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Kyrgyzstan: The many faces of tackling TB

30 Mar 2016

Australian nurse Marie Reyes has recently started her second mission with Médecins Sans Frontières. She is in Kyrgyzstan working as a nursing activity manager in Osh. Here she shares her experiences working in the field with our teams.

I am now on my second mission with Médecins Sans Frontières. This time based in Osh, Kyrgyzstan, in the historically-rich culture of Central Asia. On arrival, I was met and warmly welcomed by the team of international and local staff whom I will join during the nine month duration of my mission. This first month has been all about getting to know the team and the project in depth. And with our plan of action set for the year, I have begun preparing myself for the challenging months ahead.

According to the World Health Organisation, Kyrgyzstan is among the 27 high multidrug-resistant (MDR) tuberculosis (TB) burden countries in the world. Our project is working closely with the Ministry of Health to introduce an ambulatory care model of drug resistant TB (DRTB) management. This model aims to limit the time patients spend in hospital, and improve their adherence to treatment. My work involves supervising our nursing activities (both inpatient and outpatient care) and pharmacy, which will expand in the next couple of months to absorb the activities of our Psychosocial, Education and Counselling team. I will definitely have my hands full!

"We hope that by educating the public that TB can be cured if diagnosed early will reduce the stigma associated with the disease"

We currently have a cohort of 112 DRTB patients in the Kara Suu district of Osh Oblast. This is set to increase with a planned expansion of activities this year. The project also has a community awareness arm. We hope that by educating the public that TB can be cured if diagnosed early will reduce the stigma associated with the disease. Hopefully the community will also be less fearful about seeking medical help early if they are more aware of symptoms. The current treatment for DRTB is a long and arduous journey that can take up to two years or longer. The regimen includes injections for many months and about 20 tablets per day. There are also many terrible side effects including nausea and vomiting, diarrhoea and joint pain, rash and skin discolouration, depression, and hearing loss. The medication can also affect the liver, kidney and thyroid functions, and unfortunately, the list goes on.

Understandably, not all make it through the journey. Sadly, Dilya* is one of them. She is a young woman in her 20s that simply could not adhere to her treatment. She is now receiving palliative care and our team is providing oxygen at her home to make her laboured breathing more comfortable. Dilya is a tragic example of why we need to find a shorter and better treatment regimen for DRTB. But, to keep things in perspective, despite the inherent challenges with DRTB treatments, last month alone we had seven DRTB patients declared cured! I had an opportunity to meet one of these patients, Firuza*, at a peer support session where cured patients share their experiences and encourage others who are still being treated. Firuza had regained her life, was back at work and was all smiles on the day.

"The current treatment for DRTB is a long and arduous journey that can take up to two years or longer. The regimen includes injections for many months and about 20 tablets per day"

There is definitely a lot of beauty in and around Osh. The beauty of the mountains, the lakes and the people call out to the natural explorer in me. I got to experience the traditional Kyrgyz snow shoes that the local hunters wear as we threaded along the fine snow of the majestic Arslanbob Mountains – not something I experience everyday back home! After a month-long search, I finally found someone selling guitars in the market. So for now, I’ll allow myself to take a break and strum a familiar tune, for indeed, there's much work to come in the days ahead.

*Names have been changed

 

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