Name :
Designation :
As a medical doctor with Doctors Without Borders/ Médecins Sans Frontières (MSF), Dr.Srinivas Rao, has always wanted to serve medically neglected people. Having studied medicine in Ukraine and being able to speak Russian, he was well received by the people of Nukus in Uzbekistan and worked on the multidrug-resistant tuberculosis (MDR-TB) project for a year. Here, he writes about his professional and personal experience on his first International assignment with MSF.
Welcomed warmly, I was surprised to see how big the TB problem is in Uzbekistan
Having studied medicine in Ukraine and being able to speak Russian, I was well received by the people. They’re friendly and ask a lot of questions about India and its culture. I felt comfortable in the project, my team was very happy since I could speak to them directly without the help of a translator.
Uzbekistan is one of the many countries in Central Asia with high-levels of drug-resistant TB (DR-TB). Unfortunately, in Nukus, we had MDR-TB cases, which required 20 long months of treatment. The area where I was supervising had 110 MDR-TB patients. MSF has run TB projects in Karakalpakstan for the past 16 years, currently with a 17-member expatriate team and 130 national staff.
Cure was the greatest motivation
Many incidences left an impact on me; among them was a female patient who travelled 40 kms every day to reach the Primary Health Center to take treatment. This, in spite of no family support, poor financial background and side effects. Yet, she never missed a single day of treatment. All she wanted was a cure and that was her motivation, and she was fighting for that. Every time we spoke to her, she got emotional. Eventually, we managed to organize the treatment in her hometown and she was happy about that.
Challenges in curing Tuberculosis in Nukus
Many patients don’t want their faces photographed, as there is still a lot of misperceptions and stigma attached to TB.
Photo credit: Misha Friedman
The duration of the treatment, its pill burden and the side effects are the main challenges in treating TB. Non-adherence sets in, as most of the times, patients stop taking drugs due to side effects and sometimes they feel the treatment is too long. It is very challenging to help them begin again with the treatment.
If there is one thing that stayed with me from the experience, they were local beliefs of treating TB. People always believe in the traditional way of treatment everywhere. Some there believed consuming dog meat or fat will cure TB, and they would stop taking TB medication. It was very difficult to make them understand that that’s not a real cure for the disease. In fact, one patient asked me to bring wolf fat for him since they don’t find any wolves there. Another challenge was the stigma attached with TB, wherein sometimes, married couples separated, and later divorced, if one of the partners was diagnosed with the disease. A few such incidences happened during my time there.
But perhaps the most recurrent challenge was that despite repeated counseling, patients stopped taking drugs and later when severely sick, asked to restart TB treatment. Unfortunately, we didn’t have any new drugs to start treatment, since these patients were mostly undergoing treatment for MDR-TB, making us feel helpless
Lot of patience required working as a Doctor working to cure TB
Professionally, I learnt a lot and saw how difficult it is to treat MDR-TB. It requires a lot of patience to work as a doctor working to cure MDR-TB, since every patient needs regular follow up until the treatment is over. Personally, I learnt how to work as an expatriate and manage the team. It was a good experience working with different people in a different country.
MSF is fighting against a very difficult disease. I never expected to see so many MDR-TB cases in Uzbekistan, and MSF is doing great job to bring down the number of cases and cure them. Despite difficulties at the field level, we are continuing to support the community and I’m very proud of that.
