As a logistician with Doctors Without Borders/Médecins Sans Frontières (MSF) for seven years now, Amul Rathi has been making sure that its programmes are equipped well to run smoothly. He’s worked in tribal areas of the Indian state of Chhattisgarh, in Iraq and most recently in Tajikistan, Central Asia. He shares his experience from the last assignment:
I must admit that I was at first confused when I accepted to go as a logistician to Tajikistan. I knew MSF to be an emergency medical organisation which provides assistance and aid to people affected by manmade, natural disasters or other crises. So the question that I asked myself was - what are we doing in Tajikistan? There is no news of any conflict, no emergency due to a disaster. Then why were we needed in the country? I got my answer whilst working there.
What I saw
Tajikistan is picturesque with breathtaking landscapes and impressive mountains. I remember it for being the country with the world’s tallest flagpole and the region’s largest library. Unfortunately, I also remember it as being notorious for multidrug-resistant tuberculosis (MDR-TB), and where tuberculosis (TB) control has become a priority. Tajikistan’s children are, therefore, at risk.
There are misconceptions about TB affecting children there. For example, some people have the unfounded belief that a person can be infected by TB due to the cold, and that children get it from swimming in the cold waters of the rivers. It is likely that they will not be ready to acknowledge that children can be affected by MDR-TB (because it’s so difficult to diagnose them and prove they have the disease).
There are other factors too. The country’s hospitals are overcrowded and underfunded. The climate as well has a big role to play as family members have to stay together in heated rooms without proper ventilation during the harsh winters.
MSF has been running a comprehensive pediatric TB and MDR-TB programme in Tajikistan since 2011. Activities were expanded to Kulyab (Kulob) in mid-2012, where I was based. I helped my team with the logistics and administrative needs of the project. We were a small team of three international staff - a medical doctor from Greece, a nurse from the US and me. When I arrived in Kulob, winter was approaching soon and we expected only six hours of regular power supply to fuel the heating system, so I was also in charge of the living and working conditions of all the staff.
As I put on the mask
I cannot forget my first visit to the Kulob pediatric hospital. My medical team was going there and I joined them as I wanted to see the wards and the hospital. As soon as we reached, my colleague asked me: “Do you have a mask? Has someone done your ‘fit test’?” A ‘fit test’ is performed so that the respirator mask that best fits a person’s face can be given.
I said: “No, but give me the regular size mask.” It took me some time to properly wear the special mask and get used to it; I could hear every breath I was drawing in.
We entered the ward, and I let the medical team lead. The room was full of people with white coats and covered faces. I tried to imagine how intimidating it could be for a child to see one such person with a white coat coming near, seeing only the mask inflate and deflate as the medical caregiver asked him or her to take medicines on time and regularly. I’ve heard an anecdote of how a mother tries to stop her children from crying or throwing tantrums by asking them if they want to be taken to the doctor for an injection. But it seems in Tajikistan, children will soon start being afraid of a doctor with a mask!
Personally, it was hard for me to see the very high need for pediatric TB treatment in the country.
We’re a team
The remarkable thing about working in MSF is the bond that you have with the team. As a logistician, my involvement in the medical part of the programme was very less. Yet I shared the same frustration as my medical colleagues – the realisation that children were dying due to a disease which could be treated.
So at the MSF project, we tried our best to reach through to people, make them seek treatment for their children who had MDR-TB, sometimes providing transportation costs and food as well to motivate them. We were also in touch with the local authorities so that medical care was available for the children.
As a colleague said: “It’s weird what we are seeing in Tajikistan. The work we are doing is real, but it feels like it’s not. You think there is understanding about tuberculosis, but then there’s not as much as is needed. It’s like the landscape of the country - it looks unreal, it looks like maybe you are on the moon, but you are not.”
Also read about Amul’s time in Iraq and Chhattisgarh here.