Tuberculosis: fighting an ancient plague
On February 10, 2014, 33-year-old Damir swallowed his last handful of pills to complete 26 months of tuberculosis treatment, 20 of which he spent hospitalized and separated from his wife and two young children.
Damir’s nightmare began four years earlier while working in construction in Astana, Kazakhstan. When a colleague collapsed at work one day with tuberculosis (TB), Damir wasn’t too concerned about his own health. He worked for six more months before he returned to Kyrgyzstan to see his family and then headed to Moscow for another job. But a pre-employment physical check, which included a TB screening test, detected a small spot on his lung. Diagnosed with TB, Damir’s employment contract was revoked. Since medical treatment was expensive in Russia and Damir wasn’t experiencing any health issues, he declined treatment.
- Damir is among the 26% of all TB patients in Kyrgyzstan who have multi-drug resistant forms of TB.
- In 2013, the successful treatment rate of MDR-TB patients in Kyrgyzstan increased from 42% to 56% and the positive trend continues in 2014.
- UNDP in Kyrgyzstan implements the Global Fund programme to fight TB supporting consolidation and expansion of the Directly Observed Treatment, Short-course (DOTS).
Tuberculosis is a bacterial lung disease spread from person to person through germs in the air, usually when a person coughs, speaks or sneezes. Symptoms include fever, weight loss and a chronic cough. Early treatment prevents the progression of the infection and the possibility that it will develop into drug resistant forms of TB.
Damir worked illegally in Russia for several months before returning home. A test in Kyrgyzstan confirmed his TB diagnosis, but because the spot on his lung hadn’t increased in size and he still felt fine physically, he refused treatment again. But soon after, pain in the abdomen prompted Damir to seek medical help. The doctor diagnosed him with a liver problem and recommended that he changed his diet. Damir gave up meat and fried foods. Although this temporarily relieved the pain, a few months later he developed a fever and began coughing up blood.
A visit to the National Centre of Phthisiology (NCP) in Bishkek revealed that the spot on Damir’s lung had increased in size. Diagnosed with multi-drug resistant TB (MDR-TB) he was admitted to NCP for long-term hospitalization. He began an extensive and complex treatment regimen that involved up to 20 pills a day plus a daily painful injection.
The World Health Organization (WHO) estimates that about 26 per cent of TB cases in Kyrgyzstan in 2012 were MDR-TB with 68 per cent of those as retreatments.
In 2013, the successful treatment rate of MDR-TB patients increased from 42% to 56% and the positive trend continues in 2014. UNDP-managed Global Fund TB programme in Kyrgyzstan is a big contribution to this positive trend. The programme supports consolidation and expansion of the Directly Observed Treatment, Short-course (DOTS) with a focus on drug resistant forms of TB. Also, as part of the programme, UNDP helped to introduce a new mechanism to provide bonuses to health workers for achieving programme indicators and motivation payments for patients committed to treatment. Moreover, for the last two years, UNDP purchased 1,530 courses of treatment for MDR patients and procured drugs to treat the side effects of anti-TB drugs. For the first time in Kyrgyzstan, third-line treatment drugs were purchased to treat patients with highly drug-resistant TB.
Spending almost two years in isolation was difficult and lonely, says Damir. Fortunately, his wife brought home cooked meals to the hospital and relatives helped the family financially. Most importantly, Damir complied with the treatment. For him, the side effects of the medication were minimal and each day he walked or did some form of exercise to keep him sane.
“If you have TB, the most important thing is to follow the treatment,” said Damir. “I saw so many patients who didn’t take all their pills because of the side effects or started treatment earlier than I did but stopped because they felt better. Then, I’d see them back at the hospital again.”
Following his release from the hospital, Damir continued the treatment at home, including daily clinic visits, for six months. Doctors followed up with all the necessary tests to ensure that the tuberculosis treatment had been successful.
In July 2014, doctors gave him the all clear. Only a small scar remains on his lungs. Happy to be reunited with his family and working again, Damir says that for the time being he’ll remain in Kyrgyzstan.