In 2011, Doctors Without Borders/Médecins Sans Frontières (MSF) started a pediatric tuberculosis programme to improve access and quality of care for children with drug-sensitive and drug-resistant TB (DR-TB). The team continued to support pediatric TB care in 2013 and 2014, offering diagnosis and comprehensive care to children with TB. Here, Dr.Aravind Swaminathan shares his experience in Tajikistan.
Photo Credit : Dr. Shamsiya Mirgayosaeva
Having worked in Tajikistan for one and a half years, dealing with leishmaniasis in the first six months and pediatric tuberculosis in the subsequent twelve months, I most enjoyed the warmth and welcoming attitude of the people of Tajikistan.
Leishmaniasis is a killer disease in under-fives in Tajikistan.
"Leishmaniasis affects organs like liver, spleen, bone marrow and suppresses immunity. Untreated, the disease is progressive and is a killer disease in under-fives in Tajikistan". I particularly remember a grandfather who was teary-eyed when his two and a half year old grand-daughter recovered. At sub zero temperatures, he had to wait outside one of the local hospitals an entire night before getting referred to a hospital in the capital city of Dushanbe. The family had little hope that the child was going to survive. "The child who had clinical features of leishmaniasis was subjected to a rapid test. This came out to be negative as it happens in a small proportion of patients affected. Since clinical suspicion was strong, I performed splenic aspirate with which the diagnosis was confirmed. The child was treated and cured". Later on, the diagnostic facilities were made available in all infectious disease hospitals by MSF, so that patients didn’t have to travel far for treatment. MSF, in coordination with Republican Tropical Disease Center of Tajikistan, formulated the protocol, conducted training for health professionals and brought in diagnostic tests and medicines for treatment.
Lives we dealt with in pediatric tuberculosis care
As in many other countries, Tajikistan also faces challenges in diagnosis and management of pediatric tuberculosis. Management of drug resistant tuberculosis, whose average treatment duration ranges between 18-24 months, poses unique challenges. I recall a teenager diagnosed with Extensively drug resistant tuberculosis (XDRTB) who stayed in hospital for more than six months, most of the time on oxygen support, which severely restricted her mobility. She had already lost her mother from the same disease while others in her family rarely visited her. She also had psychosocial issues that were difficult to manage. Despite all efforts by the team treating her, she succumbed to the disease. Throughout this time, the team comprising members from the Ministry of Health (MoH) and MSF were with the child affording all possible medical and psychological support till the very end. The toll of the slow and silent killer spreads wide.
But there was also success in the case of a nine month old baby who was diagnosed with multi drug resistant tuberculosis (MDRTB) and was successfully treated with 20 months of treatment. It was great to witness the baby stand and walk for the first time while on treatment for this severe condition, thanks to the concerted efforts of the MoH and MSF teams.
I recollect another family where two sisters were on treatment in our cohort. The elder sister not only took care of her children, but also exhibited much grit to stay focused on how she could improve her treatment response. Her younger sister, similarly motivated, too successfully completed her treatment. I remember her being a very gifted person in terms of creating arts and handicrafts, samples of which she had made while at home on treatment. This really surprised me. She would always speak about looking forward to the day when she would complete her treatment and leave for Russia to pursue a course in tailoring. It amazes me to know that it is possible to be on such a painful and tiring treatment and yet be so positive about it. I learnt what it actually meant to face difficulties with courage and determination.
Although working in Tajikistan proved to be a wonderful experience, both professionally and personally, challenges related to work and living away from family and friends did exist. However, it was the friendship and affection of the people there, especially the staff I worked with, that made the experience enjoyable besides helping me learn a lot. I’m thankful to MSF for providing me this opportunity and the people of Tajikistan for making my time there memorable and teaching me so many valuable lessons.