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Let’s get this straight; with 84,000 cases of drug-resistant tuberculosis cases, India has the highest burden of DR-TB in the world. To deal with this public health crisis, for some time, MSF has been urging countries with a high DR-TB burden to urgently start implementing the new WHO guidelines for treating drug-resistant tuberculosis (DR-TB), which recommend treatment with oral drugs only, including newer, more potent drugs with fewer side effects such as Bedaquiline. 
At MSF’s clinic in Mumbai, we have so far been able to treat 210 patients with the new oral drugs , among them 155 patients are on the combination of Delamanid and Bedaquline. The newer drugs also have fewer side effects unlike the widely-used injectable drugs to treat DR-TB that can lead to severe side effects like hearing loss and deafness. MSF’s medical activities manager Dr. Pramila Singh said patients who were put on the new drugs did not suffer from any major side effects that required hospitalisation or required the need to stop treatment.  In an article published in the Hindu she explains,   “We have put patients suffering from the most complex form of extensively drug-resistant (XDR) TB or those in a pre-XDR stage on the newer drugs. So far, our observations and reports show the drugs have not led to any major side effects. The toxicity of these drugs was much less than the widely-used injectable drugs,”.
Last month, MSF’s Mumbai project facilitated over 30 DR-TB patients— who have been cured using Bedaquiline and Delamanid. Patients present at the event advocated for affordable treatment and urged governments to provide better access to the two new medicines. This Indian Express report provides more details of the event.
 
Felicitation of patients cured of DR-TB at MSF’s TB project in Mumbai. Photo: MSF
The newer drugs are also unavailable for children and anyone below 18 years of age suffering from DR-TB. “We have seen good outcomes with these drugs. Keeping in view the high unmet need of the paediatric age group, the access to Bedaquiline and Delamanid needs to be improved for children with severe resistance,” says Stobdan Kalon, medical coordinator with MSF for the Hindustan Times.

Emergency response in Mozambique:
MSF continues to provide humanitarian aid during natural and man-made disasters in various countries. In Mozambique, more than a million people continue to struggle to rebuild their lives in flood-affected areas, many of whom are in urgent need of assistance for basic supplies to survive. Last week the government also declared cases of cholera in the city of Beira, one of the hardest hit during Cyclone Idai. MSF teams are scaling up our activities to respond to the disease, seeing more than 100 suspected cases of cholera per day. We are currently one of the main actors in delivering treatment for cholera alongside the ministry of health, with 500 cholera beds in a number of locations across the city. The response to the disaster caused by heavy flooding and Cyclone Idai will be simply enormous in scale. MSF emergency teams have started medical response activities in the region and will continue to scale up the response in the coming months. You can check out our field report here to know more.
 
An MSF team walk on foot to access a village cut off by damage caused by Cylone idai in Chimanimani. Photo: MSF
International staff stories:
We also had some interesting stories from our international staff last month. Pooja Iyer, a clinical psychologist from Mumbai, returned home after spending six months in the Balkans (Serbia and Bosnia) providing mental health support to migrants from various countries including Afghanistan, Pakistan, Syria and India who attempt to enter Europe through the Balkan route. Migrants have to traverse through extended barren landscapes and dense forests with little to no access to healthcare to enter Europe, at the risk of getting caught by border security forces who, more often than not, resort to beating and critically injuring them. Pooja points out that most migrants trying to enter Europe are victims of torture and sexual violence.
Two Syrian men cook with improvised materials at an informal settlement near Velika Kladuša, Bosnia and Herzegovina. Photo: Kamila Stepien/MSF
“Migrants leave with minimal belongings and very little to eat before attempting to cross the border. During winter, migrants are also susceptible to frostbite. We had to amputate the toes of a 15 year old who suffered from frostbite.”
                                        -Pooja Iyer, mental health manager, Doctors Without Borders

In 2017, MSF had exposed the violence that continues to be perpetrated on children and young people by European Union border authorities and police on Serbia’s borders with Hungary, Bulgaria and Croatia in a report titled Games of Violence. You can check out the report here.
“For more than a year our doctors and nurses have continued to hear the same, repetitive story of young people being beaten, humiliated, and attacked with dogs for desperately trying to continue their journeys.”
                                          -Stephane Moissaing, ex- Head of Mission for MSF in Serbia.

Pooja is presently in Bangladesh providing mental health support to Rohingyas. She has previously worked in Ukraine, Malawi and with a local NGO in Mumbai and has experience working in the field of HIV, TB, and migration. Do reach out to us if you wish to talk to or interview her! We will be sharing plenty more stories once she returns from Bangladesh, so stay tuned!
Know someone in your newsroom who would be interested in our stories? Click on the link below or email us at aditi.sonrexa@new-delhi.msf.org
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