Dr. Yuriko of JICA to the YT: I hope the history of our collaboration will be a history of combating TB in Yemen [Archives:2002/10/Health]

More than three million people are killed by TB, one of the most frightening diseases in the world, every year.
In Yemen, about 15,000 TB patients are detected and treated.
Many international organizations have been working hard to help Yemen decrease the rate of TB patents since years. One of these major organization has been Japan International Cooperation Agency (JICA) which has an office in Sana’a.
As far as TB control is concerned a lot of Japanese health experts have been sent to Yemen last of whom was Dr. Yuriko Egami who left Yemen last week after two years and a half of great and sincere efforts in the field of TB control.
Ms Yuriko Egami is a doctor with a specialty of International Health. After her post-graduate training in Pediatrics for six years, she learned Public Health and have been working in this field, in Djibouti, Honduras (Central America), Geneva, Bangladesh and Yemen, with an NGO, WHO (World Health Organization), and JICA.
The Yemen Times met her just a few days before she returned to Tokyo after finishing her contract and filed the following interview:
YT – When did you come to Yemen?
I came to Yemen for the first time in January 1999 as a short-term consultant. Then, since August 1999 I stayed in Yemen for two-and-a- half years.
YT – What are the things that you have been doing?
My assignment as a Chief Advisor of the Yemen TB Control Project (third phase) is to give technical and managerial advice on TB control to the National TB Control Program (NTP), Ministry of Public Health and Population (MoPHP).
YT – Can you give us some idea about Tuberculosis and its control?
Tuberculosis (TB) is regarded as one of the most frightening diseases in the world, and more than three million people are killed by TB every year.
In Yemen, about 15,000 TB patients are detected and treated. We have effective drugs for TB, and patients have to take these medicines as indicated by health staff at least eight months to be cured, even cough or fever stops a few weeks after taking drugs. If a patient stops taking drugs before the period, there is a chance of Mycobacterium getting resistant to many anti-TB drugs (which is called multi-drugs resistance (MDR)-TB) and it costs thousands of dollars to treat a patient with MDR-TB. So, the most important in TB control is to complete the treatment by taking anti-TB drugs everyday until the end of the course, and to cure the patients so as to avoid emergence of MDR-TB.
The current strategy for TB control is called DOTS (Directly-Observed Treatment, Short-course), which more than 200 countries have adopted globally.
There are five components of DOTS which are essential to achieve successful TB control program. The most important is (1) management of the patients, i.e. to make sure that patients take medicine, by watching the patients taking the drug in front of health workers everyday which also allows better communication and reliability of health staff and patients.
The concept is that it is the responsibility of health staff, not patients, to complete the treatment.
Other components are; (2) political commitment to TB control by the Government, (3) diagnosis and follow up of the patients by sputum smear exam which is economic and reliable method to confirm the patients excrete the Mycobacteria, (4) stable and timely drug supply system with adequate amount of stocks, and (5) recording and reporting system which allows us to evaluate the treatment outcome of the patients.
DOTS strategy is effective in curing more TB patients and in controlling the emergence of MDR through preventing patients default, as well as to enable the program evaluation by patients management with reporting.
Good results
Since 1995 when the Ministry of Public Health of Yemen adopted DOTS strategy NTP has obtained prominent results with its continuous efforts and the partners’ supports. NTP, MoPHP are responsible for TB control in all of Yemen, and they are making efforts to expand DOTS strategy to enable good TB control services for the people in Yemen.
They maintain the national policy, get budgets, procure and distribute anti-TB drugs, train health staff, and collect data of the patients for cohort analysis to find out the outcome of the patients (how many % are cured). In each Governorate, one Governorate TB Coordinator (GTC) is responsible for implementing all the activities in TB control of the respective Governorate.
The next target
I have been working with NTP, MoPHP to support above-mentioned activities for better TB control services to Yemen, at both central and Governorate level. Until 2001, we expanded DOTS strategy so that at least one unit for TB control would be available in one district in Yemen. The next target is to expand DOTS to all peripheral health facilities so that TB control services will be much closer to the people.
YT – When did the TB control program begin?
The Japanese government started collaboration with the TB program in the Yemen Arab Republic in 1983, where we established the basis of a national TB Control, foundation of these TB Centers, and human resource development.
After the unification of North and South, the second phase started in 1993 where we focused on integration of NTP to Primary Health Care system as well as intensification of the TB program in the southern area. The third phase started in August 1999 and will be continued until August 2004. The Japanese Government has continuously supported the Project with strong back up by JATA (Japan Anti-TB Association).
YT – How much has been spent on TB control (from the Japanese Government)?
The provision of equipment has been at JY 466 Million. Unfortunately I have no idea about the running cost.
The Grant Aid project for TB centers has so far been JY 2500 Million plus sending Japanese experts (69) and Mission teams (17), and Yemeni trainees to Japan (63).
YT – How many Yemenis have been trained in Japan in the field of TB?
63 trainees since 1983 up to now. (see table)
YT – What is your advice to the Ministry of Health in Yemen?
First of all, I would wish that Ministry staff would work for patients and people, so that better health services may come closer to the people.
The Ministry of Health in Yemen takes a very good initiative in donors coordination. Each agency has its own strategy for support, and I would wish that the Ministry might get more ideas about which agency wants what kind of support. We are always suggesting the idea that the Japanese Government would like to support in which manner. By knowing this, the Ministry can maximize the support of donors and agencies.
Better TB Control Program in Yemen and its sustainability may rest in expanding our partnership to advocate TB control policies, to raise awareness and demand for effective TB control and to assist in the delivery of resources and services.
I believe that early this century we will witness the expansion of effective TB control in Yemen through our partnerships. I hope the history of our collaboration will be a history of combating TB in Yemen, at a time when TB is one of the biggest health problems in the world.



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