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The willingness to serve people and the thrill of travelling motivated Satish Devkota to work with Doctors Without Border/ Médecins Sans Frontières. Chechnya in the Russian Federation was his second assignment; an unseen land for him with a familiar problem – tuberculosis. He shares his experience:
I have watched the conflict in Chechnya and its aftermath unfold in daily news bulletins. So the opportunity to go there on an MSF assignment found me asking this question — what is it like to live and work in a difficult setting? Â After two years of both challenges and achievements, of helping people to recover and trying to become a better doctor, I can best describe this time as special.
The little bit of nervousness that had irked me when I arrived disappeared soon. I settled in the MSF hospital for tuberculosis (TB) patients in Grozny, the Chechen capital. It was my responsibility to make sure that treatment was up to standard at the healthcare centre and consistent with procedures adopted internationally. In the 11 years of my career as a doctor, this project proved the most hectic for me. There was just so much to be done: reviewing patient progress, finalising protocols that would be used while attending to them and conducting meetings.
The context
All of us at the hospital were fighting against a disease that has taken deep roots in Chechnya. As the healthcare system stumbled in the worst phases of the conflict, people had only a few centres to go to for treatment. If there were symptoms, there were not enough qualified doctors. Years after the second war has ended, the easy availability of medical services is still a problem and trained professionals are in short supply.
Other factors have played a part too. With their houses destroyed, people displaced in the conflict were forced to live in crowded locations thereby encouraging transmission of the infectious disease.
Even today some patients approach traditional healers in the hope of being cured, and over-the-counter drugs sold to treat TB are common. The use of both usually makes the case worse.
My learning
One of my most important lessons during the two years has come from dealing with those suffering from TB. Prescribing medicines is not just it and keeping patients persuaded enough to complete treatment is essential. We play a vital role in this– listening to patients, reassuring them in tense situations and counselling them against abandoning the medicine course.
Summer months were uncertain times for us in the hospital. Some patients who had started on the recovery path would leave for employment purposes and miss out on completing treatment. While job opportunities may have been better in this period than the winters, these people more often than not came back with complications.
Then the question was– How do you convince a patient to opt for treatment of a life-threatening disease if their priority is not that? My team set about trying to find a solution to this. We devised a plan to identify those who had left and were receiving treatment at their homes so that some of us could motivate them. If need be, we tried to facilitate options where they could be properly looked after while not leaving their jobs.
That’s the thing about difficulties. There will be negative aspects, but you have to adapt and find solutions.
Taking a step towards recovery
In this respect, it has been heartening to see the way Chechnya is rebuilding itself in spite of tough challenges. It is one particular experience, of a man who had been our patient at the Grozny hospital, which stands out for me though.
He had worked as an electrician in a healthcare centre for tuberculosis patients for many years and had developed multi-drug resistant TB by the time he retired and came back to Chechnya. Failing to take the necessary precautions to prevent infection can be risky, and two hard years of medication were now ahead of him. Yet he saw the entire course through with determination. He hasn’t stopped at that. He assists us in educating hospital staff on the need to take proper measures: a positive example that everyone can follow.
I cannot say if others would have done the same. In Chechnya, stigma makes the situation complicated for people living with TB. In my experience, many of them fear the reaction of relatives and others who may get to know about their condition. This is also why patients are sometimes reluctant to return home.
In the future
Such issues don’t have easy answers. Yet efforts are being put in to address others.
Bridging the gap between the requirement for and shortage of medical doctors is one of the pressing concerns in Chechnya. To help to some extent, MSF provides experts who train and refresh the skills of doctors who are currently present there. We are also working closely with the government so that quality healthcare is easily available.
A new experience
I will like to sign off by making a mention of the people that I met during the assignment. As busy as we were, off-time saw different nationalities playing table tennis or humming tunes from each other’s music archives. My challenge was to strengthen the foundation of the MSF programme; among the opportunities for me was refining my managerial ability by working with diverse cultures and people. I thus had entirely new experiences while making use of my previous knowledge too.
I had first heard of MSF’s work during my graduation years over a decade ago. The aspiration to acquire additional skills prevented me from joining then. As days turned to years, I became engrossed in the routine of a medical doctor.  But the wish to work with MSF persisted and ultimately won. Now, I am eagerly waiting to begin my third assignment, and Chechnya will always be a memorable journey for me.
Satish Devkota’s first assignment with MSF was in Uzbekistan. Prior to this, he has worked in Nepal for a few years as a general physician.
