WHY COME LAST STAGE?
DELAYS IN DIAGNOSIS OF TB
CHIEF INVESTIGATOR: John Wakageni
INVESTIGATION TEAM: John Maena’adi,
Esau Kekeubata, John Laete’esafi, Gilson
Fansona, Jeptha Talana, Jackson
Waneagea, Christopher Jimuru, Matthew
Honaimane, Philis Au, Esther Naui, Peter
Massey, David MacLaren, Rick Speare
Introduction

Tuberculosis (TB) is a serious infectious disease that
is common in the East Kwaio region. TB can cause
adults and children to get very sick and even die.
The disease can spread through a family and a
village. The treatment for TB is 6 months of special
antibiotics.
Introduction continued

Currently the treatment is started in Hospital and
then can be finished under supervision at home or in
Hospital. The first 2 months of treatment is in
hospital and then the next 4 months is at home. To
reduce the spread of TB in the community two
important ways are by having people come to
Hospital early in the illness, and by having babies
given a needle for TB (BCG vaccine).
Study objectives


To explore some of the reasons why people come to
Hospital in last stage of TB.
To use this information to design a larger project to
better understand the reasons and to make
suggestions for changes to health programs.
Sample

Purposive sample. Three people chosen from
patients who had been admitted to Atoifi Hospital
for TB treatment. One each from coastal, lower
mountain slope, high mountain areas.
Methods




This study was a Qualitative study: structured interview,
talking survey.
The TB Program leader (John Wakageni) at Atoifi Hospital
found names of people who came to Hospital for TB
The researchers (Esau, Christopher and Gilson) visited the
person’s home and asked them to be a part of the research.
They conducted a talking survey, structured interview in
language or pijin. The interview were recorded on a digital
recording device. The interviews were then written out in
language and pijin.
Data was analysed by looking for common themes and
different issues.
Findings
Participant 1: Male 40 yrs. Ancestral Religion. Mountain
 History: Admit TB Ward 2007. Re-admit 2011.
 Issues why come to hospital at late stage of TB.
“Becos no ani seleni, hem farawe, wanem mi doim so mi mekem lo saed
lo kastom nao. Olsem sekrifaes den faendim seleni befor mi kam.
Wans mi no faendim seleni, had for kam nao ia. Cos far awe den fae
blo kanu hem tumas ia.”
“So 10 fala pig. Sekrifaes for mi kam lo hia for no ani ting for stopim
medicin mi tekem ia. Supos if mi no sekrifaes nomata mi tekem how
mani fala medicin sai bae no woka. Des wai mi mekem sekrifaes for
mekim olketa medicin mi usim hemi woka.”
Findings
Participant 1:
 Cost
– don’t have money for transport or food. People sell
pigs to get cash to buy food while they are admitted
 Distance – many people live in remote locations some up to
3 days walk in the mountains
 Permission to go to TB Ward from ancestors because it is a
tabu place because it is joined to the Maternity Ward. Then
need to have reconciliation with ancestors on return. This
cost 10 pigs before and 10 pigs after entering the TB
Ward.
Findings
Other reasons why participant 1 came late for TB
treatment at Atoifi:
 Traditional
Medicine – used before coming to hospital
and when hospital medicine did not work
 Social Isolation – knew that when come to hospital he
had no wantoks and so was very lonely with no one to
care for him or talk with him.
Findings



Participant 2: Male 60 years. SDA. Coastal
History: Start sick 2006 admit to TB ward 2009.
Issues why come to hospital at late stage of TB.
 Tried
traditional medicine but did not recover
 Then admitted to hospital for TB treatment in 2009 but
after discharge not recover
Findings

Participant 2: continued
Came back to hospital 3 times for check but nurse told him you are
OK and no need for more TB checks.
 After that although fever, cough and coughing up blood for one
year did not come to hospital because he felt ashamed to come
back because the nurse had told him he was OK– so stay at home.

“Ngaia e fata. ‘Io lo’o mola no’ona mani mamalo ga’u mai’. Na’u taku Mamalo
uta’a la’u? late’e olo’ori oru singari esui ma taku seke la’u. Mai gaia ame aga
mola fai.”
“He said. ‘Now you just wait’. How will I wait? This kind of thing after three months I
will check again. He (the nurse) didn’t do it (the TB test).”

Research team encouraged participant to come to hospital for
check. He came next day.
Findings



Participant 3: Family- Father, Mother, children and
grandchildren (12 people in one house, no window).
Catholic. Lower Mountain slope.
History: 2 adults and 3 children admitted for TB
between 2007 – 2009.
Issues why come to hospital at late stage of TB.
 Children
between 6-16 yrs came to hospital as soon as
sick – admitted to TB Ward.
 Father – 60yrs. Chronic cough – test for TB negative
Findings

Father – 60yrs.
“Ki koko’o no’o ola bala alata ada no’o aki mae no’o. Kwa’a ki gou’u gou’u
melesin ma olate’e ato mola”
“I am very old now about the point of death. Even if I drink the medicine it
will not work”
“ Dr e makemu nau lau’u maka ngari nau na X ray. Maki kwairii no’o dari
nau’u. Ma ola abulo’onga ada mola.”
“Dr checked me, he checked me with the X ray. Then he told me about but it, I
just ignored it.
Discussion

Reasons why people come late to Hospital for TB:
 Old and time to die, so no need even if TB symptoms
 Choose to not to follow advice from hospital
 Ask for TB check and told no need by staff causing
shame so don’t want to come back
 Cost – transport and food. Sell pigs to get cash to buy
food at Atoifi because no food from hospital
 Distance – many people live in remote locations some
up to 3 days walk in the mountains
Discussion continued
 Permission
to go to TB Ward from ancestors because it
is a tabu place because it is joined to the Maternity
Ward. Then need to have reconciliation with ancestors
on return. This costs 5-15 pigs before and after
entering the TB Ward.
 Traditional medicine
 Social isolation
Conclusions and Recommendations



This pilot research project has shown that there are
many important reasons why people come to Hospital
late in their TB. Each reason needs to be addressed
to allow people to come to Hospital early.
The information from this survey should make the start
of a larger project to fully explore these reasons so
changes can be made.
A TB Ward that is away from the Maternity Ward
and not connected to the main hospital is needed,
particularly for people from the mountains.