Tajikistan: Helping children fight TB

Initially, I was a little apprehensive. I have worked as a clinical psychologist before, but never with people living with tuberculosis (TB).

Tajikistan is one of 27 high multidrug-resistant TB (MDR-TB, or TB that is resistant to first-line drugs) burden countries in the world (WHO). MSF runs a paediatric TB care programme in the country, providing diagnosis and treatment to children living with TB.

I spent nine months in the capital Dushanbe, as part of the mental health team. It was a steep learning curve for me, but I began to pick up the pulse of the project soon. The treatment for TB is a long and uncomfortable process, and can lead to side effects such as nausea, anxiety, palpitation, headache and gastric issues. The mental health team’s responsibility is to provide nutritional and psychosocial support keep the patients motivated through an arduous treatment course.  

Since the treatment for MDR-TB can take up to two years, it keeps children from going back to school, affecting their overall physical and mental development. For example, 4-5 year olds undergoing treatment won’t go to school till they are 6-7 years old. We had children in the inpatient unit who couldn’t tell red from yellow, or yellow from blue. Many of these children also come from very impoverished homes and thus do not get developmental stimulation even at home.

To ensure that a child’s development does not suffer during the course of the treatment, MSF runs a therapeutic play programme for children. The mental health team organises regular group sessions with children involving development stimulating activities, such as storytelling, drawing, handicrafts, or in the form of games. These sessions serve as a channel for them to counter the emotional stress of being away from home, deal with the isolation of having lost their parents to TB in many cases, and simply know more about how to cope with their illness.

One time in the inpatient unit we had a group of seven kids between 1 and 3; these were children who had begun to walk when they came to us but had regressed because of hospitalisation. To get them back to walking we worked with mothers showing them how to stimulate the child. The tendency for parents is to carry their child because he is sick, so whatever opportunities there are for him to reach his development milestones get further reduced.

Typically, in hospitals one is always advised that if you are sick you stay in bed. But for us it was really important to educate the parents that, ‘if your child has the energy it’s ok for him to go and run about; if he is unwell, he will stop himself.’

I also worked proactively on patient education resources. It was also my way of coping because I liked the creative process; when things were getting challenging, that was my escape. Just before I left, we finished a board game where we made these cards to say, for example – ‘Í take my drugs every day at the same time’, and anyone drawing it would move forward 3 spaces.

We wanted to engage with the children by not simply sitting and lecturing them, but in an age- appropriate way. The game was the best way to reinforce messages you want patients to understand.

I also advocated for getting a full time trained teacher in the hospital who could properly address the children’s need for education, help them develop the social skills necessary, and further motivate them to go back to school. Just before I left, a teaching vacancy was announced in the hospital.

These are changes I am proud to have been associated with. Their treatment would still go on, but through some of our interventions we were able to make sure that not all of their childhood was lost to disease. That is immensely gratifying.