago lang kayo nag-partner-partner? Di ba nag-undergo kayo ng training sa pag-

treat ng pasyente? Saan kayo nag-training?

Respondent: Opo. Dyan lang sa lumang health center.

Interviewer: So tinuruan kayo? Sino ang nagturo sa inyo?

Respondent: Si Doctora sa City Health.

Interviewer: Ilang araw kayo nag-training?

Respondent: 1 lang.

Interviewer: Ano po ang natutunan ninyo sa training, ano daw po ang role ninyo?

Respondent: Kapag may natagpuan kaming pasyente na may TB, i-refer namin sa health center. Tapos

kung nasa lugar ko, partner ko na yon.

Interviewer: So sa inyong 8 BHWs, kung nasa purok ninyo, purok po ba Ma’am?

Respondent: Zone.

Interviewer: So kung nasa zone ninyo, kayo ang responsible. Pagdating nila dito, di ba may examinations

man sila ano?

Respondent: Kung alam namin na may TB, for example neighbor namin, ubo ng ubo for 1 or 2 weeks,

pupunta kami sa kanila para magtanong-tanong kung ano ang feeling nila pag may ubo sya, kung may

lagnat ba sya sa umaga o hapon tapos kapag payat ang itsura papuntahin namin ditto sa health center. I-

schedule namin sya tapos kapag sinabi ng doctor na kunan ng sputum, sasabihin namin sa pasyente

paggising nya, kuha sya ng sputum tapos dalhin agad dito at wag paabutin ng 1 to 2 hours.

Interviewer: Sa tingin niyo ba supportive ang gobyerno sa programa ng TB?

Respondent: Opo, may sapat na gamot talaga tayo para sa pasyente ng TB. Kaya sinasabi namain sa mga

pasyente na i-take advantage ang libreng gamot. Mas mabuti pa ang magka-TB kaysa sa Diabetes dahil

may cure sa TB. Sa diabetes habambuhay diba?

Interviewer: Tama po talaga ‘yan. Pagdating dito, kapag positive sya, sino ang magbibigay ng gamo sa

kanya?

Respondent: Ang una, nurse ang nag-iinstruct sa kanya tapos kami na kapag may ID na sila.

Interviewer: So, araw-araw kayo nagmo-monitor sa kanila?

Respondent: Kung malapit lang ang bahay nila dito, sila ang pumupunta pero kapag malayo, kami ang

pumupunta.

Interviewer: Araw-araw kayo pumupunta nagmo-monitor sa pag-inom nila ng gamot?

Respondent: Oo.

Interviewer: Anu-ano ang alam nyo tungkol sa DOTS? Ano po ang mga components ng DOTS? Tinuro

po ba sa inyo kung ano ang DOTS at ano ang role ninyo o sinabi lang sa inyo na gamutin natin ang mga

may TB, ‘yon lang?

Respondent: Hindi. Sabihan mo ng ganon-ganon tapos i-treat mo na.

Interviewer: Tinuro ba sa inyo ang mga objectives ng DOTS at bakit may DOTS? Kasi di ba ang World

Health Organization ang nag-start ng DOTS? Sinabi nila na mag-DOTS tayo. Alam ba ninyo bakit

kailangang mag-DOTS talaga tayo?

Respondent: Para malaman kung ang barangay ay may TB patients, ganon at saka mag-treat na din.

Interviewer: So, sa inyo may DOTS para mag-detect tayo ng TB at mag-treat ng may TB. Ganon po ba

‘yon?

Respondent: Ganoon ang pagkaintindi namin.

Interviewer: Sa tingin nyo nakakatulong ba ang DOTS para bumaba ang TB dito?

Respondent: Oo nakakatulong dahil kung walang DOTS, walang mag-treat sa kanila. Libre naman.

Interviewer: Dati po noong wala pang DOTS, hindi ba libre ang gamot?

Respondent: Libre pero hindi marami kasi alam nyo naman ang government.

Interviewer: Pero sa tingin ninyo with DOTSmas nagging focused ba ang treatment?

Respondent: Mas organized ang mga taong responsible.

Interviewer: Itong laboratory, kailan pa po ito?

Respondent: Last month lang, mga November or December lang.

Interviewer: So, dati saan sila nagpapa-sputum exam?

Respondent: Sa City Health. Kapag positive, dito na.

Interviewer: Sa tingin ninyo, sa taong may sakit na TB, anu-ano ang mga sintomas?

Respondent: Sa umaga o hapon may lagnat. Tapos, mababa ang weight nya, payat, walang ganang

kumain, maputla.

Interviewer: Marami bang may TB dito dati?

Respondent: Hindi namin alam. Sabi nga namin, sa lugar namin ‘yon lang ang alam namin. Pero sa ibang

zone, hindi namin alam.

Interviewer: Kapag mag-choose kayo ng treatment partner, by zone lang kayo?

Respondent: Oo sa lugar lang namin.

Interviewer: May alam ba kayo kung saan galing ang medisina para sa TB?

Respondent: Sa City Health sa Region 9.

Interviewer: Tuwing kalian ba sila nagsu-supply ng gamot?

Respondent: Ang alam ko quarterly ang sa health center. Ewan ko kung kasama na ‘yon sa TB. Maraming

medisina ang binibigay nila.

Interviewer: Ganun po ba?

Respondent: Oo. Sila ang nakakaalam. Ang binibigay lang sa amin ay iyong supply para sa pasyente.

Interviewer: Nanghihingi ba kayo ng donation everytime magbibigay kayo ng gamot?

Respondent: May donation pero hindi sa TB, sa ibang gamot

Interviewer: Pero, halimbawa kukuha sila ng gamot sa TB?

Respondent: Libre talaga.

Interviewer: Di ba mahirap ‘yan Ma’am na magsabi kayo sa pasyente na ikumpleto ang 6 months na

paggagamot especially malaki ang gamot at madami?

Respondent: Opo. Nagsasabi sila na malaki daw ang gamot tapos marami.

Interviewer: Sa isang araw Ma’am ilang capsules ang binibigay nyo sa kanila? Kasi di ba ‘yong gamot

parang combination na sa isang capsule o tablet?

Respondent:Binibigay lang naming yung gamot para sa isang araw. Depende rin ‘yan sa timbang ng

pasyente.

Interviewer: Paano ninyo ini-encourage ang pasyente ninyo na makumpleto ang paggamot nila?

Respondent: Sinasabi namin “Libre na ito.bakit ayaw ba ninyong magpagamot? Importante ito at

kailangang magamot kayo kasi kung may pamilya ka, ‘yong mga anak mo mahahawa. Kung ang trabaho

mo ay tricycle driver tapos magsasalita-salita ka sa pasahero, syempre mahawa mo ang ibang tao”.

Interviewer: Ano pa ang ina-advise niyo sa kanila para hindi mahawa ang family nila?

Respondent: I-separate ang utensils nila. Tapos pagkatapos gamitin, i-sterilize talaga. Pati ang bote ng

tubig nila i-separate.

Interviewer: Ano po ba ang problema nila bakit hindi na o tamad na sila uminom ng gamot?

Respondent: Minsan siguro ganon. Pumupunta naman kami sa bahay nila nagmomonitor.

Interviewer: So kailangan talaga pumunta kayo araw-araw sa bahay nila para uminom sila ng gamot?

Respondent: Religious talaga magmonitor.

Interviewer: Nagawa nyo talaga ‘yon, Ma’am?

Respondent: Oo, nagawa naming sa 6 months. Ako may 3 pasyente ako, nagawa namin lahat.

Interviewer: Hindi ba kayo nagkroon ng problema?

Respondent: Wala. Interesado talaga sila. Minsan pumupunta sila sa amin. Minsan ang anak ang

pumupunta dito para sya na alng daw ang magpainom sa tatay nya.

Interviewer: Pero itong mga pasyenteng ito, before sila nag-start magpagamot, tinuruan ba sila kung ano

ang TB?

Respondent: lecture lng pero hindi pormal, parang counseling lang.

Interviewer: Ano ang tinuturo niyo sa kanila?

Respondent: Ganon lang katulad ng “magpa-cure kayo”. Kung paano sila gagaling at paano sila hindi

makahawa.

Interviewer: Tinuturo pa ba ninyo sa kanila na kailangang ihiwalay ang plato?

Respondent: Oo. Saka kailangang huwag silang magtrabaho ng mabigat.

Interviewer: Sa tingin ninyo, may mga bagay pa ba kayong kailangan dito sa health center para mas

maging maganda ang performance sa paggamot sa TB? Tulad ng, mayroon na kayong laboratory.

Respondent: Mayroon na kaming laboratory galling sa mga donasyon lang.

Interviewer: Diba yung pera na pinanggawa nitong laboratory ay galling sa contribution niyo, mga tauhan

dito sa health center din? Hindi galling sa gobyerno?

Respondent: Hindi. Nanghihingi lang kami ng konting tulong sa pasyente, donation 10 pesos.

Interviewer: Bale mga pasyente din ng TB ang nagbigay?

Respondent: Hindi. Sa immunization namin naipon yan. Kada nanay, humingi kami ng 10 pesos. Galling

ito sa mga tao. Hindi lang sa mga nanay, pati na rin sa mga may kaya.

Interviewer: Sa tingin ninyo may kailangan pa kayo? Sa transportation ninyo?

Respondent: Kung may magbigay… pero ayos lang kahit maglakad.

Interviewer: Sa ibang barangay, paano ninyo ma-encourage ang ibang BHWs na maging masipag sa

trabaho tulad ninyo?

Respondent: Hindi kasi namin alam ang isip ng iba. Kailangan talaga manggaling sa puso, sa loob ng tao.

Interviewer: Pero kayo may magawa kaya kayo para ma-encourage ang iba na maging active din sa pag-

treat ng TB, sa pagtatrabaho sa health center?

Respondent: Pwede naman kaya lang hindi talaga sure kasi lam mo naman…

Interviewer: Pero noong nag-start kayo as BHW, ni-recruit ba kayo o nag-volunteer?

Respondent: Ni-recruit kami. Marami kami. Nag-training sila tapos ilan lang kaming naging active kasi

ang iba may trabaho tulad ng teacher.

Interviewer: Ang nurse ninyo po dito ay si Ma’am Jo, matagal na po ba sya?

Respondent: Hindi. Bago lang sya dito.

Interviewer: Ilang years na po sya dito?

Respondent: Wala pa sigurong 1 taon.

Interviewer: So, ‘yong dating nurse po ninyo?

Respondent: Si Ma’am Corazon nasa Tumaga na, 5 years or more siguro dito. Sa lumang health center pa

dati. Sya ang nag-start ng DOTS dito.

Interviewer: So okay po ang dati ninyong Nurse?

Respondent: Oo, Okay.

Interviewer: Ang midwife ninyo matagal na po ba dito?

Respondent: Oo matagal na. Luma pa ‘yong health center nandito na sya. Noong nag-training sya ng

BHWs, sya na ang nandito, 1982 pa yata.

Interviewer: Ang barangay nyo ba ay supportive mga activities ng health center?

Respondent: Oo. Noong nag door-to-door kami sila ang nag-shoulder ng transportation.

Interviewer: About sa TB ulit Ma’am, may mga activities ba kayo sa TB monthly ba o yearly ba tulad ng

nag-iipon-ipon lahat ng mga naka-enroll sa TB?

Respondent: Wala.

Interviewer: So more of individual talaga ang pagturo sa kanila. Di ba nag-training kayo 3 years ago,

naulit pa ba ‘yon?

Respondent: Hindi na.

Interviewer: So, kung ano ang alam nyo 3 years ago, ‘yon pa rin ang baon-baon nyo hanggang ngayon?

Walang updates tungkol sa TB?

Respondent: Wala. Pero siguro kung may bago silang alam sa TB, pwedeng ipaalam sa amin.

Interviewer: Sa tingin ko rin kailangan natin ng review and update kasi kung ano ang alam natin

noon,puwedeng iba na ngayon.

Respondent: Maganda sana ‘yon.

Interviewer: Maganda kung maturuan tayo ulit kung ano talaga ang TB kasi nalaman ko sa inyo ngayon na

kailangan isolated pa rin ang plato. Dati kasi ganoon, pero ngayon hindi na kung nag-start na ng gamutan

ang pasyente for some time.

Ilang weeks mag-take ng gamot ang pasyente bago masasabing hindi na sya makakahawa sa iba?

Respondent: Depende sa sitwasyon ng pasyente. Kailangan mag-check up muna sya. Kailangan ulit i-

check ang sputum nya. Titingnan at kung negative na, may follow-up pero konti na lang.

Interviewer: Ano pa ba ang alam nyo sa TB Ma’am? Importante kung ano ang alam natin para masabi

natin sa tao na mag-take kayo ng gamot. Kasi kung mali ang sinasabi natin sa tao, hindi rin natin sila ma-

convince.

Kayo sa tingin ko marami ng alam aksi nako-convince nyo ang mga tao na magpagamot kasi kapag wala

kayong alam, wala maniniwala sa atin.

Ilang months ang paggagamot ng TB?

Respondent: 6 months.

Interviewer: Halimbawa ako may TB, 1 month pa lang ako nagpapagamot tapos nag-stop ako. Ilang

months ulit ako magpapagamot?

Respondent: Babalik ulit sa simula.

Interviewer: Alam nyo po ba ‘yong multi-drug resistance sa TB, ‘yong may mga TB na hindi na magamot

ng ordinary na gamot sa TB, kailangan na ng higher antibiotic? May alam po ba kayong ganun?

Respondent: Wala pa kameng alam na ganyan.

Interviewer: Pero alam nyo po ba kung bakit may lumalabas na multi-drug resistant?

Respondent: Hindi pa. ‘yong nalaman namin ngayon ay ‘yong mga natutunan din namin noon.

Interviewer: Kailangan kasi talaga makumpleto nila ang 6 months na gamutan kasi kung hindi, next time

na iinom sila ng TB drugs, dapat mas malakas na gamot na ang kailangan nila kasi lumakas na ang kagaw

na meron sila. So by the time na mag-take sila ng ordinary drug ulit, hindi na eepekto sa kanila.

Respondent: Sabi ng nurse nagbigay sya ng isa-isa lang tapos nag-stop sya. Pagbalik nya, instead 1 tablet

lang, naging 2 na tapos nag-stop na naman sya kaya naging 3 na hanggang sa injection na ang binigay sa

kanya.

Interviewer: Ganun talaga ang nangyayari kung hindi tinatapos ng pasyente ang gamutan. Imagine niyo

na lang kung mapass ng mga pasyente itong resistant bacteria sa iba? Magiging mas complicated na

problema ‘yan, diba? Kung may mga tanong pa ako sa inyo, okay lang kaya mag-meet tayo ulit?

Respondent: Okay lang. Inform lang kami para mai-advance namin ang mga gagawin naming sa bahay at

appointment. Okay din kung may meeting by district para marami kami. Kung sa Mercedes lang, 2 lang

kami pero 8 kami galling sa buong district.

Interviewer: Galing sa interview na ito, gagawa po ako ko ng survey questionnaires tapos hihingi ako ng

tulong niyo na mafill-up niyo ito para sa akin. Salamat po.

~ End of Interview with Mercedes BHWs ~

Respondent: Mercedes Defaulter 1

Interviewer: Researcher

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Interviewer: I’m from Ateneo de Zamboanga University-School of Medicine, taking up Masters Degree

in Public Health. So, doctors na kami pero under board pa.

Ang pinag-aaralan naming ngayon ay TB. Bakit may mga pasyenteng hindi tinatapos ang kanilang

paggagamot? Iyon ang research ko. Anong taon noong malaman ninyong may TB Kayo, sir?

Respondent: Mga 2004.

Interviewer: Nagpa-treat ba kayo agad? So, noong 2004, tinapos nyo talaga ang 6 months treatment?

Respondent: No.

Interviewer: Pero anong taon na ito ng naulit, Sir?

Respondent: Ngayong taon na ito, kulang ang gamutan ko.pumunta ako dito sa health center para magpa-

inject at kumuha ng anti-TB drugs.

Interviewer: Bakit Sir?

Respondent: Hindi ako makapunta dito at hindi ako makapagtrabaho kasi nahihilo ako.

Interviewer: May side effect ang gamot ninyo?

Respondent: Oo. Nanghihina ako. Hindi ako makatrabaho.

Interviewer: Noong 2004 ng malaman ninyong may TB kayo, ano ang naramdaman ninyo?

Respondent: Syempre natakot ako ng nalaman kong may TB ako.

Interviewer: Ilang months o weeks na ang ubo ninyo noon?

Respondent: Noong una naramdaman ko, nagpa-check-up ako, nagpa-x-ray at nagpa-sputum.

Interviewer: Pero may pumunta ba na health worker sa inyo at nagsabing magpa-x-ray kayo o kayo lang

ang nag-decide magpa-x-ray?

Respondent: Ako ang nagdesisyong mag-x-ray.

Interviewer: Saan kayo nagpa-x-ray?

Respondent: Sa Sanitarium.

Interviewer: Anong sinabi sa inyo sa Sanitarium?

Respondent: Sinabihan din ako na magpa-sputum at dalhin sa doctor ang resulta ng x-ray.

Interviewer: Noong nalaman ninyo ang resulta, nagpa-sputum kayo doon din? So, noong pumunta kayo

dito, binigay ninyo agad ang resulta at binigyan din kayo ng gamot?

Respondent: Oo.

Interviewer: Paano ang pagbibigay sa inyo ng gamot?

Respondent: Every week ako binibigyan ng gamot sa Talabaan pero ni-refer nila ako dito sa Mercedes

kaya every week na lang ako pumupunta dito sa health center.

Interviewer:Tapos kumukuha kayo ng gamot dito sa Mercedes every week, hindi everyday?

Respondent: Oo.

Interviewer: Sino ang nagbabantay sa inyo kapag umiinom kayo ng gamot?

Respondent: Asawa ko.

Interviewer: Sinisiguro ba ng asawa ninyo na iniinom ninyo ang gamot araw-araw?

Respondent: Yes, Ma’am. Iniinom ko ang gamot ko araw-araw.

Interviewer: Noong 2004?

Respondent: Oo.

Interviewer: Anong taon ng bumalik ulit?

Respondent: 2007.

Interviewer: Ano’ng naramdaman ninyo? Sa tingin ninyo bakit bumalik?

Respondent: Noong naramdaman ko na magaling na ako at nakapagtrabaho na ako, hindi na ako uminom

ng gamot.

Interviewer: Bakit nandito ka ngayon?

Respondent: Pina-check-up ko din ang mga anak ko kasi natatakot ako na nahawa narin sila.

Interviewer: Ilan po ba ang anak ninyo?

Respondent: 4.

Interviewer: Ano ang tinuturo sa inyo ng mga BHW’s at Midwife para hindi kayo magkahawahan sa

pamilya?

Respondent: Kung mag-ubo o hatsing ako, takpan ko ang bibig ko ng panyo, ihiwalay ang mga plato,

kutsara, unan, hugasan ang kamay ko.

Interviewer: Ano ang sinabi nila noong sa inyo? Sinabi ba nila na pwede kayong mamatay dahil sa TB

kung hindi niyo tatapusin ang gamutan?

Respondent: Oo.

Interviewer: Ngayon, kung ayaw ninyo magpagamot ulit kahit ipagamot ninyo ang asawa at anak ninyo,

tapos ikaw ayaw mo magpagamot, babalik lang ang TB nila. Ngayon, hindi mo na pinagamot ang TB mo

ulit?

Respondent: Hindi na. Okey naman ako ngayon.

Interviewer: Wala na ba kayong planong ipagamot ang TB ninyo ulit?

Respondent: Kung ok lang sa kanila pwede naman kasi nakakapagtrabaho naman ako. Pero, kapag

uminom kasi ako hindi pwede putul-putulin. Araw-araw kailangan kumuha dito, paano ang pag-aaral ng

mga bata?Malaking abala sa trabaho ko ‘yon.

Interviewer: Pero mas delikado kapag hindi mo napagamot ang iyong TB. Pati ang asawa ninyo meron

din di ba?

Respondent: Oo. May TB narin ang aswa ko. ‘Yung isa sa kambal ko, may pneumonia daw.

Interviewer: Sa tingin ninyo ang health center ba ginagawa nila talaga ang kanilang trabaho para mawala

ang TB?

Respondent: Oo.

Interviewer: Sa tingin ninyo ang problema nasa pasyente ba o sa health center?

Respondent: Sa akin po kasi libre ang gamot, ako lang putol2x ang paggamot.

Interviewer: Sa tingin ninyo handa ba o kumpleto ba ang gobyerno o hindi sila nagpapabaya sa

panggagamot ng mga pasyenteng may TB?

Respondent: Opo.

Interviewer: Ano’ng pwedeng gawin ng mga tao dito para makumbinsi na maggamot kayo ulit?

Respondent: Pwede po i-continue ko na lang po ang nagkulang na gamutan ko po o kailangan gamutin na

naman ako mula umpisa?

Interviewer: Kailangan mong simulan ang iyong gamutan.

Respondent: Ganoon po ba?

Interviewer: Opo kasi nag-stop kayo. Nahiya po ba kayo ka sa ibang tao? Naisip ninyo bang may ibang

interpretasyon ang tao sa sakit na TB?

Respondent: Kung ano man po, i-continue ko na lang. Hindi. Kung made-detect naman po Ma’am pwede

naman po gamutin.

Interviewer: Kung makakakita ka ng taong may TB ano ang sasabihin mo sa kanya?

Respondent: Sasabihin ko lang sa kanya na magpunta sa health center para magpa-check-up kasi nangyari

na po ‘yan sa akin. Dapat ituloy niya ang gamot para masabing magaling na siya.

Interviewer: Sige, Sir, thank you po. Salamat po sa oras ninyo.

~ End of Interview with Mercedes Defaulter1 ~

Respondent: Mercedes Defaulter 2

Interviewer: Researcher

---------------------------------------------------------------------------------------------------------------------------------

Interviewer: Ano’ng pangalan ninyo Sir?

Respondent: Jaime

Interviewer: hindi pa po ako nagpakilala. Ako po si Aisa Presas ng Ateneo de Zamboanga

UniversityGraduate po ako ng Medisina noong nakaraang April 2007pero kumukuha ng masteral sa Ateneo

ngayon. May research po ako tungkol sa mga pasyenteng hindi nagtatapos ng paggagamot sa TB.

Respondent: Ganun po ba. Handa po akong ikuwento ang aking experience.

Interviewer: Kailan po ninyo nalaman na mayroon kayong TB?

Respondent: 2 o 3 years na.

Interviewer: Anong taon po ‘yon Sir?

Respondent: Ma’am 2006

Interviewer: So noong 2006, nag-ubo ba kayo ng dugo?

Respondent: Ganoon din. nagsuka ako tapos nakita ko. Nagpunta ako sa doctor, tapos nagpa-x-ray tapos

nag-continue ng medication dito.

Interviewer: Opo.

Respondent: Tapos noong bandang huli nag-stop ako kasi maraming tao at saka matigas talaga ang ulo.

Tapos bumalik na naman ito ngayon.

Interviewer: Mga ilang months o weeks na kayo nag-take ng gamot noong 2006 bago kayo huminto?

Respondent: Matagal naman, mga 4 months.

Interviewer: Naka-4 months ka din?

Respondent: Yes.

Interviewer: Araw-araw talaga yung pag-inom niyo sa 4 months na iyon

Respondent: Tapos the following day sinabi sa akin na 6 months lang, hindi ko na tinapos ang 2 months.

Tumigil na ako. Nagmamatigas na naman ako ng ulo.

Interviewer: Bakit, ano po ang sinabi sa inyo ng doctor? Bakit po matigas ang ulo ninyo?

Respondent: Kasi hindi ako naniniwala, hindi tinutuloy-tuloy ang paggagamot. Tapos ang katawan

pinapabayaan, sumasama pa mag-inuman sa mga barkada.

Interviewer: Umiinom?

Respondent: Tapos nitong 25th

may dugo na naman. Iba na, itim na talaga. Dead blood.

Interviewer: 25 noong dumaang week lang?

Respondent: Itong 2007.

Interviewer: December 25?

Respondent: Opo.

Interviewer: Sigurado kayo na dugo yun?

Respondent: Opo. Dugo po talaga. Every time umuubo ako may dugo talaga. Tapos, nag-continue ako ng

medication, then nag-skip na naman hanggang sa nag-stop na talaga. Tapos kundi si Dr. na taga-CHO…

Interviewer: Yung sabi niyong si Dr. Calaw?

Respondent: Opo.

Interviewer: Na-admit kayo noon?

Respondent: Hindi ako na-admit, nagpa-check-up lang ako tapos nag-recommend sya ng gamot for 15

days. Noong una nag-recommend sya ng gamot for 10 days. The following day nag-recommend na naman

siya for 1 week. Natapos ko naman tapos noon na nya sinabi sa akin na gawan na kita ng recommendation

para hindi na kayo gumastos kasi wala na po talaga akong pera. Wala na po talaga tapos may pamilya pa

ako. Tapos ang trabaho ko wala na talagang income, magastos talaga. Umaasa na lang ako sa Diyos kung

paano ako at ang araw-araw na gastos namin. Tapos…

Interviewer: Tapos ano po ‘yon Sir?

Respondent: Pumunta na nga ako nagpa-check-up dito parang tulong na lang sa akin ‘yon at nagpa-

register na nga ako dito dala ang aking x-ray. Tapos sinabi dito na halos mahulog na ang lungs ko.

Interviewer: Nakita ni Doctor ang x-ray?

Respondent: Sinabi nya sa akin kung pwede nga mag-injection na lang ako everyday for how many times,

2 times. Maski how many times kumporme po ako para gumaling ako. Four times na ako ngayon simula

noong Friday kasi bago pa lang ako. Noong Friday binigyan nila ako ng good for 4 days. Then, nagtanong

ako kay Doctor kung magg-iinjection pa ba ako o hindi kasi wala naman si Doctor hinihintay ko sya.

Interviewer: So noong tumigil kayo uminom ng gamot, naramdaman ninyo na okay na kayo?

Respondent: Opo. Okay na ang pakramdam ko at tinatamad na akong pumunta ng health center.

Interviewer: Naramdaman ninyo na magaling na kayo?

Respondent: Opo, iyan ang akala ko. Pati Doctor nga nagagalit na kasi matigas daw ang ulo ko. May

panahon na pumupunta ako dito na pinapagalitan ako kasi matigas ang ulo ko. Sinasabihan ako na “gawin

mo ito” pero kadalasan hindi ko ginagawa. Pero kung may sasabihin sila sa akin ngayon, maniniwala na

ako.

Interviewer: Sa tingin ninyo, ginagawa ba nila ang kanilang mga trabaho na bigyang-lunas ang sakit na

TB o hindi?

Respondent: Ginagawa ‘yan nila dito. Kaso nasa tao po ‘yan. Hindi naniniwala. Pero mas maganda kung

may makakatulong sa amin para pwede i-concentrate ‘yan gaya namin mga patient.

Interviewer: Pero noong last time na pinagamot ninyo ang TB ninyo, may nag-guide po ba o nagsupervise

sa pagagamot ninyo o wala?

Respondent: Ako lang mag-isa.

Interviewer: Hindi kayo araw-araw pumupunta dito? Paano ninyo iniinom ang gamot ninyo?

Respondent: Noong una pumupunta ako dito. Pinapupunta ako everyday para masiguro daw nila na

umiinom kami ng gamot kasi kung hahayaan lang daw nila kami, may panahon na hindi kami iinom. May

panahon na nag-explain na lang ako na naghahanapbuhay din ako para hindi ako pabalik-balik. Binibigyan

nila ako ng good for 10 days or 15 days. Pumupunta lang ako dito para kunin. Iniintindi naman kami.

Interviewer: Ang problema nyo lang?

Respondent: Gusto ko po talagang gumaling. Kung susuportahan lang talaga ito ng government dito sa

problema namin, maraming salamat talaga.

Interviewer: Pero ‘di ba ang gamot ninyo ay libre naman?

Respondent: Opo. Pero noong pumunta ako sa hospital, humanap talaga ako ng paraan.

Interviewer: Alam po ba ninyo na ang TB ay kayang gamutin?

Respondent: Opo. Kaya nga nandito ako at nagpapagamot kasi ayaw ko pa pong mamatay. Kaya nga po

kung mayroon mang makakatulong sa amin…kasi ang government hindi naman kami pinapabayaan. Kung

para sa akin, hindi ko na titigasan ang ulo ko, i-concentrate ko na ‘yan hanggang gumaling ako. Kung

hanggang kalian nila sabihin na iinom ako ng gamot, gagawin ko po.

Interviewer: Ngayon naniniwala na kayo?

Respondent: Opo, naniniwala na po ako.

Interviewer: Alam po ba ninyo na nakakahawa ang TB?

Respondent: Opo. Kaya nga po hinihiwalay nila ako pati sa tulugan. Kasi alam ko po na may diperensya

talaga ako. Kaya nga po pinapa-check up ko po ang anak ko kasi po may sipon ngayon.

Interviewer: Ngayon po na gusto nyo ng gumaling, sa tingin nyo nakumbinsi po kayo na magpagamot

kayo?

Respondent: Opo. Dati humihingi talaga ako ng advice kung ito daw talaga. Ito daw ang ginamit nila kasi

may panahon na may depekto na ang katawan. Meron first time, 3rd

time, 2nd

time, meron naman grabe na.

Ang mga taong gumagaling agad ay iyong hindi pa grabe. Paano na ang grabe? Paano kung grabe na ako?

Syempre hihingi ako ng advice sa Nurse o sinong may experience.

Interviewer: Sa tingin ninyo kung mababait ang mga BHW’s natin sa mga pasyente, sila ang makaka-

convince sa mga tao na tapusin ang treatment?

Respondent: Opo. Kailangan po. Hindi natin masisisi ang mga BHW’s kung magalit kasi may karapatan

sila kasi gusto nila gumaling ang patient. Pero ang patient kadalasan umaandar ang pride kapag nagagalit

ang BHW’s,.

Pero ang importante nandiyan ang kailangan namin. Magpasalamat lang kami kasi libre ang gamot.

Interviewer: Sa tingin ninyo ano ang rason ng mga psyente bakit hindi nila tinatapos ang gamutan?

Respondent: Walang interes, tinatamad, matitigas ang ulo o baka naman walang interes na gumaling kasi

kung gusto nilang gumaling, tatapusin nila. Sacrifice tapusin talaga.

Interviewer: Libre naman ang gamot.

Respondent: Opo libre naman ang gamot, bakit hindi tapusin ang gamutan. Kaya nga po kailangan tapusin.

Interviewer: May nalaman po ba kayo na ang budget ng DOH, 95% po para sa TB Program?

Respondent: Kaya nga po kasi nangyari na po ‘yan sa akin. Ayaw ko na mauulit pa maski ano ang

sabihin nila. Hindi na ako magmamatigas, makikinig talaga ako. Gagamutin ko talaga ang sarili ko

hanggang kalian nila sabihin.

Interviewer: Natatakot kayo Sir na…

Respondent: Opo. Natatakot na talaga ako at isa pa, may pamilya ako.

Interviewer: Dati po ba wala kayong ganyan?

Respondent: Meron po Ma’am pero…

Interviewer: Pero konti lang? tapos hindi tumagal?

Respondent: Hindi po tumagal kasi po gumagaling naman din. Dati po noong gumaling na ako, hindi na

ako pumunta tapos lumala kasi hindi ko na po kaya kasi po tumigil ako.

Interviewer: Matamlay talaga kayo Sir?

Respondent: Opo, payat po talaga ako. Mas payat pa po dito.

Interviewer: Ngayon Sir naninigarilyo pa po kayo?

Respondent: Hindi na po tlaga.Paminsan-minsan nga po tinatanong ako ng mga kasama ko at kakilala sa

trabaho kung saan ako pupunta kasi kapag naninigarilyo sila, umaalis ako kasi alam ko kahit hindi ako

naninigarilyo tapos naaamoy ko ang usok, parang naninigarilyo na din ako. Kapag nakakaamoy po ako ng

sigarilyo inuubo ako kaagad kasi po itong baga ko hindi na kaya. Hindi kailangan pabayaan kung guso

kong gumaling.

Interviewer: Ang problema po sa pasyente talaga?

Respondent: Opo sa amin talaga.

Interviewer: Thank you po talaga Sir.

~ End of Interview with Mercedes Defaulter2 ~

APPENDIX C

SURVEY QUESTIONNAIRE ON BARRIER TO SUCCESS OF DOTS

(ENGLISH) ---------------------------------------------------------------------------------------------------------------------

Name:

Occupation:

Age/Sex:

Address:

Barangay Assigned:

Date Answered:

---------------------------------------------------------------------------------------------------------------------

Instruction: Please encircle the letter of your answer..

Quality of Treatment Partner:

1. How many years have you been working as a health provider?

a. 2-5

b. 6-10

c. >10

2. Were you able to attend educational session regarding Tuberculosis detection?

a. yes

b. no

3. Were you able to attend educational session regarding Tuberculosis treatment?

a. yes

b. no

4. Were you taught about DOTS?

a. yes

b. no

5. Who taught you about DOTS?

a. City Health Office

b. Non-Government Health Sectors

c. Colleagues in the Barangay Health Center

d. Self-study or Reading

e. Others, pls. specify____________________

6. Were you oriented regarding DOTS’s objectives?

a. yes

b. no

If yes, what are the DOTS’s objectives that you know?

a. To detect at least 85% of the new smear-positive TB cases and to cure at least 90 of these

cases.

b. To detect at least 70% of the new smear-positive TB cases and to cure at least 85% of

these cases.

c. Others, pls. specify________________________________

7. Do you believe that education is important for you to become an effective treatment partner?

a. yes

b. no

8. Do you have a physician in your barangay health center that could give regular consultations to you?

a. Yes

b. None

9. Do you believe that all cases of tuberculosis should be referred to a physician?

a. yes

b. no

10. Do you believe that, as a keyworker, you should oversee care and act as the point of contact between

the patient and the physician?

a. yes

b. no

11. Do you believe that the patient completing the treatment is already enough basis for the success of

DOTS?

a. yes

b. no

12. Do you believe that you should also do counseling regarding TB patients’ health condition?

a. Yes

b. no

13. What will you do when you suspect someone of having symptoms of TB in your area?

a. I will wait for him to consult the health center.

b. I will immediately advise him/her to do sputum examination.

c. I will start TB treatment.

d. Others, pls. specify______________________

14. Do you believe that you should also educate patients about TB treatment?

a. yes

b. no

15. Do you believe that doing home visits can improve compliance?

a. yes

b. no

Main Reason for Patients Defaulting

16. Have you encountered a defaulter under your DOTS care?

a. yes

b. no

If yes, What is the reason why most patient defaults?

a. long course of treatment

b. improvement of symptoms

c. adverse reactions of drugs

d. problems regarding the services of the health center

e. transportation cost

f. stigma

g. others, pls specify. ______________

17. Have you encountered a defaulter who complained of side effects of the anti-TB drugs?

a. yes

b. no

If yes, what is the most common reasoned side effects?

a. nausea

b. loss of appetite

c. body malaise

d. body itchiness

e. dizziness

f. others, pls. specify_____________

18. Have you encountered a defaulter whose condition worsened or did not improve after taking

medication in midstream of treatment?

a. yes

b. no

If yes, what is the symptom most worsened?

a. cough

b. lost of appetite

c. fever

d. weight loss

e. others, pls. specify____________________

19. Have you encountered a defaulter who preferred to seek help from traditional or spiritual healers than

the services you offer at the health center?

a. yes

b. no

If yes, what reasons did they offer why they consult traditional healer instead?

a. cultural beliefs

b. influenced by family and friends

c. no improvement of symptoms due to anti-TB drugs given by the health center

d. financial problem

e. others, pls. specify______________

20. Have you encountered a defaulter who stopped from going to the health center due to embarrassment

that they will be identified as a PTB patient?

a. Yes

b. no

21. Have you encountered a defaulter who did not complete treatment because of fear of losing their

jobs?

a. yes

b. no

22. How can a patient best complete his/her medication?

a. he/she should be given his/her medication on a weekly basis for self-treatment

b. he/she should be given his/her medication daily at the health center

c. others, pls. specify___________________________

Structural Barriers:

23. In your opinion, what could be improved among the services of your barangay health center to have a

more successful DOTS program?

a. manpower

b. separate room for DOTS patients

c. sputum microscopy follow-up

d. anti-TB drugs

e. others, pls. specify_________________

24. Is there lack of manpower in your barangay health center for the implementation of DOTS?

a. yes

b. no

If yes, what is not accomplished because of lack of manpower?

a. daily recording of treatment

b. supervision of the daily intake of medicines by the patient

c. house visits whenever patient fails to go to the health center

d. others, pls. specify___________________

25. Do you have a physician in your barangay health center that could give regular consultations to your

TB patients?

a. yes

b. none

26. Do you have a separate room where you receive only PTB patients in your health center?

a. yes

b. none

27. Is there a need for a separate room to receive PTB patients?

a. yes

b. no

28. Will a separate room decrease the stigma among PTB patients consulting your center?

a. yes

b. no

29. Do you have sputum microscopy available in your health center?

a. yes

b. none

30. Do you require sputum exam before starting of treatment?

a. yes

b. no

31. Do you charge patients for sputum microscopy?

a. yes

b. no

32. Do you have enough anti-TB drugs for your patients in the health center?

a. yes

b. no

33. Do you charge patients for the anti-TB drugs?

a. yes

b. no

34. Do you always require chest x-ray before starting of treatment?

a. yes

b. no

35. Do you believe that only certified residents of the barangay should be given treatment so that they

would be assured of completion?

a. yes

b. no

36. Why do non-resident of your area consult your center for TB?

a. no anti-TB drugs in their area

b. no health workers in their area

c. no health center near there are

d. transients in your area

e. others, pls. specify____________

37. Do you believe that all PTB patients should come to the health center daily to avail their

medication regardless of their distance to the health center?

a. yes

b. no

38. Do you receive any stipend for TB DOTS implementation from the government?

a. yes

b. no

38.1. If yes, do you think the stipend is already enough to sustain your activities in DOTS?

a. Yes

b. No

38.1.1. If no, why not?

a. it is not enough for the transportation expenses

b. it is not enough to give incentives to my compliant patients

c. others, pls. specify_________________

39. Is there a need that you would be given stipend for the implementation of DOTS?

a. yes

b. no

40. Are there institutional shortcomings in the implementation of DOTS?

a. yes

b. no

40.1. If yes, what is the institutional shortcoming of DOTS implementation that you know of?

a. unsustained political commitment to increase human and financial resources

b. poor recording and reporting system

c. lack of access to quality-assured sputum smear microscopy

d. lack of trained personnel to ensure quality treatment partner

e. others, pls. specify_____________________

Interpersonal Relationship:

41. How do you convince your patients to complete treatment?

a. scold

b. befriend

c. give incentives

d. threat patients as to the consequences of defaulting

e. others, pls. specify_____________________

42. What will I do if my patient failed to take his/her medication?

a. I will not hesitate to scold him/her

b. I will talk to him/her and try to find out why he was not able to take his medication

c. I will not mind at all

d. others, pls. specify_______________________

43. Do you believe that treatment can only be completed if the patient is personally motivated to comply?

a. yes

b. no

43.1. If yes, do you think patient motivation is already enough to sustain your activities in DOTS?

a. Yes

b. No

44. In your experience, which patients are likely not to comply?

a. lazy

b. committed

c. poor self-motivation

d. others, pls. specify_____________________

APPENDIX D

SURVEY QUESTIONNAIRE ON BARRIER TO SUCCESS OF DOTS

(TAGALOG) ---------------------------------------------------------------------------------------------------------------------------------

Pangalan:

Trabaho:

Edad/Kasarian:

Tirahan:

Barangay Kung Saan Na-Assign:

Petsa ng Pagsagot

---------------------------------------------------------------------------------------------------------------------------------

Panuto: Bilugan ang titik na iyong sagot..

Kalidad ng “Treatment Partner”

1. Ilang taon na kayo nagtatrabaho bilang “health provider”?

d. 2-5 years

e. 6-10 years

f. >10 years

2. Nakadalo ba kayo ng “educational session” tungkol sa deteksiyon ng Tuberculosis?

a. Oo

b. Hindi

3. Nakadalo ba kayo ng “educational session” tungkol sa paggamot ng Tuberculosis?

c. Oo

d. Hindi

4. Naturuan ba kayo tungkol sa DOTS?

c. Oo

d. Hindi

5. Sinong nagturo sa inyo tungkol sa DOTS?

a. City Health Office

b. Non-Government Health Sectors

c. Kasamahan sa Barangay Health Center

d. Sariling Pag-aaral o Pagbabasa

e. Iba pa, paki sulat___________________________

6. Naturuan ba kayo tungkol sa layunin ng DOTS?

c. Oo

d. Hindi

Kung Oo, ano mga layunin ng DOTS na alam mo?

d. Para maka-detek ng hindi bababa sa 85% na bagong positibo sa smear na kaso ng TB at

makagamot ng hindi bababa sa 90% mula sa mga kasong ito.

e. Para maka-detek ng hindi bababa sa 70% na bagong positibo sa smear na kaso ng TB at

makagamot ng hindi bababa sa 85% mula sa mga kasong ito.

f. Iba pa, paki sulat______________________________

7. Naniniwala ba kayo na ang edukasyon ay importante para maging epektibong “treatment partner”?

a. Oo

b. Hindi

8. Mayroon bang doktor sa inyong Barangay Health Center na makakapagbigay ng regular na konsultasyon

sa iyo?

c. Oo

d. Wala

9. Naniniwala ka ba na lahat ng kaso ng tuberculosis ay kailangan i-refer sa doktor?

c. Oo

d. Hindi

10. Naniniwala ka ba na responsibilidad mo ang mamahala at gumanap bilang tagapamagitan sa pasyente at

doctor?

c. Oo

d. Hindi

11. Naniniwala ka ba na ang pagkumpleto ng pasyente sa gamutan ay sapat ng basehan ng tagumpay ng

DOTS?

a. Oo

b. Hindi

12. Naniniwala ka ba na kailangan kang magcounseling tungkol sa kondisyon o kalusugan ng Pasyente ng

TB?

c. Oo

d. Hindi

13. Ano po ang iyong gagawin kung mayroon kang nalaman na may sintomas ng TB sa inyong sakop na

barangay?

a. Aantayin ko na lamang siyang kumonsulta sa health center

b. kaagad ko siyang papayuhang magpa-eksamin ng plemas

c. magsisimula na ako ng gamutan para sa TB

d. iba pa, paki sulat_______________________

14. Naniniwala ka ba na kailangan mong turuan ang pasyente tungkol sa paggamot ng TB?

a. Oo

b. hindi

15. Naniniwala ka ba na kailangan mong bisitahin ang iyong pasyente para mapabuti ang pagsunod sa

tamang gamutan?

c. Oo

d. Hindi

Prinisipal na Dahilan ng mga Pasyenteng Hindi Nagtapos ng Paggagamot

16. Nakatagpo ka ba ng pasyente na hindi nagtapos ng paggagamot sa ilalim ng pangangalaga mo ng

DOTS?

c. Oo

d. Hindi

Kung Oo, ano karamihang dahilan kung bakit hindi natapos ng pasyente ang gamutan niya?

h. Mahabang panahon na panggagamot

i. Pagbuti ng simtomas

j. Grabe o masamang reaksyon ng gamot

k. Problema sa serbisyo o sa mga tao sa health center

l. Mahal na pamasahe

m. takot o hiya na makilala nilang pasyente ng TB

n. iba pa, paki sulat. ______________

17. Nakatagpo ka na ba ng pasyente na hindi nakatapos ng gamutan at nagreklamo tungkol sa masamang

epekto ng gamot na pangontra sa TB?

c. Oo

d. Hindi

Kung oo, ano ang laging dinadahilan na masamang epekto ng gamot?

g. nasusuka

h. hindi makatulog

i. panghihina ng katawan

j. pangangati ng katawan

k. pagkahilo

l. iba pa, paki sulat_____________

18. Nakatagpo ka na ba ng pasyente na hindi nakatapos ng gamutan dahil sa paglala o hindi pagbuti ng

kondsiyon pagkatapos uminom ng gamot habang nasa kalagitnaan ng gamutan?

c. Oo

d. Hindi

Kung Oo, ano ang simtomas na masasabing lumala?

f. ubo

g. walang ganang kumain

h. lagnat

i. pagbawas ng timbang

j. iba pa, paki sulat____________________

19. Nakatagpo ka na ba ng pasyente na hindi nakatapos ng gamutan at mas ginustong humanap ng tulong

mula sa tradisyonal o ispirituwal na manggagamot kaysa sa serbisyong ibinibigay sa health center?

c. Oo

d. Hindi

Kung Oo, ano binigay nilang dahilan kung bakit sila kumokonsulta sa mga tradisyonal na

manggagamot?

f. Kultural na paniniwala

g. Impluwensiya ng pamilya at mga kaibigan

h. Walang magandang pagbabago sa simtomas sanhi ng gamot para sa TB na ibinigay ng

health center

i. Pinansiyal na problema

j. Iba pa, paki sulat______________

20. Nakatagpo ka na ba ng pasyenteng hindi nakatapos ng gamutan at tumigil sa pagpunta health center

dahil sa kahihiyang makilala bilang pasyenteng may TB?

c. Oo

d. Hindi

21. Nakatagpo ka na ba ng pasyenteng hindi nakatapos ng gamutan dahil sa takot na mawalan ng trabaho?

c. Oo

d. Hindi

22. Paano mas makukumpleto ng pasyente ang kanilang paggagamot?

a. bibigyan sila ng gamot kada-linggo para sa sariling paggagamot

b. bibigyan sila ng gamot araw-araw sa health center

c. Iba pa, paki sulat___________________

Istruktural na Hadlang:

23. Sa iyong opinyon, ano pa ang maaaring mapabuti sa mga serbisyo ng inyong health center para mas

maging matagumpay ang programa ng DOTS?

f. Dami ng tauhan

g. hiwalay na silid para sa mga pasyente ng DOTS

h. sputum microscopy follow-up

i. gamot para sa TB

j. iba pa, paki sulat_________________

24. Kulang ba ang tauhan sa inyong barangay health center para sa implementasyon ng DOTS?

c. Oo

d. Hindi

Kung oo, ano ang hindi na nagawa dahil sa kakulangan ng tauhan?

a. araw-araw na pagtala ng gamutan

b. pamamahala ng araw-araw na pag-inom ng gamot ng mga pasyente

c. pagbisita sa bahay ng pasyente kung nabigo siyang pumunta sa health center

d. iba pa, paki sulat___________________

25. Mayroon ba kayong doctor sa inyong barangay health center na makakapagbigay ng regular na

konsultasyon sa inyong pasyenteng may TB?

c. Oo

d. Wala

26. May hiwalay ba kayong silid kung saan ninyo tinatanggap ang inyong pasyenteng may TB?

a. Oo

b. Wala

27. Kailangan bang magkaroon ng hiwalay na silid para sa mga pasyenteng may TB?

a. Oo

b. Hindi

28. Ang hiwalay na silid ba ay makakaalis ng “stigma” sa mga pasyenteng may TB na kumokonsulta sa

inyong health center?

a. Oo

b. Hindi

29. Mayroon ba kayong “sputum microscopy” sa inyong health center?

c. Oo

d. Wala

30. Kinakailangan bang mag-eksamin muna ng plema bago magsimula ang gamutan?

c. Oo

d. Hindi

31. Humihingi ba kayo ng bayad para sa “sputum microscopy”?

c. Oo

d. Hindi

32. Mayroon ba kayong sapat na gamot na pangontra sa TB para sa inyong mga pasyente na may TB sa

health center?

c. Oo

d. Wala

33. Humihingi ba kayo ng bayad para sa mga gamot na pangontra sa TB?

c. Oo

d. Hindi

34. Nangangailangan ba kyo lagi ng X-ray ng baga bago magsimula ng gamutan?

c. Oo

d. Hindi

35. Naniniwala ka ba na ang puwede lamang bigyan ng gamot ay ang mga tunay na residente lamang ng

inyong barangay para makasigurado sa pagkumpleto ng gamutan?

c. Oo

d. Hindi

36. Bakit kumukonsulta ang hindi mga residente ng inyong barangay sa inyong barangay health center?

f. Walang gamot na pangontra sa TB sa kanilang lugar

g. Walang health workers sa kanilang lugar

h. Walang health center na malapit sa kanilang lugar

i. Panandaliang Tira sa inyong barangay

j. Iba pa, paki sulat____________

37. Naniniwala ka ba na lahat ng pasyenteng may TB ay kailangang pumunta araw-araw sa health center

para makakuha ang kanilang gamot gaano pa man sila kalayo?

c. Oo

d. Hindi

38. Nakakatanggap ba kayo ng sahod mula sa gobyerno para sa implementasyon ng TB DOTS?

c. Oo

d. Hindi

Kung Oo, sa tingin niyo ba na sapat na ang sahod na iyon para maipagpatuloy ang mga aktibidad

ng DOTS?

c. Oo

d. Hindi

Kung hindi, bakit?

a. kulang ito para sa gastos sa transportasyon

b. kulang ito para makapagbigay ng sapat na pabuya sa mga pasyenteng patuloy

na umiinom ng kanilang gamot

c. iba pa, paki sulat_________________

39. Kailangan ba kayong bigyan ng “sahod” para sa implementasyon ng DOTS?

c. Oo

d. Hindi

40. May mga institusyonal na pagkukulang ba sa implementasyon ng DOTS?

c. Oo

d. Wala

Kung oo, ano ang pangunahing institusyonal na pagkukulang sa implementasyon ng DOTS ang

alam mo?

a. hindi tuloy-tuloy na suporta mula sa gobyerno para sa pinansiyal na pangangailangan

at pangangailan ng tauhan sa programa.

b. kakulangan sa sistema ng pagtatala at pagreport

c. kakulangan sa daan tungo sa siguradong kalidad ng “sputum microscopy”

d. kakulangan sa mga sanay na tauhan para masigurado ang kalidad na treatment partner

e. iba pa, paki sulat_____________________

Interpersonal Relationship:

41. Paano mo makukumbinsi ang iyong pasyente na kumpletuhin ang kanyang paggagamot?

f. pagalitan

g. kaibiganin

h. bigyan ng pabuya

i. takutin ang pasyente tungkol sa resulta ng hindi pagtapos ng paggagamot

j. iba pa, paki sulat_____________________

42. Ano ang gagawin ko kung nabigo ang aking pasyente sa pag-inom ng kanyang gamot?

a. Hindi ako mag-aatubiling pagalitan siya

b. Kakausapin ko siya upang alamin ang dahilan kung bakit hindi siya nakainom ng gamot

c. Hindi ko na lang bibigyan ng pansin

d. iba pa, paki sulat_______________________

43. Naniniwala ka ba na makukumpleto lang ang paggagamot kung ang pasyente ay may sariling

kagustuhan sa paggagamot?

c. Oo

d. Hindi

Kung oo, sa iyong palagay, ang sariling kagustuhan ba ng pasyente ay sapat na para magpatuloy

ang aktibidad ng DOTS?

a. Oo

b. Hindi

44. Sa iyong karanasan, sinong pasyente ang maaaring hindi makakatapos ng gamutan?

e. tamad

f. desidido

g. walang sariling kagustuhuan

h. iba pa, paki sulat_____________________

APPENDIX E

HEALTH PROVIDERS’ RESPONSES TO SURVEY QUESTIONNAIRE

Questions Response Frequency

(N=33)

Percentage

(%)

1. How many years have you

been working as a health

provider?

a. 2-5 6 18

b. 6-10 12 36

c. >10 15 46

2. Were you able to attend

educational session regarding

Tuberculosis detection?

a. yes 33 100

b. no 0 0

3. Were you able to attend

educational session regarding

Tuberculosis treatment?

a. yes 33 100

b. no 0 0

4. Were you taught about

DOTS?

a. yes 33 100

b. no 0 0

5. Who taught you about

DOTS?

a. City Health Office 32 97

b.Non-Government Health Sectors 0 0

c. Colleagues in the Barangay Health Center 1 3

d. Self-study or Reading 0 0

e. Others, pls. specify 0 0

6. Were you oriented regarding

DOTS’s objectives?

a. yes 33 100

b. no 0 0

6.1. What are the DOTS’

objectives that you know?

a. To detect at least 85% of the new smear-

positive TB cases and to cure at least 90 of

these cases.

18 55

b. To detect at least 70% of the new smear-

positive TB cases and to cure at least 85% of

these cases.

15 45

c. Others, pls. specify 0 0

7. Do you believe that education

is important for you to become

an effective treatment partner?

a. yes 33 100

b. no 0 0

8. Do you have a physician in

your barangay health center that

could give regular consultations

to you?

a. yes 33 100

b. no 0 0

Questions Response Frequency

(N=33)

Percentage

(%)

9. Do you believe that all cases

of tuberculosis should be

referred to a physician?

a. yes 27 82

b. no 6 18

10. Do you believe that, as a

keyworker, you should

oversee care and act as the

point of contact between the

patient and the physician?

a. yes

33

100

b. no

0

0

11. Do you believe that the

patient completing the

treatment is already enough

basis for the success of

DOTS?

a. yes 31 94

b. no

2

6

12. Do you believe that you

should also do counseling

regarding TB patients’ health

condition?

a. yes 32 96

b. no 1 4

13. What will you do when

you suspect someone of

having symptoms of TB in

your area?

a. I will wait for him to consult the health

center.

3 9

b. I will immediately advise him/her to do

sputum examination.

28 85

c. I will start TB treatment. 2 6

d. Others, pls. specify 0 0

14. Do you believe that you

should also educate patients

about TB treatment?

a. yes 33 100

b. no 0 0

15. Do you believe that doing

home visits can improve

compliance?

a. yes 31 94

b. no 2 6

16. Have you encountered a

defaulter under your DOTS

care?

a. yes 13 39

b. no 20 61

16.1. If yes, What is the

reason why most patient

defaults?

a. long course of treatment 1 8

b. improvement of symptoms 5 38

c. adverse reactions of drugs 1 8

d. problems regarding the services of the

health center

0 0

e. transportation cost 6 46

g.stigma 0 0

Questions Response Frequency

(N=33)

Percentage

(%)

17. Have you encountered a

defaulter who complained of

side effects of the anti-TB

drugs?

a. yes 11 33

b. no 22 67

17.1. If yes, what is the most

common reasoned side

effects?

(N=11)

a. nausea 4 36

b. loss of appetite 0 0

c. body malaise 2 18

d. body itchiness 2 18

e. dizziness 3 28

f. others, pls. specify 0 0

18. Have you encountered a

defaulter whose condition

worsened or did not improve

after taking medication in

midstream of treatment?

a. yes 32 96

b. no 1 4

18.1. If yes, what is the

symptom most worsened?

a. cough 3 9

b. loss of appetite 28 85

c. fever 1 3

d. weight loss 1 3

e. others, pls. specify 1 4

19. Have you encountered a

defaulter who preferred to seek

help from traditional or spiritual

healers than the services you

offer at the health center?

a. yes 8 24

b. no 25 76

19.1. If yes, what reasons did

they offer why they consult

traditional healer instead?

a. cultural beliefs 6 75

b. influenced by family and friends 1 12.5

c. no improvement of symptoms due to anti-

TB drugs given by the health center

1 12.5

d. financial problem 0 0

e. others, pls. specify 0 0

Questions Response Frequency

(N=33)

Percentage

(%)

20. Have you encountered a

defaulter who stopped from

going to the health center due

to embarrassment that they

will be identified as a PTB

patient?

a. yes 4 12

b. no 29 88

21. Have you encountered a

defaulter who did not

complete treatment because of

fear of losing their jobs?

a. yes 2 6

b. no 31 98

22. How can a patient best

complete his/her medication?

a he/she should be given his/her medication

on a weekly basis for self-treatment

5 15

b. he/she should be given his/her medication

daily at the health center

26 79

c. others, pls. specify 2 6

23. In your opinion, what

could be improved among the

services of your barangay

health center to have a more

successful DOTS program?

a. Manpower 5 15

b. Separate room for DOTS patients 10 30

c. Sputum microscopy follow-up 14 43

d. Anti-TB drugs 1 3

e. Funding for transportation expenses of

health providers

3 9

f. Others, pls. specify. 0 0

24. Is there lack of manpower

in your barangay health

center for the implementation

of DOTS?

a. yes 8 24

b. no 25 76

24.1. If yes, what is not

accomplished because of lack

of manpower?

a. daily recording of treatment 1 12

b. supervision of the daily intake of

medicines by the patient

2 25

c. house visits whenever patient fails to go to

the health center

5 63

d. others, pls. specify 0 0

25. Do you have a physician in

your barangay health center

that could give regular

consultations to your TB

patients?

a. yes 30 91

b. no 3 9

26. Do you have a separate

room where you receive only

PTB patients in your health

center?

a. yes 28 85

b. no 5 15

Questions Response Frequency

(N=33)

Percentage

(%)

27. Is there a need for a

separate room to receive PTB

patients?

a. yes 32 97

b. no 1 3

28. Will a separate room

decrease the stigma among

PTB patients consulting your

center?

a. yes 24 73

b. no 9 27

29. Do you have sputum

microscopy available in your

health center?

a. yes 29 88

b. no 4 12

30. Do you require sputum

exam to all patients before

starting of treatment?

a. yes 31 94

b. no 2 6

31. Do you charge patients for

sputum microscopy?

a. yes 3 9

b. no 30 91

32. Do you have enough anti-

TB drugs for your patients in

the health center?

a. yes 33 100

b. no 0 0

33. Do you charge patients for

the anti-TB drugs?

a. yes 4 12

b. no 29 88

34. Do you require chest x-ray

to all patients before starting

of treatment?

a. yes 16 48

b. no 17 52

35. Do you believe that only

certified residents of the

barangay should be given

treatment so that they would

be assured of completion?

a. yes 24 73

b. no 9 27

36. Why do non-resident of

your area consult your center

for TB?

a. no anti-TB drugs in their area 4 12

b. no health workers in their area 8 24

c. no health center near there area 4 12

d. transients in your area 17 52

e. others, pls. specify 0 0

37. Do you believe that all

PTB patients should come to

the health center daily to avail

their medication regardless of

their distance to the health

center?

a. yes 20 61

b. no 13 39

Questions Response Frequency

(N=33)

Percentage

(%)

38. Do you receive any stipend

for TB DOTS implementation

from the government?

a. yes

0 0

b. no 33 100

38.1. If yes, do you think the

stipend is already enough to

sustain your activities in

DOTS?

a. yes 0 0

b. no 0 0

38.1.1. If no, why not? a. it is not enough for the transportation

expenses

0 0

b. it is not enough to give incentives to my

compliant patients

0 0

c. others, pls. specify 0 0

39. Is there a need that you

would be given stipend for the

implementation of DOTS?

a. yes 20 61

b. no 13 39

40. Are there institutional

shortcomings in the

implementation of DOTS?

a. yes 7 21

b. no 26 79

40.1. If yes, what is the

institutional shortcoming of

DOTS implementation that

you know of?

a. unsustained political commitment to

increase human and financial resources

2 29

b. poor recording and reporting system 0 0

c. lack of access to quality-assured sputum

smear microscopy

1 14

d. lack of trained personnel to ensure quality

treatment partner

3 43

e. others, pls. specify 1 14

41. How do you convince your

patients to complete treatment?

a. scold 2 6

b. befriend 19 58

c. give incentives 1 3

d. threat patients as to the consequences of

defaulting

11 33

e. others, pls. specify 0 0

42. What will I do if my

patient failed to take his/her

medication?

a. I will not hesitate to scold him/her 0 0

b. I will talk to him/her and try to find out

why he was not able to take his medication

33 100

c. I will not mind at all 0 0

d. others, pls. specify 0 0

43. Do you believe that

treatment can only be

completed if the patient is

personally motivated to

comply?

a. yes 29 88

b. no 4 12

Questions Response Frequency

(N=33)

Percentage

(%)

43.1. If yes, do you think

patient motivation is already

enough to sustain your

activities in DOTS?

a. yes 29 100

b. no 0 0

44. In your experience, which

patients are likely not to

comply?

a. lazy 18 55

b. committed 0 0

c. poor self-motivation 13 39

d. others, pls. specify 2 6

APPENDIX F PHOTOS WITH HEALTH PROVIDER RESPONDENTS

PHOTOS WITH HEALTH PROVIDER RESPONDENTS

APPENDIX G PHOTOS WITH SOME DEFAULTER RESPONDENTS

CURRICULUM VITAE

PERSONAL INFORMATION

Name: Aisa Ratag Presas

Age: 26 years old

Sex: Female

Civil Status: Single

Date of Birth: June 29, 1981

Address: Doña Benita Drive Canelar Street, Zamboanga City

Religious Affiliation: Islam

Father: Lorenzo Navales Presas

Mother: Hdja. Sitti Sharra Madtahir Ratag

EDUCATIONAL BACKGROUND:

GRADUATE

Degree: Masters in Public Health

School: Ateneo de Zamboanga Graduate School

Place: La Purisima Street, Zamboanga City

Year of Grad.: 2008

Degree: Doctor of Medicine

School: Ateneo de Zamboanga University School of Medicine

Place: La Purisima Street, Zamboanga City

Year of Grad.: 2007

COLLEGE

Degree: Bachelor of Science in Biology

School: Ateneo de Zamboanga University

Place: La Purisima Street, Zamboanga City

Year of Grad.: 2003

HIGH SCHOOL

School: Ateneo de Zamboanga University

Place: La Purisima Street, Zamboanga City

Year of Grad.: 1998

ELEMENTARY

School: Immaculate Conception Elementary School

Place: La Purisima Street, Zamboanga City

Year of Grad.: 1994

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