Inside a Vietnamese home perched precariously by a fast-flowing river, a Woolcock field officer sits down to talk to an elderly man.
The researcher asks about the villager’s hacking cough, the fever and the fatigue that’s dogged him for years to seek an answer to one question: Does he have TB?
Tuberculosis, a bacterial lung infection, is cutting a swathe through Vietnam, where more than 100,000 people catch it and 17,000 die from it every year. Despite being preventable and curable, TB here is both common and deadly. Current drugs are costly and ineffective, and sufferers often inadvertently spread the bacteria to their loved ones when they cough or sneeze.
Sydney-based Woolcock Institute of Medical Research is fighting to turn around dire statistics with a screening program to annually test adults in 60 villages for the disease.
The ACT3 study, run from the Woolcock’s Hanoi office, will track households for four years and compare diagnosis and treatment results with adults in 60 control villages.
They hope this first-ever community-wide screening will rapidly reduce the prevalence of the disease, but it can only be done with extensive on-the-ground door knocking, interviews, and sputum and blood tests.
The days often start at dawn, with research teams piling into their cars with medical equipment to head off to a remote part of Vietnam’s Ca Mau province to screen patients.
Going from door to door, the researchers are greeted warmly by local families who are curious about the visitors and their questions, as Australian student researcher Annalise Lance discovered during a recent volunteer mission to the region.
At each house, the field officer screens every occupant, asking key questions that reveal whether they, like 40 per cent of their community, have latent or active TB.
At one house Annalise and the field officer are offered freshly-made iced coffees as some respite from the heat. At another a woman animatedly asks her what creams she uses to keep her skin so white.
“I talked to a school-aged girl, helping her to practise her English and trying out my handful of Vietnamese phrases on her,” Annalise says.
As she explains, 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.”
Annalise also helps the team take blood from randomly-selected screened participants to check for latent TB. Villagers begin streaming into the make-shift medical centre as Annalise sets herself up as an assistant blood drawer, laying out needles, handing out alcohol wipes and applying Band-Aids. “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.”
On the waiting benches, neighbours socialise, discuss the out-of-town visitors and laugh at Annalise’s confused attempts at speaking Vietnamese. “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.”
A few hours and dozens of tests later, the team is ready to pack up and move to the next village.
For Annalise, the experience was both illuminating and inspiring. “I was able to help this team on one day, meeting some of the 60,000 people they visit for screening every year,” she says. “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.”
But as she explains, the work of the ACT3 research team is far from over. “Each community selected for the project is screened yearly for four years,” she says. “That’s a very big and very important job.”
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,” says Annalise.
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