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01 Feb 15

Student opinion Author / Annalise Lance

Woolcock draws blood in Ca Mau: Tackling tuberculosis in rural Vietnam

A highlight of my 10-week volunteering trip to Vietnam this Summer was spending a day with the field staff of the Woolcock Institute’s ACT3 project in Ca Mau province. On 12 January I visited one of the communities participating in the project, to assist the people at the forefront of research into the management of tuberculosis in Vietnam.

It was an early start, leaving for the community health centre at 6am to pick up the day’s supplies from the lab. We piled the equipment into the car and headed off to Tan Phu district, making a quick stop to pick up banh mi for breakfast.

We arrived at the village at 7am and met up with some of the other field workers who had been staying out in the region for the past week in order to perform the screening. The ACT3 project team is actively looking for cases of tuberculosis within communities with the aim of limiting the spread of TB in Vietnam.

This was the final day for screening in this area, where the team had been going door-to-door, reaching every member of this community in order to check for tuberculosis. As it was the last day, blood collection was taking place as a part of the ACT3L subproject, which takes a random sample of screened participants to have a blood test for latent tuberculosis.

I received a small glimpse of the incredible work being done through this research, and met some of the many faces of rural Ca Mau this project is impacting.

Annalise Lance (fr 2014)

The building used for the blood draw was the local community meeting hall. This small open building had been set up like a classroom with rows of wooden benches and tables. At 8am community members began to arrive, with a steady stream forming and keeping all the field officers busy. The waiting benches became a chance for socialising with the neighbours and laughing at the confused Australian greeting them with “xin chao!”.

I stationed myself as an assistant blood drawer, setting up needles, handing alcohol wipes and applying Band-Aids. This enabled me to meet some of the people this screening project was helping. In this region, where the hardworking farming culture is balanced by laid-back afternoons in coffee shop hammocks, this interruption to the daily routine was a cause for interest. As I faced men and women giving up their time and blood for the project, I was impressed with the way they endured the needle without so much as a flinch.

It has been estimated that up to 40% of people in Ca Mau have latent TB. This is a form of tuberculosis in which the bacteria are kept under control by the body’s immune system, but can later develop into active tuberculosis, becoming infectious. The ACT3L project aims to more accurately determine the prevalence of latent TB in Ca Mau province, in order to get a better idea of the spread of TB.

A few hours later the stream of participants flowing past our desk stopped, and I looked around, needle at the ready, for a reason. We had reached the end of our list for the day, leaving only a handful of no-shows to be followed up on.

With the blood clinic packed away, the field staff headed off to do the last of the screening at various houses in the region. As the main goal of ACT3 is to determine the impact of actively looking for tuberculosis patients through yearly screening, the project team spends most of their days making house visits. First they interview individuals on their symptoms, before requesting a sputum sample to be analysed for the presence of the tuberculosis bacteria.

We headed a few minutes down the main road, stopping at a house hanging precariously over the river with a shop selling fishing nets at the front entrance. We were invited inside, and sat down to interview the one remaining family member who had not yet been screened. The field officer went through the screening process, asking questions about symptoms and then collecting the sputum sample. As this went on the women of the family gathered around me, pointing and commenting animatedly. Tin, the ACT3 assistant supervisor, translated the women’s words, explaining that they were wondering what products I had used on my skin to keep it so white. I talked to a school-aged girl, helping her to practice her English and trying out my handful of Vietnamese phrases on her.

At the next house we visited we were greeted with freshly made iced coffees and introduced to the head of the household. He made us feel welcome as his son was screened by the field officer, chatting animatedly about the work we were doing.

In an ordinary day a field officer will visit 20 houses for screening. The team will live out in the community, working closely with the local government and community groups. Through this collaboration with the local leaders, they are able to test a model for tuberculosis detection with the potential to dramatically reduce the prevalence of this disease, keeping community at its heart.

I was able to help this team on one day, meeting some of the 60,000 people they visit for screening every year. I received a small glimpse of the incredible work being done through this research, and met some of the many faces of rural Ca Mau this project is impacting.

The work of the ACT3 project is far from over, with each community selected for the project screened yearly for four years. The Woolcock team hopes that if this model is shown to be successful, it can be implemented throughout Vietnam and other high burden countries. This represents a small but crucial step towards a Vietnam free from tuberculosis.

Story by Annalise Lance (fr 2014)