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FROM afghanistan Helen Melville is a nurse from Wagga Wagga, who has recently returned to the city of Herat in Western Afghanistan for a second ‘tour of duty’ working on a tuberculosis program. This is her fourth mission, following previous postings in Uzbekistan and Congo-Brazzaville. Médecins Sans Frontières has worked in Afghanistan since 1980. Last week I returned to Afghanistan after a two month break. The weather has become cold and bitter, and violence towards NGOs has increased around the country. For our safety travel has become more and more restricted. However, I was still able to return to Mashlakh camp to commence another tuberculosis treatment for the camp population of internally displaced people. The screening for patients had commenced whilst I was away and has exceeded all my expectations: it is well organised, professional and accountable. The national staff have truly taken on this venture. Every time I think about what they have achieved my eyes water with pride. It is now truly their project. But before any treatment could start, the staff took me to a grave, so I could say goodbye to a friend - ‘Mountain Flower’ who had died whilst I was away. The national staff explained that she died a week after she completed her tuberculosis treatment. Her failure to respond to her treatment, indicates that it is very likely she had multi-drug resistant tuberculosis. The drug resistant form of the disease is incurable in Afghanistan. Quietly we sat on a wind-swept plain beside the grave, blankets and burkas pulled tight against the bitter cold, thinking about what is lost; her bright smile and warm personality. And then we think of her two lively children. Two days later treatment began for approximately 40 residents of Mashlakh camp. For some patients this is their last hope of a cure. Unfortunately it may be too late for many of the patients. They may have taken anti-tuberculosis drugs before, buying the drugs directly from the market, but may have failed to complete their course. Treatment for tuberculosis should be for six months. If medication is only taken for short periods of time – a week here or there – it greatly increases the risk of multi-drug resistant tuberculosis developing. Today is discharge day for a man who I consider more of a friend then a patient. He has photos of my family and I have photos of his. Against insurmountable odds he stayed to complete a treatment lasting 13 months. In that time he sent his family home, suffered terrible homesickness, and was robbed completely of all his possessions - including the windows and door of his shelter. He is completely cured and now walks upright instead of being carried in a wheelbarrow. We say goodbye. We are both crying and at that moment it is all so, so beyond words. March 2004
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