FOREWORD

Alhamdulillah, thank God for to Allah SWT who gave His Grace and
guidance, so that the author can finish this paper. This paper is structured to fulfill
the assignment of the English Lesson Course, which is one of the Nursing
Semester III courses. We realize that in writing this paper is far from perfect,
therefore we expect constructive criticism and suggestions for the perfection of
this paper.

Finally, we hope that this paper will be useful for readers, as a reference in
improving the ability to learn.

Serang, August 2019

i
 TABLE OF CONTENTS

FOREWORD ........................................................................................................... i
TABLE OF CONTENTS ........................................................................................ ii
CHAPTER 1 PRELIMINARY ............................................................................... 1
1.1 Background ................................................................................................. 1
1.2 Formulation of the problem ........................................................................ 1
1.3 Purpose ........................................................................................................ 1
CHAPTER 2 DISCUSSION ................................................................................... 3
2.1. INFORMATION AND EDUCATION IN THE EXPECTED TB............... 3
2.2. INFORMATION AND EDUCATION IN TB PATIENTS EARLY
MEETING ................................................................................................... 7
2.3. INFORMATION AND EDUCATION IN THE FAMILY ........................ 18
2.4. INFORMATION AND EDUCATION ON THE ENVIRONMENT AND
OTHER HEALTH OFFICERS ................................................................. 23
2.5. INFORMATION AND EDUCATION AT THE END OF TREATMENT
................................................................................................................... 24
CHAPTER 3 INTERVIEW .................................................................................. 29
CHAPTER 4 CLOSING ....................................................................................... 31
4.1 Inference ...................................................................................................... 31
4.2 Suggestion ................................................................................................... 31

ii
 CHAPTER 1

PRELIMINARY

1.1 Background

Communication with suspected TB patients is an attempt to prepare the

psychological condition of the patient. In this stage patients can feel anxious
and worried about the possibility of their illness. DPM must recognize this and
empathize with patients. Convey information that supports well and correctly,
because understanding the patient in this stage is very important. Messages
that need to be communicated:

1. TB disease
2. TB can be cured.
3. People suspected of TB.
4. The examination that must be undertaken
5. Prepare patients to receive the results of laboratory examinations
6. Prevention of Transmission.

1.2 Formulation of the problem

1. What is pulmonary tuberculosis?

2. What are the symptoms of pulmonary tuberculosis?
3. how to treat pulmonary tuberculosis?

1.3 Purpose

General Learning Objectives:

After studying this material the participants were able to carry out tuberculosis
information and education
Specific Learning Objectives:
After studying this material the participants were able to explain
1. Information and education on patients suspected of TB.

1
2. Information and education on TB patients
3. Information and Education on the Family
4. Information and Education on the Surrounding Environment and Other
Health Officers
5. Information and Education at the End of Treatment

2
 CHAPTER 2

DISCUSSION

2.1. INFORMATION AND EDUCATION IN THE EXPECTED TB.

Communication with suspected TB patients is an attempt to prepare the

psychological condition of the patient. In this stage patients can feel anxious and
worried about the possibility of their illness. DPM must recognize this and
empathize with patients. Convey information that supports well and correctly,
because understanding the patient in this stage is very important. Messages that
need to be communicated:

1. TB disease

2. TB can be cured.

3. People suspected of TB.

4. The examination that must be undertaken

5. Prepare patients to receive the results of laboratory examinations

6. Prevention of Transmission.

MESSAGES NEED TO BE COMMUNICATED:

a. TB disease

In general, patients are not aware of the symptoms of TB they feel, they feel
cough is an ordinary illness that will heal with over-the-counter cough medicine.
Explain in simple language. Provide information about TB to patients in the
following ways:

"Mr. / Mrs. experienced symptoms of cough with phlegm for more than two
weeks. That is the main symptom of TB, but other symptoms also exist such as
weight loss, no appetite, night sweats even if you don't do work. This disease is
not an ordinary cough that can be cured after taking medicine bought at a stall. "

3
b. TB can be cured

The patient may be afraid to know that he has TB. For this reason, inform as early
as possible that TB can be cured as long as the patient follows the treatment
correctly. This is to provide motivation and hope to patients.

c. People suspected of TB

This explanation can be conveyed in the following way:

"A person may suffer from TB if they experience symptoms such as ... (explain
the symptoms of TB)"

1) The main cause of TB

The patient may have a suspicion why he might get TB. Look for information
on how far the patient knows about TB. Then provide information about TB.

To explain TB, convey the following key message:

a) TB is caused by TB germs, Mycobacterium tuberculosis, which is

transmitted through the air when someone with TB coughs or sneezes.

b) TB can be cured with regular treatment according to doctor's instructions.

c) If left untreated, TB can spread to other people in the vicinity and can
cause severe pain and even death.

d) TB is not a hereditary disease or is caused by witchcraft.

d. Examination that must be undertaken

Explain to the patient that he must undergo sputum examination in the laboratory
to confirm the diagnosis whether or not TB is suspected. Explain how to
expectoration and whenever expectoration is taken.

e. Prepare patients to receive laboratory results.

Prepare the patient's psychological condition to receive the results of laboratory

tests to prevent the unexpected, for example, patients are afraid of undergoing

4
treatment. Increase patient expectations that even if the results are positive, they
can still be cured.

1) If the results of laboratory tests are TB, submit information directly by

conducting face-to-face communication as follows:

"From the results of laboratory examinations, it turns out that you are proven
to have TB, which means there are TB germs in your body. But you can
recover as long as you regularly swallow the medicine. After this, you have
to undergo treatment for 6 months. The treatment is indeed long but we will
help you during the treatment period and we hope you will also be willing to
follow the treatment completely. "

2) If the results of laboratory tests are not TB, submit information directly
by conducting face-to-face communication as follows:

"From the results of laboratory tests, it turns out that the father / mother are
not affected by TB. This is good news. This means there are no TB germs in
the body of the father / mother. However, you already know what the
symptoms of TB are, so if you or the people around you have the same
symptoms, advise you to get checked immediately, OK?

f. Prevention of transmission

Suspected TB has a great potential to transmit TB to others, therefore the patient

needs to know what he has to do to prevent TB transmission to his family and
those around him. Don't forget to ask the patient's opinion about transmission in
exploring the patient's knowledge and understanding. The following are examples
of information about transmission that is conveyed to patients

"To prevent TB transmission in families and people around you, make it a habit to
keep your mouth shut when coughing and sneezing. At home, open windows and
doors so that fresh air can enter. You do not have to separate the eating utensils
because the transmission of TB does not go through the eating utensils.

List of Questions and Key Messages for Suspected TB

5
During the visit: Display a caring attitude. Give praise and encouragement to
patients. Speak clear and simple. Encourage the patient to ask questions.

According to you, why do you have to check with the health facilities?

You should check with the Health Center because there may be TB germs in your
body. To find out if there are any germs, we have to check the phlegm of the
father / mother.

What is TB?

TB is an infectious disease caused by germs. The germ that causes TB is

Mycobacterium Tuberculosis. TB can be cured as long as the patient follows the
medication every day for 6-8 months.

According to you, why did you get TB?

TB is transmitted through sputum sputum of people who are ill with TB and have
not been treated. Sputum containing germ can be inhaled by anyone. If the
immune system of the person who breathes the air is weak, it can cause TB pain.

How do you know whether you have TB?

TB can only be known through sputum examination that is seen under a

microscope. The patient will be asked for a sputum sample. (DPM is expected to
convey the correct way of sputum examination to patients).

It is possible that TB patients also need to have a chest X-ray examination if

needed.

How to prevent transmission?

• Do not expel phlegm and spit carelessly.

• When coughing (there is a cough ethic):

There are 2 simple but effective methods to reduce the spread of TB germs,
namely:

6
a. cover your nose and mouth with a tissue or handkerchief when coughing or
sneezing. Coughing or sneezing directly into the hand is not recommended
because it can spread germs to whatever you touch with your hands. If there are
no handkerchiefs, cough or sneeze into the inside of your elbow or upper sleeve.
Change your clothes immediately

b. Washing hands after contact with a sick person. Use soap, water to wash your
hands and wipe or you can use an alcohol cleansing liquid without water.

When will you find out the results of the laboratory examination?

Within a maximum of a week, patients can come back according to the time the
agreement was made at the time of sputum collection

What should be done if the laboratory examination results show TB?

Patients will get TB treatment for 6-8 months according to their category.

What should be done if the results of the examination are not TB?

Patients will get treatment according to the examination of the symptoms they are
experiencing

2.2. INFORMATION AND EDUCATION IN TB PATIENTS

EARLY MEETING

Before giving information to patients about TB, ask questions first to explore their
current knowledge about TB. Then use available tools such as flipcharts for
patients to convey information about TB.

Messages that need to be communicated:

a. TB disease

Repeat the message that was delivered at the time the patient arrived as suspected
to reinforce the information.

b. TB can be cured

7
Tell the patient that TB can be completely cured if he goes on medication
regularly and does not stop taking medication in the middle of the road.

c. Willingness of patients to undergo treatment

Before giving medicines to patients, convey that treatment must not be

interrupted. Dropping out from treatment will cause the remaining germs in the
body to become resistant to the drugs currently available in Indonesia and the
treatment is expensive.

The medicines currently given are of high quality and are provided by the
government. For this reason, you should ask the patient's sincerity in taking TB
treatment.

d. How to prevent TB transmission

Prevention can be done by:

- Swallow the medicine regularly and thoroughly.

- Cover mouth and nose when coughing or sneezing.

- Open a window or door so that the sunlight and fresh air into the house.

- No special diet is needed, no separate cutlery, and sterilize cutlery for drinking
or household utensils.

e. Housemate

All children under 5 years who live in the same house with TB patients must be
examined, because this age is very susceptible to various diseases. Children may
need preventative treatment or referral to a doctor.

Other family members who live in the same house who experience symptoms of
TB should be examined immediately.

f. Need for supervision to swallow drugs

DPM must explain the importance of drug swallowing supervision for patients.
Explain that the patient swallows all medications by being supervised by a Drug

8
Swallow Supervisor (PMO), to ensure that the patient swallows all medicines
correctly, regularly, and according to the specified time. Thus DPM will find out
whether patients experience problems in treatment such as side effects and others.
Through surveillance of swallowing drugs, DPM will immediately find out if the
patient has missed taking the drug, and immediately investigate the cause.

g. Explain drug alloys

Describe the treatment mix including:

- Duration of treatment

Example: If a patient is new

"TB drugs are given for 6 months. You will get medicine for 6 months
because you are a new patient "

- Drug dosage and adjustment according to body weight

Example: "If during treatment there is an increase in body weight then the
dose of the drug will be adjusted.

- Types of drugs and how they are given

Example: If the patient relapses

"Drugs consist of two types, swallowed drugs and injectable drugs. The drug
will be given in two stages. The initial stage of the drug must be taken every
day for 3 months and you will also be injected for two months. Furthermore,
after the results of sputum examination are negative, the injecting drug will be
stopped and oral medication will be given 3 times a week for 5 months.

- quality of medicine

Example:

"The drug that is provided by the government is free and of high quality, this
drug is the best combination that is used throughout the world to treat TB. If
you treat it regularly and thoroughly, it will recover."

9
 - Frequency of visits to take drugs.

Example:

"You have to come to the health facilities every day for two months to get
injections and take medicine."

- Where to go to get medicine

Example:

"You can come directly to the TB room if you take medicine, if there are
complaints, you can see a doctor. You can take medicine according to the time
and day agreed with the officer "

h. Further examination at the end of the initial stage

Explain to the patient to see the progress of the treatment and ensure that the
patient can continue the treatment to an advanced stage so that sputum needs to be
re-examined.

Example:

"Ladies and gentlemen, after taking the medicine and injecting it in the initial
stages, the sputum will be reexamined at the end of the initial stage to see if the
germ has been negative (not found) and to assess whether this drug can work well
in the body of the father / mother. "

i. The possibilities that occur during treatment and the actions that must be taken

Patients need to know clearly what might happen during TB treatment, and what
to do next.

Example:

The fact that rifampicin can make urine orange or red as a drug reaction.

"Ladies and gentlemen, one of these medicines will make the urine reddish like
tea water. This is not dangerous. If there are other complaints, you can notify the
PMO or DPM. Later the doctor will help resolve the complaint "

10
j. Clean and Healthy Behavior (PHBS) in TB Patients

It should be said that patients should maintain health by living clean and healthy,
for example:

- drying the sleeping tools,

- Open windows and doors so that air and sunlight come in. Good air flow
(ventilation) in the room can reduce the number of germs in the air. Direct
sunlight can kill germs,

- Eat nutritious food.

- Do not smoke and do not drink alcoholic beverages,

- Exercise regularly if possible.

List of Questions and Key Messages for TB Patients in Early Treatment

During the visit: Display a caring attitude. Give praise and encouragement to
patients. Speak clear and simple. Encourage the patient to ask questions.

What do you know about TB?

What do you think is the father / mother who caused TB

TB is a contagious disease

The cause of TB is Mycobacterium Tuberculosis. If the lung is damaged by TB

germs, the patient coughs up phlegm and has difficulty breathing. Without proper
treatment, the patient will die.

Do you know what happens to people who have TB?

Do you know that TB can be cured?

TB if not treated will be fatal, in addition to being able to transmit it to other

people it can also result in death.

TB can be cured with the right treatment. Patients must swallow all drugs in
accordance with the provisions in order to recover.

11
Medication for TB is provided free.

Treatment can be done without disrupting daily life.

Do you really want to take TB treatment to get well?

Patient Willingness

TB can be cured. Mr / Mrs must be serious about running the treatment, not to
neglect to come for treatment until healed.

According to you, how is TB transmitted?

TB transmission.

TB is contagious when TB patients cough or sneeze, spit germs into the air.
People around may inhale these germs and get infected.

Germs are easily transmitted to family members or live close together. Anyone
can get TB, but not all people who contract TB get sick.

TB patients who have been treated for two weeks will no longer transmit it to
other people but still have to take medication.

How can you prevent TB transmission?

Prevention can be done by:

- Swallow the medicine regularly and thoroughly.

- When coughing (there is a cough ethic):

There are 2 simple but effective methods to reduce the spread of TB germs,
namely:

a. cover your nose and mouth with a tissue or handkerchief when coughing or
sneezing. Coughing or sneezing directly into the hand is not recommended
because it can spread germs to whatever you touch with your hands. If there are
no handkerchiefs, cough or sneeze into the inside of your elbow or upper sleeve.
Change your clothes immediately

12
b. Washing hands after contact with a sick person. Use soap, water to wash your
hands and wipe or you can use an alcohol cleansing liquid without water.

- Open a window or door so that the sunlight and fresh air into the house.

- No special diet is required or sterilizing or separating utensils or household

furniture.

How many people live with you? How old?

Are there more people in your home who cough? Who ?

Home contact examination

All children under 5 years who live in the same house with TB patients must be
examined. This is important because children under five are at risk of developing
severe TB disease.

These children need precautions or are referred to the health facilities.

Family members who have TB symptoms should be examined.

Do you think this treatment needs to be monitored?

The importance of monitoring swallowing drugs

Because of the length of treatment, a TB patient can lose motivation to swallow

the drug.

A DPM or PMO (Drug Swallowing Supervisor) must monitor the father / mother
swallowing the medicine in accordance with the schedule. This is to ensure that
the father / mother swallows the medicine correctly and regularly.

With regular observations, DPM or PMO will find out whether there are side
effects or other problems.

With direct supervision of swallowing the drug, DPM or PMO will know if you
missed a dose and will quickly explore the problem.

13
If you have to travel, or plan to move, tell the DPM or PMO that treatment can be
arranged again without having to delay.

Explain in detail the patient's drug alloy

Explain to the patient.

- Duration of treatment.

- Drug Quality

- Frequency of visits to take drugs

- Where and when to go for treatment

Explain the importance of sputum examination after an intensive stage

Sputum examination at the end of the intensive phase is done to see whether the
number of germs is reduced which indicates that the anti-TB drugs that are
ingested are working properly.

Explain what might happen due to swallowing the drug and what to do if side
effects occur

Example:

Rifampicin will cause orange / red urine from the drug. This should happen and
not dangerous. If you feel nauseous from swallowing the medicine, at the next
dose, eat something while swallowing the medicine.

(Make sure that the patient knows when and where to go for the next treatment.
Ask the patient to make sure he will return.

Remind patient to bring family and people close to the patient for TB
examination).

STAGE CONTINUE ALL TREATMENT.

After the initial meeting with the TB patient, continue to provide precise
information about TB at each visit. Don't forget to use good and effective

14
communication skills, such as asking questions, showing caring attitudes, praising
and encouraging patients, and using simple language.

During the treatment period, information that needs to be communicated is:

a. Drug side effects (if complained by the patient and or recognized by the
officer).

Each visit, ask the patient about how he feels, or is there a problem during taking
medication. Then listen to the patient's answers and observe the patient, whether
there are any side effects or not. Provide appropriate action if there are
complaints.

b. Type, color of packaging, amount and frequency of drugs.

Communicate to patients:

- The color of the packaging, so that it is recognized by the patient.

- Remind the number of drugs / tablets, how often, for how long.

- Reassure the patient that the medication for the entire treatment period is stored
in the box with the patient's name.

- If there is a change in the drug alloy, due to the change in treatment stage,
explain in detail the new alloy.

c. The importance of patient compliance.

Communicate to patients:

- Compliance with treatment is very important.

- Patients must swallow all the recommended drugs at the allotted time in order to
recover.

- If the patient feels better, should continue treatment until completion.

- It is important to convey, if the patient is traveling or moving, it must inform the

DPM or PMO, so that continuity of treatment can be arranged again.

15
d. If the patient only swallows some of the medicine or stops swallowing the drug,
communicate to the patient:

- Swallowing some drugs or swallowing drugs on an irregular basis, is dangerous

and makes patients very difficult or impossible to cure, it can even make TB
germs become resistant so it is more difficult to cure.

- These patients will continue to transmit TB germs to their families and

surrounding communities.

- If the patient complains of too much medication, explain that TB is caused by

strong germs, because it requires a lot of drugs both in type and amount.

e. The importance of sputum examination, frequency and meaning of examination

results.

Communicate to patients:

- TB germs cannot be seen with ordinary eyes, so to find out the presence or
absence of TB germs, sputum examination using a microscope is needed.

- Frequency of sputum examination during the treatment period.

End of initial stage. After two or three months of the initial phase, sputum will be
examined, then will continue the next stage of treatment.

During the next stage, sputum examination is performed again at month 5. If no

bacteria are found, continue treatment. However, if germs are still found, the
treatment category will change.

The last sputum examination is done one week before the end of treatment. If no
bacteria are found at the final examination, the patient is cured.

f. Clean and Healthy Behavior (PHBS) in TB Patients

Remind the patient to continue to run PHBS

List of Questions and Key Messages for TB Patients in the Advanced Stage

16
Ask questions to identify side effects.
- How do you feel ?
- Is there any problem ?
- Listen and see if there are severe side abdominal
effects
- Itching, red patches on the skin
- Deafness
- Dizzy / dizzy, lost balance / loss
- Yellow (skin or eyes)
- Repetitive vomiting
- visual impairment
If there are mild side effects, give
advice:
- If you do not have an appetite, nausea,
pain, recommend
swallowing medicine with food or
porridge.
- If joint pain, take aspirin medicine
- If there is a burning sensation in the
legs, drink 100 mg of pyridoxine a day.
- If the urine is orange / red, that is
normal, due to the influence of the
drug.

Convince the patient to continue

- visual impairment treatment. If there are severe side
effects, stop the TB drugs, and refer a
doctor immediately
If the patient has not brought family Every child under the age of 5 living in
members who contact for examination the same home should be examined for
symptoms of TB. Other family
members who have symptoms of TB
should be examined
If the patient is not familiar with drugs, Give an overview of the type, color and
or there is a change in drug mix amount of medication that must be
If the patient feels well swallowed. Also how many times to
If the patient plans to travel or move swallow the medicine and for how long
Even though you feel better, you should
continue taking the medicine for the
time specified.
If you plan to travel or move, inform
the officer / PMO.
Will be arranged about the continuity of

17
 treatment, so that no dose is forgotten
or missed.
If the patient has missed 1 dose of In order to get well, you have to
medication swallow the medicine entirely in
If the patient complains about the accordance with the provisions, during
continuity of treatment the time of treatment. If you don't do
that, you will continue to transmit TB
to others.
Swallowing only a portion of a drug, or
swallowing medicine irregularly, is
dangerous, and makes the disease
difficult to cure

2.3. INFORMATION AND EDUCATION IN THE FAMILY

Informing health messages to patients' families is an inseparable part of health

services in all health care facilities. Support from family members determines TB
treatment outcomes. For this reason, families must also be given information
about TB in order to continue being able to assist patients during treatment.

The DPM must be able to provide information and education to the patient's
family in clear and appropriate language about the disease, its treatment and side
effects, actions or examinations to be carried out and prevention efforts. Effective
communication is conveyed according to the cultural background and level of
family education.

a. The role of the family in medicine

After someone is determined as a TB patient, the family is the person most needed
support in carrying out treatment. Some family roles in supporting the treatment
of TB patients, namely:

1) Motivating patients to undergo treatment until recovery, by:

18
• Recognize factors that can support or hinder treatment for patients and help find
alternative solutions

• Convince the patient that the treatment will be beneficial for the patient and his
family

2) Accompanying and providing moral support to patients in order to undergo

complete and regular treatment, namely:

• Motivate the patient to keep swallowing the medicine when the patient gets
bored.

• Make sure the patient swallows the medicine witnessed by the family.

• Listen to each patient's complaints, comfort them and foster self-confidence.

• The thing that should not be forgotten is to give time for patients to express their
feelings. If needed, seek and include the patient in patient group meetings
(associations).

3) Remind TB patients to come to health facilities to get drugs and check the
sputum according to the schedule by coordinating with PMO and DPM about the
schedule for taking drugs and sputum examination of TB patients.

4) Find and recognize the symptoms of drug side effects and refer to health
facilities.

• Ask and pay attention to whether the patient has a complaint after swallowing
the drug.

• Immediately refer patients to health facilities if there are side effects.

• Calms the patient and makes sure that the complaint he has is dealt with.

The messages must be conveyed to the family

DPM must provide important information and education about TB and TB

treatment to families about the importance of family support for patients in
dealing with their illnesses.

19
1) During the first visit after the patient was diagnosed with TB

• Important messages to convey to the families of TB patients are:

• Explanation of TB symptoms and causes of TB

• TB can be cured

• TB treatment

• Treatment plan

• Dosage and administration of TB drugs

• Regularity of swallowing the drug thoroughly as directed by the doctor

• Drug side effects and make sure the family knows when and where to look for
help

• The importance of regular monitoring of swallowing drugs during treatment

• TB transmission

• Prevention of TB transmission can be:

Provide a sputum disposal site so that patients do not expel their sputum
carelessly

• The importance of regular sputum examinations

• The importance of a healthy and clean lifestyle for patients and their families

• Stop smoking and drinking alcoholic drinks on patients.

• Suggestions for cleaning the house or the environment regularly.

• Exercise for the patient.

• Counseling and improvement of patient nutrition

• No special diet is required, sterilize or separate drinking utensils.

2) Next Visit During the Treatment Period

20
At the next meeting, if the patient comes with his family, DPM can repeat the
messages as in the first meeting. Don't give too much information on one visit.

Reassure the family of the importance of treatment until completion. If a patient

does not come to take medicine or seems unenthusiastic, the health worker can
find out through family members what is the problem and help find solutions
according to their needs and abilities.

b. The role of PMO in medicine

TB patients require close monitoring and routine to see the reaction to the
treatment that has been given and to find out the side effects of treatment. Because
of the high adherence required in treatment, a Drug Swallow Supervisor (PMO) is
needed to monitor treatment and remind examinations that need to be done.

The role of the PMO is:

1) Make sure the patient swallows the medicine according to the rules from the
beginning of the treatment to recovery, namely:

• Make an agreement between the PMO and the patient regarding the location and
time of ingestion of the drug.

• PMO and patients must keep the agreement that has been made.

• The patient swallows the drug witnessed by PMO.

2) Accompanying patients during consultation visits to health facilities and

providing moral support to patients in order to undergo complete and regular
treatment, namely:

• Reassure patients that TB can be cured by taking medication in a complete and

regular manner.

• Motivate patients to continue taking their medication when they are bored.

• Listen to each patient's complaints, comfort them and foster self-confidence.

21
• Explain the benefits if the patient completes treatment so that the patient does
not drop out of treatment.

3) Remind TB patients to come to health facilities to get medication and check

phlegm according to schedule, namely:

• Remind patients to come to health facilities to get drugs based on the schedule
on the patient's identity card (TB. 02).

• Ensuring that the patient has taken medicine.

• Remind patients of the sputum check schedule based on what is printed on the
patient's identity card (TB. 02).

• Ensure that the patient has sputum re-check.

4) Find and recognize the symptoms of side effects of OAT and contact a health
facility.

• Ask if the patient has any complaints after swallowing OAT.

• Accompanying patients to health facilities when experiencing side effects of the

drug.

• Calms the patient that complaints can be handled.

5) Provide counseling about TB to patients' families or people who live in the

same house, namely about:

• TB is a contagious disease, how TB is transmitted, TB symptoms and how to

prevent it,

• TB is caused by germs, not caused by witchcraft or curses and not a hereditary

disease,

• TB can occur because TB patients don't take tuberculosis regularly,

• TB can be cured with complete and regular treatment,

22
• Treatment is given in 2 stages, namely: the initial and advanced stages, which
range from 6-8 months,

• TB drugs must be taken all at once at the same time every day,

• There are no other drugs to treat TB,

• The importance of supervision so that patients receive complete and regular

medical treatment,

• Possible side effects of the drug and the need to immediately seek help from the
health facilities

6) Identify the existence of close contact with TB patients and what should be
done with such close contact.

2.4. INFORMATION AND EDUCATION ON THE ENVIRONMENT AND

OTHER HEALTH OFFICERS

TB patients can be cured with the right treatment. To avoid stigma from people
around the patient and the surrounding environment, information on how to
prevent transmission is intended, so that everyone who is in contact with the
patient can take care of himself without hurting the patient's feelings. The
community around patients, officers and PMOs are expected to play an active role
in disseminating information about TB. This information can be conveyed
through counseling facilitated by health workers.

The surrounding environment is defined not only as the closest associations such
as family, but also includes the treatment environment such as health facilities
where patients undergo treatment and the workplace of patients. The attitude of
health workers who are not directly related but still related (such as counter staff,
cleaning staff, etc.) is also expected to support the patient's treatment process by
showing a positive attitude towards patients.

In this regard, officers are expected to provide information and education to the
surrounding environment. Health workers who handle TB can socialize about TB
in a coordination meeting held at the Health Center to provide colleagues with

23
information about TB. This is needed to get the same understanding in avoiding
negative attitudes from health workers who do not interact directly with patients.

The things that need to be conveyed to the environment around the patient are:

• TB patients do not need to be ostracized

• TB is dangerous but can be cured

• TB is contagious but prevention of transmission can be done

• After taking regular treatment for 2 weeks TB has no contagious potential.

• TB patients need psychological and social support in their daily relationships to

support the success of their treatment.

• The recovery of TB patients is very important to break the chain of TB

transmission

• The length of time for treatment, the severity of side effects caused by the drug
and the social impact resulting from TB, makes TB patients in dire need of
support from the surrounding environment.

2.5. INFORMATION AND EDUCATION AT THE END OF TREATMENT

At this stage the patient reaches the end of the treatment period. Patients can
recover and can also experience failure. Information and education at this stage is
intended to give credit to patients who have tried to adhere to treatment with the
expected results and also support to patients who have failed.

Appreciation for patients who have recovered can motivate patients to share
positive experiences so that it becomes motivation for other patients. Support for
failing patients is intended so that patients are not discouraged to undergo the
possibility of further therapy for healing.

Support is given to patients depending on the outcome of treatment.

1) Complete Cure or Treatment

24
Patients who have successfully recovered or completed their treatment in full must
be rewarded for their efforts so far.

Example:

"Congratulations, ladies and gentlemen have successfully completed a long and

quite difficult treatment. I am proud that you have the will and zeal to recover for
the past 6 months. Now you don't need to take medicine anymore. I hope that you
will always be healthy. "

2) Treatment Failure

Patients will need family support and counseling to deal with the results of failed
treatments.

Example:

"Mr. / Ms have tried well and quite hard during this treatment. Unfortunately
these drugs do not work to kill germs in the body of the father / mother. But there
is still a chance with further treatment, sir / ma'am. "

NOW I KNOW

1. Information and education for TB suspects:

a. 1. TB Disease.

b. 2. TB can be cured.

c. 3. People suspected of TB.

d. 4. Examination that must be endured.

e. 5. Prepare the patient to receive the results of the Lab examination.

f. 6. Prevention of transmission.

2. Information and education for TB patients:

a. Initial Meeting.

25
1) TB disease.

2) Tb can be cured.

3) Willingness of patients to undergo treatment.

4) How to prevent transmission of TB.

5) Domestic contact.

6) Need for supervision to swallow the drug.

7) Explain drug alloys.

8) Follow-up Examination at the end of the initial stage.

9) The possibilities that occur during treatment and the actions that must be do.

10) Clean and Healthy Behavior (PHBS) in TB patients.

b. The Advanced Stage throughout the Treatment:

1) Drug Side Effects.

2) Type, Color of Packaging, Amount and Frequency of Medication.

3) The importance of patient compliance.

4) If the patient swallows only partially swallowed the drug or stops swallowing
the medicine.

5) The importance of sputum examination, frequency and meaning of examination

results.

6) Clean and Healthy Behavior (PHBS) in TB patients.

3. Information and education to families:

a. The role of the family in medicine.

b. Messages that must be conveyed to the Family.

c. Subsequent visits during the treatment period.

26
4. Role of PMO in Medicine:

a. Making sure the patient swallows the medicine according to the rules from the
beginning of the treatment until healed,

b. Accompanying patients during consultation visits to health facilities and

providing moral support to patients in order to undergo complete and regular
treatment,

c. Remind TB patients to come to the Health Center to get medicine and check the
sputum according to the schedule,

d. Find and recognize the symptoms of side effects of OAT and contact a health
facility.

e. Provide counseling about TB to patients' families or people who live in the

same house

f. Identify the existence of close contact with TB patients and what should be done
about these close contacts.

5. In the Surrounding Environment and Other Health Officers

a. TB patients do not need to be ostracized

b. TB is dangerous but can be cured

c. TB is contagious but prevention of transmission can be done

d. After undergoing regular treatment for 2 weeks TB has no contagious potential.

e. TB patients need psychological and social support in their daily relationships to

support the success of their treatment.

f. The recovery of TB patients is very important to break the chain of TB

transmission

g. Lamanya waktu pengobatan, beratnya efek samping yang ditimbulkan obat

serta dampak sosial yang diakibatkan dari TB, membuat pasien TB sangat
membutuhkan dukungan lingkungan sekitarnya.

27
6. At the End of Treatment

Support is given to patients depending on the outcome of treatment.

a. Cure or Complete Treatment

Patients who have successfully recovered or completed their treatment in full must
be rewarded for their efforts so far.

b. Treatment Fail

Patients will need family support and counseling to deal with the results of failed
treatments.

28
 CHAPTER 3

INTERVIEW

Eki : good morning sus

Rt.bilkis : good morning Sir, how can I help you?

Eki: I want to consultation about my health, Sus

Rt.bilkis: ok sir, please mention your name, address and date of birth, Sir?

Eki: eki syaefullah fatah, 19 years old.

Rt.bilkis: What are your complaints?

Eki: weakness, my chest is pain when i cough, sometimes I feel fever, no appetite

Rt.bilkis: How many coughs have you had?

Eki: It's been 3 weeks, sus

Rt.bilkis: Have you ever taken medication or taken medicine?

Eki: not yet sus

Rt.bilkis: yes sir, please enter the examination room

Eki: good morning doc

Bilqis: morning sir, sit down please

Eki: thank you

The doctor looks at the patient's history

Bilqis: Did you smoke before?

Eki: yes, I am smoke

Bilqis: Oke. During coughing out blood or dry cough?

Eki: dry doc, but his chest is tight

Biqis: Alright, I'll check it first, breathe out slowly, Dad

Eki: breathe in

Bilqis : yes sir, to find out what your problem, I’ll suggest you to do x-ray to
your lungs. You can come here and find out the results tomorrow, while I make a

29
prescription of the medicine first. (submit prescription drugs) you can redeem at
the pharmacy

Eki: yes, doctor. thank you

Bilqis: yes, you're welcome, hopefully get well soon

30
 CHAPTER 4

CLOSING

4.1 Inference

TB is an infectious disease caused by germs. The germ that causes TB is

Mycobacterium Tuberculosis. TB can be cured as long as the patient follows the
medication every day for 6-8 months.

There are 2 simple but effective methods to reduce the spread of TB

germs, namely:

a. cover your nose and mouth with a tissue or handkerchief when coughing or
sneezing. Coughing or sneezing directly into the hand is not recommended
because it can spread germs to whatever you touch with your hands. If there are
no handkerchiefs, cough or sneeze into the inside of your elbow or upper sleeve.
Change your clothes immediately

b. Washing hands after contact with a sick person. Use soap, water to wash your
hands and wipe or you can use an alcohol cleansing liquid without water.

4.2 Suggestion

based on the above conclusions the things that should be done while
maintaining a good lifestyle, do not smoke, change unhealthy behavior patterns.

31