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Daru, Papua New Guinea, July 2018 ¨C Most people know that Tuberculosis (TB) is a deadly, but curable, disease. But what people may not realize is how challenging it is to successfully treat it.

Once diagnosed, TB patients must take heavy doses of medication every day for at least nine months. Medication is calculated according to a person¡¯s weight ¨C some have to take up to 18 tablets a day ¨C and has significant side effects such as nausea, mood swings, joint pain and lethargy.

If treatment is not completed, TB bacteria can become drug resistant, morphing into a much more dangerous strain that is more difficult, painful and expensive to treat. People with multi-drug resistant TB must go through a two-year treatment plan that requires a huge personal commitment and takes an enormous physical and emotional toll.

In Daru, high rates of multi-drug resistant TB have caused considerable alarm among global health experts, who named the small island as a global hot spot for the disease in 2016. Overcrowding in Daru¡¯s urban areas have contributed to particularly high transmission rates; not helped by the physical distances many people need to travel to get to the island¡¯s hospital, as well as the fear and stigma associated with the disease.

Bringing treatment closer to the community

The answer was to establish dedicated treatment sites closer to people¡¯s homes. There are now five dedicated treatment sites on Daru Island, each funded by the Australian government and operated by World Vision, work that is now being supported by the World Bank. Each treatment site provides personal healthcare to TB patients, helping to ensure successful completion of the stringent treatment programs. The results from the treatment sites have been impressive: in the first year, the number of people diagnosed with TB but ¡®not completing their treatment has been reduced from 30% to almost zero.

Globally, TB kills over 4000 people every single day, making it the single biggest infectious killer in the world. (Tom Perry / World Bank)

Dedicated treatment sites ¨C a local success

So why are these dedicated treatment sites so successful? The highly personalized care has been a key factor. Across Daru¡¯s five treatment sites, there are 430 people receiving TB treatment, with around a third of these carrying the multi-drug resistant strain of the disease. And every patient has a dedicated ¡®TB Treatment Supporter¡¯ ¨C often a volunteer ¨C who shows up every day to personally administer the medication and provide encouragement to keep going amidst the tough treatment regime.

¡°When they are not coming every day, that¡¯s when we go out and look for them, to bring them back and then start giving them the treatment,¡± says Aikasa Sabake, a volunteer TB Treatment Supporter.

Daily medication compliance is integral to the treatment of TB, yet it¡¯s the emotional, social and psychological support that makes this model so unique.

¡°Little gestures are very important. Just talking and spending time with them; they can really open up and talk to you about anything that they face,¡± says Iru Tofinga, a former TB patient now working as a Counsellor for . ¡°I¡¯ve felt what they are feeling ¨C being discriminated and being talked about on the streets; so I have a lot of empathy.¡±

Despite its prevalence in Daru, TB carries significant stigma within the community. Many people who are newly diagnosed face social isolation from their family and friends, making recovery a lonely experience. As patients arrive at the treatment sites for their daily medication and conversation, they¡¯re greeted warmly by the health workers.

¡°When I come and enter this gate, when I see my treatment supporter I feel better, I feel comfortable that she¡¯s here to help me,¡± says Edna Daii, who has been on treatment for multi-drug resistant TB for nearly six months, and has been supported by Lilian Dada, a volunteer treatment support officer.

¡°I encourage [Edna] to take her drugs,¡± explains Lilian. ¡°But I also say to her, ¡®Whatever problem you come here with, we are part of your family and you will always be happy here, our love is always with you¡¯.¡±

In addition to individual healthcare, TB patients also receive a cooked lunch every day. Kitchen staff start at 5am each morning to cook 100+ meals for patients, each one packed and transported by a team of drivers to the five sites ready for collection. Their dedication is a key part of the TB fight, with the meals ensuring adequate nutrition for patients throughout their intense treatment.

It is all part of the fight against TB, and the sense among many in Daru is that this is a fight that can ¨C and must ¨C be won. From the nurses, van drivers, cooks and the treatment support officers, the effort to fight TB in Daru has achieved outstanding results due to a passionate and dedicated team to kick TB out of Daru.