Nina Tatamo Rahjonson is a health worker in Madagascar’s capital, Antananarivo, with a vital role to play in the fight against tuberculosis. She is what is known in Madagascar as a “motivator”. Her job is to persuade patients who have fallen by the wayside to get back on treatment and stay the course until they are cured. This is no easy task because TB treatment, in order to be effective, has to be taken every day for up to 6-8 months.
Nina is 46 years old and she has been working as a social worker since 2007 at the Institute of Social Hygiene, the main center for testing and treating tuberculosis in Madagascar’s capital, Antananarivo. Nina’s choice of job is no coincidence. Her husband contracted tuberculosis 20 years ago and her son, aged 26, is also afflicted with the disease and has been on medication for the last 4 months. When it comes to explaining what tuberculosis is, Nina knows what she is talking about. Every day around 100 to 150 people come to receive treatment or to get tested at the Institute. Nina painstakingly explains the treatment to her patients, the do’s and don’ts and the precautions that need to be taken. She also advises them on hygiene. But her most difficult task is to impresses on them the need to stick with the treatment.
Nina Tatamo Rajonson, health worker at the Institute. Photo The Global Fund/Georges Merillon.
Nina's salary is fully funded by the Global Fund. She is paid 481, 000 Ariary per month, the equivalent of 180 euros, which in Madagascar is considered a decent salary. The Global Fund also pays for all the medicines distributed in the center and for the testing. The Global Fund also financed the renovation of the Institute which now meets international standards.
Nina’s main job is to persuade patients who, for whatever reason, have stopped taking medication to get back on treatment. "I must make them understand how the disease manifests itself, how it can be treated. We call these patients "drop outs." My task is to bring them back on treatment and to convince them not to give up. I have to go to their homes and persuade them. In 2011, I had 86 drop outs out of 1003 registered patients and I managed to get almost all of them back onto treatment. But when I visit their homes I don’t go there to lecture them. I know they all have problems, family difficulties, problems with work and money. Others react badly to the treatment and sometimes they do not dare to go back to the doctor. "
Tuberculosis, which is a disease of poverty, affects more and more people in Madagascar, which is blighted by poor sanitation. Most people have little or no access to drinking water. About 70% of the country’s 20 million inhabitants live in rural areas and are sometimes up to 10 kilometres from the nearest health facility. When Nina enters people’s homes, she always encounters the same thing. Families have practically no possessions. Above all else, she knows that the head of the household must not lose his (or her) job. "I often go to their employers to make them understand that they should not dismiss a sick employee. I also explain to them that when a patient is on treatment there is no risk that they will infect their work colleagues. Tuberculosis is a disease that frightens people and people who are ill with the disease are often stigmatized. Many TB patients do not dare tell their relatives or work colleagues that they have the disease, for fear of being ostracized. Sometimes I go myself and deliver the drugs in person to patients in their own homes so that they don’t run the risk of being late for work and facing dismissal.
The Institute of Social Hygiene treats more than 150 patients against tuberculosis every day in Antananarivo. The Global Fund to fight AIDS, Tuberculosis and Malaria pays for all the treatments and the testing.Photo The Global Fund/ Georges Merillon.
Nina works about ten hours a day in the center or on the road, taking taxis or buses to reach her patients. Sometimes she even gives her own money to people who are too tired or weak to return home on foot. She admits that sometimes it takes a lot of energy and conviction to persuade people to resume treatment. But for her, failure is simply not an option.
"Yes, there are times I want to give up when for example I visit a patient for the third or fourth time, who continues to refuse treatment. It takes love, persistence and staying power to convince them, as well as lots of energy. I have had some failures, of course, but also a lot of success. It makes me very happy when a patient has completed the treatment and I see him or her leave the center on the last day with a big smile and expressing warm thanks. This is hugely rewarding.”