Geeta*, an XDR-TB patient at the MSF clinic at Mumbai, photographed at her home. Patients face stigma that can cut them off from their families and communities. The masks they wear while infectious adds to their sense of isolation. The intense tropical heat makes the mask extremely uncomfortable to wear.
Doctors Without Borders/Médecins Sans Frontières (MSF) delivers healthcare to people with HIV/AIDS and tuberculosis (TB) in bustling Mumbai, where such services can be difficult to access for many because of lack of availability, the cost of treatment and the social stigma associated with the diseases.
We set up a medical centre in Khar area to provide free healthcare for marginalised groups like transgender communities. We assist people with complex medical conditions, such as those who are HIV-positive and co-infected with TB or hepatitis C. The illness is hard to treat in these circumstances and we offer new combinations of drugs as second and third-line treatments.
Doctors, nurses, counselors and other staff hold regular meetings at MSF’s Mumbai Clinic. The facility cares for patients infected with DR-TB and HIV. Concurrent infection with both diseases is common. Treatment for DR-TB alone takes two years and has awful side effects, making it difficult for patients and caregivers alike to manage.
MSF India also works with people who have developed drug-resistant tuberculosis (DR-TB), strains of the disease which do not respond to the usual drugs, and which are difficult and expensive to tackle.
Rama*, co-infected with XDR-TB/HIV, gets a routine check-up. By the time patients reach the MSF clinic, they are often critically ill. In their long journey to find appropriate care, they may have survived incomplete or incorrect treatment and used up their financial resources.
Supporting patients through treatment
Rama* is just one of a growing number of Indians with DR-TB. A large number of TB formulations are available and irrational prescription practices by private medical services has played a significant role in the emergence of DR-TB in India. Poor compliance to World Health Organization (WHO) treatment guidelines is common among private doctors in India
DR-TB treatment can be hard on patients and have severe side effects. To help them stay motivated, our counsellors offer psychological support. We follow-up on patients with home visits when they are unable to come to the clinic.
MSF offers both medical and psychosocial services to help DR-TB patients cope with their lengthy treatment and the disease’s profound impact on their lives. Here, an XDR-TB/HIV patient speaks with an MSF psychologist.
A patient support manager speaks with a newly admitted patient. “I cry every day,” said one woman of her response to the injections and pills she receives for DR-TB at the clinic. Another patient described treatment as being “as bad as or worse than the disease itself.”
Advocacy
An HIV/MDRTB patient waits to see the doctor for his regular check-up. MSF’s advocacy work on DR-TB includes demanding more tolerable, effective and affordable treatments. So few people with TB now receive complete, effective diagnosis and treatment that drug-resistant forms of the disease are increasing.
MSF India conducts operational research to improve disease prevention and care for patients. We also advocate for public policy change in favour of better alternatives for them.
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*indicates that the name of the patient has been changed to protect their privacy.
All photos by Sami Siva.
