Tuberculosis Returns

At one time we thought TB was on its way to being eradicated. Yet the disease, which in the past afflicted hundreds of thousands of "consumptives" in Europe with the most privileged seeking treatment in sanatoriums in the Alps, is coming back with a vengeance. Today the main hotbeds of its resurgence are southern Africa, southeast Asia, and central Asia, three regions where MSF teams are operating and are treating TB patients.

MSF works in Swaziland and Kyrgyzstan, where it treats patients with the disease, but its volunteers also care for TB patients in many other countries from Myanmar and Djibouti to Mozambique. While in Swaziland the combination of HIV and TB is taking a terrible toll, in Kyrgyzstan hundreds of TB patients are concentrated in the prisons: TB prevalence among prisoners is 20 to 30 times greater than in the rest of the population. MSF has been intervening since 2006 in two Kyrgyz penitentiaries where more than 1,700 prisoners were since then diagnosed and treated for the disease.

Following an anti-tuberculosis treatment is very restrictive—even more so when it is a form of the disease that is resistant to certain medicines, which is more and more frequent. In additional to medical follow-up, MSF ensures that its patients can receive their treatment in the best conditions. In Swaziland, as in Mozambique, MSF has trained "expert patients" who help other patients correctly follow their treatment through to the end. In Kyrgyzstan a team of MSF social workers and a network of volunteers bring aid to approximately 70 former patients who are ex-prisoners, so they can finish their treatment against the disease. The assistance includes advice, information, and training as well as food and money for transportation.

[Claude Mahoudeau/MSF]

Umutai Dauletova, an MSF social coordinator in Kyrgyzstan, explains that it can be difficult for former prisoners with TB to be admitted to public hospitals. "Our patients are stigmatized in their community not only because they have TB, but also because they were in prison. Some of them are homeless, jobless, alcoholics, drug addicts, and even undocumented. We're now trying to implement a case management system, a communal approach that volunteers can use to help patients adhere to their treatment."