Ambulatory Tuberculosis Chemotherapy on an Indian Reservation

¹ USPHS Indian Hospital, Whiteriver, Arizona

Forty-two White Mountain Apache Indians with tuberculosis were placed on a supervised twice-weekly ambulatory treatment program of streptomycin and isoniazid after short periods of hospitalization. Previously, prolonged off-reservation hospitalization had been the rule due to skepticism that chemotherapy could be maintained in the nonurban setting of an Indian Reservation. Although 12 percent of the scheduled appointments were missed, chest roentgenogram findings remained stable or improved and sputa cultures remained negative. No treatment failures occurred, and no patient has been lost to follow-up in spite of the great distances, cultural conflicts and serious social problems which exist. Monetary savings have amounted to an estimated $9,000 to $14,000 (104 clinic visits @ 3.75 = $389.00 VS 365 x $40.00/day = $14,600.00) per patient treated. The early results show that ambulatory chemotherapy has proved effective, well tolerated and economical in this nonurban setting.