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FROM afghanistan Helen Meville is a nurse from Wagga Wagga. She has been working with Médecins Sans Frontières on a TB program in Afghanistan since January 2003. This is her third mission with the agency, following previous postings in Uzbekistan on a TB program and Congo-Brazzaville during an Ebola outbreak. Médecins Sans Frontières has worked in Afghanistan since 1980. The TB patient program in Herat :: Today I discovered what I had guessed for about a week, that a friend of mind is dying. She is a little younger then I, thirty; she has a loving husband and has four children. Her name means mountain flower, and she comes from a country that is so different from mine. In her short life span she has lived the life that I will never understand, she is a Kuchie woman of Afghanistan. Despite the barrier of language, we developed a friendship, based on caring and acceptance of our differences. She is a patient our tuberculosis program, one of forty-six. We first meet, as she lay unwell eight months ago, on her dirt floor of her mud brick shelter in the camp for Internally Displaced Person, outside Herat. Her youngest son lying beside her, her husband sitting quietly outside the house. I was there to give her first dose anti-tuberculosis treatment, and teach the health care workers to do the same over the eight months. Slowly with help she lifted her head to take the medication, gradually she sipped the milk provided, but didn't have the strength to eat the biscuit given for extra nutrition, important in fighting the disease. I then didn't see this lady again for three months, at which time the difference was remarkable. She walked into the clinic from her house, her youngest son in toe. Her smile so wide, her teeth so beautifully white, it was hard not to be enchanted by her happiness. Her kindness to other patients, encouraging them all with their tuberculosis treatment. But sadly this happiness didn't last as her condition deteriorated, over the next several months, so that again she is no longer able to walk into the clinic. She developed fever, lost her appetite, her weight dropped so that her skin was taught across her face, her chest x-ray indicated her tuberculosis had spread and a sputum test was still positive for tuberculosis bacilli. It's hard to make sense of why her condition is failing, and not responding to our drug regimens, as she takes her drugs under supervision everyday, but ultimately it comes back to one factor, she probably has a multi-drug resistant tuberculosis. Tuberculosis is difficult enough to cure, requiring treatment of at least six months and a combination of at least four anti-tuberculosis medication. Multi-drug resistant tuberculosis is even worst, it is incurable here in Afghanistan, and that means it's a life sentence. Mountain Flower probably developed MDR-TB after taking an incomplete course of anti-tuberculosis medication bought at the local bizarre a year before I met her. She took these medications for only three months before mistakenly thinking she was better. The previous wrong treatment will cost her her life, as it has made it impossible for a correct tuberculosis treatment to be of any benefit. Tomorrow is my last day in the camp, before returning to Australia for a two-month break. Mountain flower will not be with us when I return, I will miss her, her bright smile, her warm personality, as will the national staff who have cared for her over the past eight months. When her death finally occurs it will effect everyone here who is involved in the tuberculosis program. National staff have openly cried cried for her, and have asked for a photograph so that she will never be forgotten. Such is the effect this lady has had on everyone. One of my most poignant memories was my last visit to Mountain Flower. She was lying on the ground, the act of simple movement caused her pain, bringing tears to her eyes. Her husband left me to sit with her for a while. I sat down next to this women, and she with great effort moved her head onto my leg, and there without words we sat, tears running down our cheeks. As if to signify the moment, the usual group of onlookers that follow me round the camp, disappeared as if they knew the importance what we were sharing. In amongst the dust and dirt we sat, sharing something so important, so unique that I will carry that moment forever. October 2003
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