Many patients with chronic health conditions become overwhelmed with the complex demands of their daily care. Which medications have to be taken at what time of day? How many times each day for this pill or that syrup? Which to take with food, and which to take on an empty stomach? Which medicines can be combined and which must be taken alone?
Complex treatment plans can be especially overwhelming for people who are battling multiple chronic conditions, say heart disease and diabetes, or tuberculosis and HIV infection.
Patients who suffer from chronic problems worldwide could benefit from a program in Lima, Peru. The program shows that patients can improve when a kind of “health coach” visits them at home.
Not long ago, a young mother was emaciated and weak. For fear of discrimination, she asked us to call her “Carmen.”
Carmen discovered she was pregnant, and she went to seek ordinary prenatal care. A blood test showed she was HIV-positive. She was shocked and distraught over the news. She was terrified that her baby would be born with HIV, and both of them would die.
Carmen took medicines to reduce her daughter’s chance of infection. Her daughter was born premature. Doctors couldn’t tell for sure right away whether the baby was infected with HIV or not.
Additional medicines to fight her own HIV infection were available to Carmen. But like a lot of women, she was too busy taking care of others to properly care for herself.
“Because of my own lack of care, I abandoned treatment for six months. They gave me a new regimen. Sometimes I would take the pills, sometimes I would not take them. I was very irregular. And they didn’t really help me much, because I lost a lot of weight. I think one of them gave me anemia. I would only take them when I would remember, or only when I wanted to. I went to the doctor and they did some tests. The doctor told me that my viral load was way too high and my tests results were poor.”
Carmen’s brother developed tuberculosis. “I took care of him because there was nobody else to do it,” Carmen says. “I would go to the hospital and my mother would stay here with my baby. And I got TB. For me, that was a very heavy load, because I had to take the tuberculosis pills,” in addition to her HIV medications.
Carmen didn’t think she could make it on her own. “Because at that point in time, I didn’t have anybody who would come to me and talk with me,” Carmen says. “I didn’t have anybody who would help me manage the medicines.”
That’s when a trained volunteer called a “health promoter” stepped in. Now she visits Carmen at home almost every day.
“She comes here, she talks with me, she gives me my pills, she gives me advice,” says Carmen. “She plays with my daughter. She spends time with me. She’s worried about me when I’m sick. She takes me to a doctor. She’s concerned with my health and that gives me joy, knowing that somebody who is not my family is with me and is supporting me. That’s something that gives me a lot of comfort.”
The volunteers are trained by “Partners in Health,” an international medical group that serves low-income people, working with Peru’s Ministry of Health.
Carmen’s health coach is Maria Soledad Pobisas Carate. She herself suffered from tuberculosis long ago. She says it was a very isolating illness. “Discrimination still exists and we have to work against that, little by little, providing patients with our support and our affection,” she says. “I think the level of confidence and the strength of the relationship you manage to build with your patients, that’s what makes them want to follow your advice.”
Maria helped Carmen complete her tuberculosis treatment with success. In the meantime, news came through that Carmen’s daughter did not have HIV.
Maribel Muñoz Valle is a Project Coordinator for “Socios en Salud,” the local partner for the program. She says visiting coaches can prevent severe health crises, by catching dangerous problems early. “If there’s a fever, or nausea, or headaches, home visits allow us to avoid a rapid decline,” she says. “Because once an infection takes hold, if you don’t respond quickly, it can turn deadly very fast.”
Clemente’s family was terrified he would die from complications brought on by infections with HIV and tuberculosis. Clemente himself was convinced there was no hope for him. “I was like an empty bag,” he says. “I was dead. Because of my health, I didn’t have energy to do anything.”
Now Clemente is strong enough to carry passengers and their burdens with his transport business. He drives a small motor cart around Lima. Clemente credits his health promoter for his dramatic recovery. Explaining the role of health coaches, he says, “They keep track of our medication, they’re with us, they give us moral support, they talk with us, they tell us about the experience of other people, they motivate us to be able to do well. And not to abandon treatment.”
Sticking with treatment benefits patients, their families and communities – lessening the burden of infectious disease.
Clemente’s health promoter is Nelly Palomino. She says, “He’s 100% better. He was sad and stuck in bed. He was a man who weighed 48 kilos (105 lbs), and now he weighs 73 kilos (160 lbs). He’s alive and he’s working and he’s being useful to his family. He has a small child who he feeds and who he supports. He is no longer a burden on his family, nor a source of sadness for them. This is my happiness as a promoter, to see him well.”
Program sponsors say they’re having success with health promoters in other locations, including Haiti and the United States. They say health coaches could also be effective for patients with non-infectious diseases, like diabetes, hypertension and heart disease, worldwide.
Take Action: For more information about how you can get involved, visit Global Health Frontline News.