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Dr Harihara Subramanian recently returned from Uzbekistan, where Doctors Without Borders/Médecins Sans Frontières (MSF) provides treatment for people living with TB.
When I went to Uzbekistan in April 2016, I saw everyone wearing masks in hospitals. The doctors wear N95 respirator masks, and the patients wear surgical masks. This is unlike anything you’re likely to come across in hospitals and clinics in India, and you can be pretty sure this wasn’t always the case in Uzbekistan either. In medical jargon, this is an example of what we call behavioural change communication (BCC). It’s not easy to bring about. It takes time.
MSF has had a big role to play in bringing about this change in Uzbekistan – one of 27 high multidrug-resistant tuberculosis (MDR-TB, or TB that is resistant to first-line drugs) burden countries in the world. MSF has been a part of the fight against TB in the country for nearly two decades now.
Comprehensive Healthcare
I spent four months as a medical doctor in the Republic of Karakalpakstan, where MSF runs a comprehensive healthcare project for people living with TB in collaboration with the regional and central health ministries. By comprehensive healthcare, I mean not just diagnosis and treatment but a broad package that includes psycho-social support, infection control, and health education.
The treatment for MDR-TB is a long and arduous process, and can result in side-effects such as nausea, anxiety, palpitations, headaches, and sleep disturbances. To help people living with MDR-TB cope with these side-effects and to ensure that they do not drop out, MSF teams carry out individual and family counselling sessions. For patients who are very poor, MSF provides social support in the form of income supplementation.
MSF is also carrying out a study with the Ministry of Health (MoH) for a nine-month regimen instead of the standard two years. The results of this study will be presented later this year. This regimen has the potential to improve adherence to treatment, and the preliminary results of the study have been encouraging.
Nukus, equipped by MSF, examine slides of sputum (fluid from
the lungs of patients) to try and detect TB bacilli. The slides are
coloured with a special stain so that TB bacilli show up bright red.
Photo: Donald Weber /VII
New Drugs
MSF is also providing access to new drugs for people living with extensively drug-resistant TB (XDR-TB, or TB that is resistant to the currently available first and second-line drugs). The people receiving these drugs have typically failed to get cured despite at least two years of treatment for MDR-TB, and in some cases for up to three-four years.
As someone involved in the process of selection of patients for the new drugs, I got to see some of them up close. I remember two 16-year-old girls in particular. They had failed the standard MDR-TB treatment regimen, and a reinforced MDR-TB treatment regimen they’d been put on was also not working. So they’d been undergoing treatment for nearly three years to no avail.
Normally, when you’re diagnosed with MDR-TB you cannot go to school and you cannot work because of the risk of the infection spreading. You have to stay at home, complete the treatment and get a certificate saying you’ve been cured. So for these young girls, some of their best years had been curtailed by TB.
They had been selected for new drugs and were on treatment when I joined the project. And just before I left, I met them. They are now smear converted and culture converted, meaning they are no longer infectious. They are now waiting for their certificate.
The girls have a long way to go. When they and their families heard the news, their eyes welled up with tears of joy. Those tears belong as much to MSF.
By the time I left earlier this year, around 33 other patients were receiving the new drugs through MSF and MoH. The new drugs – the first in half a century – have proven to be a lifeline for these people.
