Rose, a nursing officer in-charge at Kyabazaala Health Center III (HCIII), a tuberculosis (TB) diagnostic and treatment center in Mukono District, Uganda. Photo credit: URC

Rose is a nursing officer in-charge at Kyabazaala Health Center III (HCIII), a tuberculosis (TB) diagnostic and treatment center in Mukono district, Uganda. With support from the USAID Defeat TB Project, Rose formed a quality improvement team at the facility to improve TB service delivery. Through peer-to-peer learning sessions and mentorship, she taught her team how to conduct active TB case finding and targeted screening for high-risk populations in the community.

Through the process, Rose discovered that a lower-level health facility, Kateete HCII, was not routinely providing TB services to their catchment population – a fishing community. The Kateete HCII health care workers needed the same capacity building that Rose and her team received from Defeat TB.

Despite an already heavy workload at her own facility, Rose decided to take on the challenge of improving the skills of the Kateete health care workers. She and her team conducted continuous medical education sessions for Kateete HCII staff on TB screening, sputum sample referral, and interpretation of GeneXpert test results. She worked with the health workers to review their processes for TB screening and linkage to services. She showed them how to identify gaps in service delivery – namely lack of patient referral for further evaluation and sample testing at the district laboratory.

And she did not stop there. She helped the team implement changes to address the gaps.

Helping New TB Patients Start and Maintain Treatment

For example, Rose aided the team in requesting a hub motorcycle rider to retrieve sputum samples from the clinic twice a week and deliver to the testing site. She also set up a system for TB patients to receive their treatment at Kateete HCII instead of traveling further to a diagnostic and treatment center which helped with treatment adherence and retention. Rose pre-packed TB medicines for treatment and had the medicines delivered to Kateete HCII for pick-up by patients. The Kateete team ensured that patients returned to Kyabazaala HCIII for follow-up sputum testing at two, five, and six months of treatment.

When the Kateete team told Rose they had identified a multidrug-resistant TB patient, she immediately notified the Mukono District TB and Leprosy supervisor who ensured the patient was referred and admitted to Mulago National Referral Hospital for treatment. After several weeks of treatment, the patient was discharged and continued to receive treatment at Kateete HCII under Rose’s supervision.

All of these efforts led to a TB screening outreach in the Kateete community, where Defeat TB and the local government chairman participated and supported the Kateete HCII team to identify additional TB patients and start them on treatment, helping to curb the spread of the disease.

Rose’s leadership and commitment saved and improved lives. Her cascade mentorship approach – which helped improve TB service delivery and led to increased TB case finding – will be replicated and scaled up. She will continue to make a difference. If you know a nurse like Rose, please be sure to extend your gratitude for all they do, especially on International Nurses Day, observed on May 12.