Resistance

The return of TB to the painful honour roll of global epidemics is accompanied by an even more worrisome phenomenon: the emergence of forms of the disease that are resistant to standard treatment (MDR-TB). These treatments, antibiotics discovered during the mid-twentieth century, are no longer effective and, when confronted with the resistances developed by some patients, health workers must prescribe a much longer and more difficult treatment. Moreover, recovery is not always guaranteed. "These patients receive injections every day for an average of six months, and their treatment, which is based on multiple tablets, can last up to three years with numerous side effects," explains Dr. Hermann Reuter, an MSF volunteer in Swaziland. These side effects range from unpleasant to unbearable, or even dangerous. Several TB medicines have horrible gastric effects, causing sudden nausea, and may lead to dysfunctions in the kidneys and liver. The only way to fight these side effects is to take even more medicines in addition to the already extremely high number of daily pills.

"It was a nightmare. You can't even imagine how hard it was to take the medicines," says Ruslan, a former Kyrgyz prisoner who was cured of his MDR-TB by MSF. "You want to sleep, but you can't. You're tired, you have heartburn….you vomit, but you don't feel better. I took the medicines even if I was at my worst, but my former cell mate couldn't continue. The side effects were unbearable for him."

Every year 120,000 people around the world die from MDR-TB, while nearly a half-million new cases are identified. Among those, 97.5% do not have access to an appropriate diagnosis or treatment and must live from day to day with this infectious and potentially deadly disease. The number of patients with forms of drug-resistant TB is climbing. Most patients contract MDR-TB because they are not properly treated. However, more and more people are first infected with a resistant strain of the disease.

Faced with the threat of the worldwide resurgence of the epidemic and its malicious alliance with HIV/AIDS in certain regions, MSF can not just treat patients. The organisation also acts so that the disease can be treated more easily and more quickly. "We're fighting on several fronts in our discussions with governments, the WHO, and pharmaceutical laboratories," asserts Dr. Frauke Jochims, a referent doctor for TB at MSF headquarters in Geneva. "On the one hand, better tools for detecting and diagnosing TB need to be developed, especially for resistant forms of the disease. On the other, it's clear that current antibiotics are both ineffective and the cause of unbearable side effects for patients. We need new treatments and quickly, medicines that are effective and affordable for developing countries."

In Djibouti, for example, many of the malnourished children being treated at MSF's therapeutic nutrition centre also suffer from TB. Children are the most neglected among TB victims because, at present, we do not have diagnostic tools that suit their needs. MSF is insisting that laboratories develop formulas suitable for children.

The fight against TB should, unfortunately, remain a priority for MSF volunteers in the field in coming years.