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The importance of localised programmes and tailored training to tackle TB infection

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We caught up with Dr Ignacio Monedero-Recuero, Senior Consultant at The Union - who has decades of experience in TB care, prevention and delivering tailored training across the globe.

Dr. Nacho Mondero

Dr Monedero is part of The Union faculty team which has designed programmes for some of the world’s leading lung health organisations. 

In this blog, he shares his views on importance of localised programmes, why governments need to continue investing and his experiences travelling the world to further our mission to end TB.

How does the diagnosis, management and treatment of TB differ from country to country and what factors can affect this?

There is a wide variety of circumstances in countries that may critically influence TB control, and they need to be considered to adapt the response to the unique needs or existing gaps.

Differences can include epidemiologic variances such as rates of TB, resistance to antibiotics, TB in different age groups, social vulnerability and the prevalence of HIV infection or other comorbidities such as diabetes.

Other considerations that need to be taken into account include health services availability, geospatial and social circumstances plus many more. In brief, the quantity and complexity of TB, and the services and abilities available to face it.


Why is it so important for countries to have localised TB programmes in place?

Standard guidelines have been created to help both patients and medical professionals. These are general recommendations because no two countries are the same.

The universal practices included in guidelines are helpful to support the majority of patients, but in complex clinical, programmatic and social realities, we need added support.

Adapting to local reality and needs is necessary to supply an adequate and acceptable response. This is exercise of flexibility and adaptation is always needed when implementing localised TB programmes. No one should be left behind in our mission to end TB.


Equally, why is it so important for national TB programmes to seek out tailored training courses with The Union?

The Union training has been really well received over the past decade due to our ability to go the extra mile and adapt to different realities in countries.

For example, some countries present a profile of urban TB with high rates of intravenous drug use with important social problems, while other nations present rural TB cases that are managed by health care workers with low training. At The Union, we have expertise in resolving various issues relating to each nation/area.

At the same time, we can deliver training that could be highly programmatic or highly clinical depending on the nation’s requirements.

The key to success has arrived through clear communications between countries about their aims, needs and expectations. It has been possible to achieve impressive results so far due to a talented team of committed healthcare workers at The Union who boast a wealth of experience operating in many countries. The staff have a clinical and programmatic background that is supported by their ability to be flexible and offer empathy with other cultures and circumstances.

Active participation from attendees is a key factor. We work hard during training in what tends to be an intense experience for participants, but we believe that this is what our patients and programs deserve.


How many localised TB programmes have you worked on now?

It’s difficult to say. Before joining The Union in 2008, I worked for 2 years in TB and HIV programmes in Sub-Saharan Africa. I had worked for WHO as a Green Light Committee consultant alongside other roles such at IOM (International Organization for Migration) and other agencies.

If I recall correctly, I will have worked in TB programmes in more than 35 countries including Latin America, Europe, sub-Saharan Africa, Maghreb, the Middle East, and Asia.

Working in so many varying nations is tough, but it certainly helps you to think out of the box, forces you to be flexible and discover similarities/opportunities in vastly different scenarios. Travelling across the globe has been a wonderful learning experience not only in medicine but for me as a person.


How many tailored training courses have you delivered with The Union?

During the last 17 years, I have delivered at least 45-50 national and international TB programmes. Due to the pandemic, tailored training courses shifted online and became accessible to countless people. However, I am pleased that face-to-face training has resumed and that we can enjoy that level of interaction once again.


Can you name a favourite instance of delivering tailored training courses with The Union?

One of those examples would be my experience in South Africa back in 2009-2011. The Union agreed to use a train of trainers methodology, so we trained qualified physicians, the nation’s decision-makers and scientists while DR-TB was starting to be recognized as a major issue in the country. Now, more than 10 years later, South Africa has dramatically improved its DR-TB service, policies and capacities, from laboratories to PMDT sites, with an exemplary political commitment.

They have spearheaded many of the new regimens and they are among the best performers among DR-TB high burden countries. I feel proud to had contributed to that in the very early stage.

Another fond experience is a series of trainings on DR-TB management in the Philippines. In one of those trainings, focused on the management of DR-TB in children, a nurse raised her hand in the middle of the lecture and presented the case of a 4-year-old boy badly ill but with atypical symptoms yet GeneXpert positive.

After explaining viable solutions, the nurse and the Philippines team decided to place the child on DR-TB treatment. I didn’t hear back on the child’s condition for a while. A year later, right before I was due to perform surgery in the operating theatre, I received an email from the nurse with an image of Andrei; the boy mentioned during the lecture, who had survived. The nurse explained that Andrei was achieving fantastic school grades and wanted to become a health care worker. That filled me with joy.

The impact of training cannot be measured only in rates or figures, but in each individual stories too. In another life, this boy could have been my son. These things matter just as much. Nowadays, the Philippines is amongst the countries enrolling more children in DR-TB treatment.


Andrei holding a thank you note for Dr. Monedero


The Union can work with you to design courses and curriculum to meet your specific training needs, particularly in low-resource settings.  

We specialise in programmes designed to reduce the burden of lung disease from both a clinical, programmatic and organisational management perspective, which includes the management of TB and implementation of tobacco control programmes.