Under the Global Fund Grant, the UNDP purchases quality drugs for the treatment of tuberculosis, improves diagnosis and provides support for patients to complete treatment. One of its projects, implemented by the National Red Crescent Society, consists in returning non-adherent patients to their treatment.

Kumarkul never puts down her phone for more than 5 minutes. But she’s not addicted to her smartphone, she just cares about the TB patients who may call her at any time. “Kuma,” as they like to call her, works with non-adherent TB patients in Bishkek to return them to their treatment and make sure they are cured. She spends her time chatting with them on the phone or texting them on WhatsApp, pulling out one argument after the other on why they should take their treatment and want to live.

This Friday afternoon, Kumarkul brings a wheelchair, donated by the NRCS, to one of her patients. Maksat has spinal TB on top of HIV and can’t get up after his surgery. He had interrupted his TB treatment, tired of taking both his ART treatment for HIV and the dozens of TB pills every day, sure he wouldn’t make it. But Kumarkul told him otherwise, and now he’s getting better and hopes to be on his feet soon to help his grandmother, the only person living with him in their shaggy house north of Bishkek.

Improving treatment results

Doctor by profession, Kumarkul Jumagulova has been working with the National Red Crescent Society (NRCS) since summer 2018 to help reduce the number of patients interrupting their TB treatment in Bishkek. The project, funded by the UNDP / Global Fund, has reached significant improvements: the number of patients lost-to-follow up (ie, who have stopped treatment for two months or more) in Bishkek has dropped from around 23% to only 4%. This huge step in ending TB is for a large part Kumarkul’s success.

“I never give up on patients. Even if it takes time, I know there’s a way to bring them back to treatment,” says Kumarkul. Treatment for tuberculosis, and especially for its drug-resistant forms, is very long (up to two years) and causes side-effects. Many patients lose hope if they do not see improvement, and others are in situations that make it difficult for them to take the pills every single day: financial difficulties, need to work, co-infections, migration, addictions, homelessness… But the only way to cure TB is to ensure that patients take all of their prescribed pills regularly and until the end of the treatment. 

Finding a solution to every problem

“At the beginning, we ourselves try to return patients to treatment. But if we see that our efforts aren’t successful, we ask Kumarkul to help,” explains Cholpon Abdumanapovna, vice-director of the Bishkek City TB Hospital. “She finds out what the problem is and tries to solve it. Sometimes, it’s simple. For example one of our patients just didn’t have a coat for winter so couldn’t come here when it was cold. Sometimes, it’s a more complex problem, but she almost always figures it out.”

In the 18 months she’s been working for the project, Kumarkul was asked to return 187 patients to treatment, out of which 121 were lost-to-follow-up. She found all of them and returned 71 patients to treatment. She convinced 45 others to at least get monitored regularly. 62 of the patients were taken out of the list, as it turned out they had immigrated, were already cured, or died.

“Out of these patients, 43 were from a risk group: these are homeless patients, patients with addictions, ex-prisoners, or patients with co-infections. 15 of them already completed their treatment and 23 are on treatment now, 5 are under monitoring,” says Kumarkul.

Being supportive

Kumarkul calls her patients regularly to make sure they continue taking treatment and as she says, she’s become friends with most of them. “In some cases, it took almost a year to return patients to treatment. Returning just one patient to treatment is colossal work. But now they’re cured, and all efforts are worth it,” says Kumarkul.

On top of her regular calls or visits, Kumarkul also organizes monthly peer-to-peer support groups for her patients. “I try not to scare them, but to be always supportive. I smile all the time, listen to them, build trust so they know they can rely on me. And we find a solution together.”

“I don’t know what we would do without this project,” says Dr. Cholpon Abdumanapovna. “We have a lot of patients, and we don’t have enough time to give them the attention they need to adhere to treatment. Kumarkul and the case managers talk to patients as if they were their own children. They explain over and over again why they need to take their treatment, they talk to them, support them, make them feel loved and needed…”

And often, that plays a huge role in getting cured, as says Nuraim, a TB survivor who now helps other patients: “When a person is sick, they need a lot of help. In the hospital, I saw some patients whose mother abandoned them because they had TB. I saw patients, like me, who didn’t even have sugar or tea. If you feel loved, if you have someone to rely on, then you get back on your feet really quickly. But if there’s no one around, you start to feel useless and to lose hope.”