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30 April 2019

For PhD student, J’Belle Foster, the statistics she is exploring about the spread of tuberculosis in the Torres Strait Islands are more than just numbers.

They represent the individual lives of patients she has met through her own front line healthcare initiatives.

“As I trawl through my data, I often come across individuals that I have come to know, that have been treated within our program for this disease,” said Ms Foster, the Nursing Director of Queensland Health’s Torres and Cape TB Control Unit – the first of its kind in the region – which she established in 2016.

Her joint AITHM/JCU-supervised PhD study aims to characterise the epidemiology and management of tuberculosis in the Torres Strait Islands from 1950-2020, including the emergence of multi-drug resistant TB, particularly in Papua New Guinea (PNG).

“There has been much media hype on cross-border transmission, but little academic research done on the subject,” Ms Foster observed.

“The best way I can effect change and improve outcomes in this community is by shining a light on the TB situation that is evidence-based.”

Sydney-born and raised, Ms Foster embarked on a Bachelor of Nursing degree at the University of Technology in Sydney in 2007 and was focussed on acquiring skills to work in the developing world. She went on to obtain both a Master of International Health and Master of Public Health from the University of New South Wales, before working throughout the developing world on TB and public health projects.

Ms Foster returned to Australia in 2013 and worked as a TB Clinical Nurse Consultant with Queensland Health in Brisbane, before seizing the opportunity to return to the field. She moved to Thursday Island in 2014 to work on a Federal Government-funded Australia/PNG cross-border TB project, which led to her current role.

“I am in the very fortunate position that my PhD is directly aligned with my nursing role,” she said.

“I frequently identify issues in the TB Control Program and make a note to follow it up within my PhD and vice versa.”

There is evidence that primary transmission of TB is occurring in the cross-border region, with some 27,000 PNG nationals visiting the Torres Strait Protected Zone (where local Indigenous residents from both Australia and PNG may move freely – without passports or visas – for traditional activities) each year.

Tuberculosis in PNG, including Daru Island, (where the general hospital handles the referral of all PNG national TB patients diagnosed in the Torres Strait) has been declared a public health emergency, with rapidly rising rates of multi-drug resistant TB.

“We know that there are various risk factors that perpetuate high rates of TB, and most are found within the cross-border region,’’ Ms Foster said.

“These include poor nutrition, overcrowding, treatment delay and interruptions, co-morbidities, personal financial constraints, disrupted health services and limited human resources.’’  

Within the first two years of operation, the Torres and Cape TB Control Unit handled 959 patient consultations, not including TB vaccinations.

Community support plays a crucial role in both Ms Foster’s research and work roles, with many residents highly anxious about the risk of TB infection and/or reeling from the impact the disease has already inflicted on their families and villages. In fact, community consultation helped to form her PhD research proposal.

“Although I live and work in the Torres Strait, I have a different connection to the place than locals, and what I may see as a priority may not be the same as for community members,’’ she said.

“So, consultation with community members has helped me to shape my research proposal to best provide answers important to them.

 “I firmly believe that there is no point in doing research, if it isn’t going to benefit anyone.

“I don’t want a PhD that just collects dust on a shelf.

“Any results of my research need to be shared with the community and that is what I intend to do.” 

J’Belle Foster

JCU PhD Candidate

Queensland Health’s senior Tuberculosis (TB) nurse

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