24 Mar 2020
World TB Day 2020 | A day in the life of a TB Clinical Nurse Consultant
Alistair McKeown is a clinical nurse consultant with the Victorian Tuberculosis Program as part of The Royal Melbourne’s Hospital clinical services. He loves being part of a broad team of healthcare workers with patients at the core. Tuberculosis (TB) is a preventable and curable disease, providing hope that we can save lives and end suffering. Alistair brings this hope to his patients.
My patients are spread across Victoria. I might be there on day one when a patient is diagnosed with active TB, and I will be there to support them throughout their treatment.
To be a small part of a person’s journey to recovery from TB is rewarding in all sorts of ways.
A lot of the time when I tell people what I do they are surprised to hear that TB is an issue in Victoria or Australia. While the number of people with active TB is relatively low here, the impact for individuals and their family is real.
TB is an airborne bacterial infection. Around the world an estimated 10 million people become ill with active TB annually. It remains the leading cause of death from a single infectious agent worldwide.
The good news is that TB is completely curable. An estimated 58 million lives were saved globally through TB diagnosis and treatment between 2000 and 2018.
When a person in Victoria is diagnosed with active TB, they receive support from the Victorian Tuberculosis Program (VTP), based at the Peter Doherty Institute for Infection and Immunity. We are a multidisciplinary team of nurses, social workers, doctors, epidemiologists and others, working for better public health management of TB across the state.
I might start my day with a home visit. At any given time, I look after about 40 patients. I work closely with a person and their treating team to advocate and assist in navigating the healthcare system. I encourage patients to follow their treatment plans, ensure they are not experiencing side effects, and counsel them.
The TB treatment course is long, and people can lose steam partway through. Treatment changes too, making keeping track of medications a big task. Have you ever tried to get a toddler to take medicine every day for six months? It’s hard.
Treating TB takes much longer than treatment for other bacterial infections – a patient has to take a course of antibiotics for at least six months. A patient might feel better within that time and not feel the need to take the rest of their course. This is when it is particularly important that we keep a respectful connection with the patient, and encourage, reassure and educate them along the way.
As with any bacterial infection, stopping a course midway encourages antibiotic resistance. Any bacteria that do not die initially because they were a tad more resistant, will bounce back, and this increased resistance carries over to all the new bacteria.
For TB, this is a serious problem. Multidrug-resistant TB, caused by bacteria that do not respond to the two most powerful first-line anti-TB drugs, remains a public health crisis.
We have a close relationship with the Victorian Infectious Diseases Reference Laboratory (VIDRL), who helps to diagnose cases and grow bacteria from patients in the lab to assess for sensitivities to different anti-TB drugs. Knowing which medications will help get patients onto the best treatment as soon as possible.
As I guide each of my patients through their treatment, there is also an element of incidental counselling. Having TB not only affect a person’s health, but can lead to additional social and financial burdens for them and their family. Patients might go through periods of isolation, especially when they are infectious or facing stigma. I provide a listening ear and connect them with other supports when necessary.
Some patients want me there in person. Others might prefer calls, text messages, or to chat online. The most important thing is that I meet the individual patients’ needs and provide support in a way that is acceptable to them.
If a person with active TB has had close contact with others (e.g. family and friends), I need to screen all those individuals to see if infection has occurred and to arrange follow up as necessary to break the chain of transmission. Sometimes this extends to workplaces, schools and other settings. In all of these contexts, I provide education to patients and the people around them.
I regularly attend TB clinics at public hospitals to support both the patients and treating doctors. During medical consults, it is beneficial to have patients, doctors, and nurses in the same room so that everyone is on the same page. A big part of the job is providing linkage and good communication for patients, their loved ones, doctors, and pharmacists.
Sometimes my patients are going through difficult circumstances, making it tough to keep them on long-term treatment. I might have patients who are homeless, jobless or in correctional facilities. Sometimes the stigma of TB alone can cause relationship breakdowns. Providing factual information to patients and family can be very reassuring.
Many people with TB are born overseas. Because of this, I am constantly learning about my patients’ cultures, hearing life stories, and their views on health. It is a pleasure and a privilege to share in the lives of people from many countries around the world, as well as the lives of people born in Australia.