Rishi,
I have no experience of the problems you face, but I am so encouraged by
you. Others have given practical solutions that you can try (female peer
workers, use of picture books), and from my contact with people in north
east India, I can only offer words of encouragement to perservere. Your work
at times, must appear too hard, but only through perserverance can small
changes be seen.

Shirley Warren ([log in to unmask])
Sydney, Australia
----- Original Message -----
From: "Rishi Ram Parajuli" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, September 13, 2001 3:34 PM
Subject: Motivation for patient education


This is my first time in the [log in to unmask] I am working in the National
TB control programme of Nepal for last 6 years. Nepal has achieved very
encouraging result in this programme after implementation of  DOTS (Directly
Observed Treatment, Shortcourse) strategy from  1996. We provide treatment
from primary health care facilities of government health care system, NGO
and private practitioners as well. Our national cure rate is gradually
increasing every year and is around 85%. This 85% is the national target as
well. However,  we have high rate of defaulters and have not very effective
defaulter tracing system. We know that the high number of defaulters could
be prevented by an effective health education  to the patients at the
beginign of treatment because TB needs to 8 months long treatment in our
country. We realise that patient education that is being provided  by the
health workers is not found effective and adequate enough to make the
patients to complete their treatment. The health workers usually complain
that they do not have enough time to teach the patients due to limited
number of staff  and high nunber of patients in  some of these facilities.
But we think this is not only the reason for poor or ineffective patient
education. It is found that  most of the health workers are not patience to
teach patients who are illiterate villagers.   My question to you who are
involved in the TB programmes is that, how can we encourage those health
workers to teach their patients an effective way so as to reduce the
defaulters to make the programme success.What makes the health workers
motivate for  quality health education? Could  you please give me some
examples and success stories about this issue so that we could practice
those tips in our country?

Rishi Ram Parajuli
National TB Center
Thimi, Bhaktapur
Nepal