Page 141 - Social Marketing for Public Health Global Trends and Success Stories

57977_CH05_final.qxd:Cheng 11/5/09 4:38 PM Page 114

114 CHAPTER 5 ■ Tuberculosis: Keys to Success in Peru

facts about the disease. It also highlighted concerns with access to diagnosis, drugs,
and coordinated care.
Downstream, many of those infected were unaware that their persistent
cough was a signal they should get tested. Others, who suspected they were in-
fected and knew they should be tested, did not know where they should go or
imagined they would not be able to afford it. Those being treated were not always
convinced they needed to be taking their drugs as prescribed, believing that since
they felt better they were cured, or seeing the burden of traveling on foot to a
clinic several times a week as too exhausting. These barriers of stigma and access
were magnified several-fold for those who were homeless, in prison, or in mental
institutions. In addition, those with MDR-TB were having difficulty accessing or
paying for the type of drugs needed.
Midstream barriers were the greatest for healthcare workers, where stigmas
as well as misconceptions were even more pronounced. Some believed, for ex-
ample, that they could get TB by shaking hands with an infected patient, even by
sitting on a chair that an infected person sat on. As a result, healthcare workers
would take protective measures such as setting up two desks between themselves
and the TB patient or by asking the patient not to face them while they talked.
Some even expressed that they perceived an assignment to work on TB at a
clinic as a punishment. The healthcare system’s capacity for diagnosis, clinical
services, and lack of coordination threatened success if patients downstream re-
sponded in large numbers.
Upstream policy makers were distracted, especially in 1990, by changes in
leadership and other national priorities including crime, illegal drugs, inter-
nal terrorism, and poverty. A priority to revamp the healthcare systems and
increased funding for TB would be challenging, with the national TB program
functioning at the time only on the periphery of the primary healthcare
system.

P O S I TI O NIN G

Given these barriers to getting tested, completing regimens, “being around” pa-
tients, and competing country priorities, planners wanted “everyone” to have a
sense of urgency about the impact tuberculosis was having on citizens, as well as
their country. At the same time, they wanted “everyone” to be hopeful: for patients
to know that there are cures and that free help is available; for family members,
friends, and healthcare workers to realize that their help is needed; for the media
to see TB as a major issue of public interest and concern; and for policy makers
to see their efforts as a good investment.