A mobile brigade visits a TB patient. Photo: Marion Biremon / UNDP Kyrgyzstan

Because of the Covid-19 pandemic, patients are facing many difficulties receiving the medical help they need. The UNDP project “Effective TB and HIV control in the Kyrgyz Republic”, financed by the Global Fund to fight AIDS, Tuberculosis and Malaria has extended its activities to continue providing the best services to people in need. Mobile brigades now help patients with tuberculosis (TB), people living with HIV and key population groups in need get quality medical care and social support regardless of the new situation.

 

Svetlana welcomes us with a hopeful smile in her small home near Bishkek, but her deep blue eyes show signs of fresh tears. Last February, her husband Alexander was diagnosed with lung and spinal tuberculosis and had a surgery. Although he takes his treatment as prescribed, recovery seems out of reach. He is bedridden and suffers from strong pains and terrible bed sores. Looking at his scraggy, agonizing body is heartbreaking. And as if the illness was not enough, Svetlana and her family have no sources of income. Her five minor children help her care for their father and sometimes, the eldest works in the fields to bring at least some bread home for dinner.

But Svetlana found her light at the end of the tunnel in September. A mobile brigade made of one health care worker and one social worker now visits her every week to check on Alexander's health and do everything they can to help the family survive. While Salya, a medical worker, checks Alexander's blood pressure and monitoring graphic, Lidiya talks to Svetlana about getting a disability status for her husband, which would entitle him to a small monthly payment that would be life-saving for the family.

A mobile brigade visits a TB patient. Photo: Marion Biremon / UNDP Kyrgyzstan

Financed by the UNDP's Global Fund project, the mobile brigades were conceived as a response to the many barriers brought along by the Covid-19 pandemic for TB patients. Four brigades coordinated by the Red Crescent Society and working in the Chuy, Osh and Jalal-Abad regions, pay weekly visits to patients who cannot themselves go to health facilities to help deliver drugs, take analyses and support them in this difficult moment of their life.

Support is key

“We can’t just give patients their medication and leave. We need to make sure that they take treatment and that they’re doing fine,” says Lydia, a social worker. She helps patients with any social, judicial or psychological problem they encounter and offers a kind shoulder to lean on. “Some just need someone to talk to. I try to support them with a smile and nice words. And most of the families we work with need material support.”

In Kyrgyzstan, TB is associated with a lot of stigma. Although it is a curable disease, many patients see TB as a death sentence, and they’re also scared someone will learn they are sick. “Sometimes we have to park our car a couple of blocks away because families don’t want their neighbors to learn they’re getting help. We don’t even wear any clothes with logos, otherwise they just don’t let us in,” says Lydia. Support is key to helping patients win their fight against TB, and, as she puts it: “Someone who is positive will get better much faster than someone who is negative.”

A mobile brigade visits a TB patient. Photo: Marion Biremon / UNDP Kyrgyzstan

“The pandemic made patients vulnerable”

Because of the Covid-19 pandemic, many of these families were left in even worse financial situations and struggle to make the ends meet. Patients have also had difficulties receiving medical aid and getting monitored for their treatment due to movement restrictions. Salya, a medical worker, helps patients in exceptionally difficult situations and who cannot themselves go the health center receive their treatment at home. Most of her patients are bedridden, over 70 years old or with young children. She doesn’t just bring them their drugs but, if needed, checks their blood pressure, screens them for side-effects, informs them on TB or Covid-19, takes sputum and blood analyses for treatment monitoring and brings them to medical specialists for consultations.

“It’s a very interesting, useful and needed job,” says Salya. “Family nurses and doctors have hundreds of patients and they just don’t have the time to care for every one of them individually. Some patients in difficult situations need additional help to successfully complete their treatment. ”

Salya takes her time when she consults patients and makes sure they don’t suffer from any side-effects. She educates them on TB and explains how the treatment works, “and I always tell them that anyone can get TB. Many self-stigmatize and think something is wrong with them because they have TB.”

A mobile brigade visits a TB patient. Photo: Marion Biremon / UNDP Kyrgyzstan

Originally, Salya is a TB laboratory doctor. She can conduct tests and analyses at patients’ home and always pays particular attention to biomedical safety. After each visit, she updates the patients’ treating doctor on their condition to help them make decisions on the course of treatment.

 “I think mobile brigades are always needed, but the pandemic made people even more vulnerable. And patients now receive less medical attention because the focus switched to Covid-19”, adds Salya. In total, the mobile brigades work with 60 multi-drug resistant tuberculosis (MDR-TB) patients around the country who are seriously ill, financially vulnerable, non-adherent to treatment, encounter family problems or live in isolated regions far from medical facilities.

Giving hope

“TB treatment is difficult and needs constant control,” explains Viktoria Kanina, the TB project coordinator for the Red Crescent Society. “Because of the Covid-19 pandemic, it’s become more difficult to monitor treatment and patients cannot always receive medical services. That’s why we conceived mobile brigades together with the UNDP / Global Fund.”

Among the mobile brigades, one employee is a TB survivor. “I had TB eight years ago and it was so bad that I already parted with life. But look at me now: I’m happy and healthy. I’m so fortunate to be able to do this job, to be an example for patients and show them that TB is curable. I feel blessed to be able to give them hope,” she says. She tries to show the positive side of things to her patients, for example by telling them they now have time to spend at home, and explains that they just need more patience and everything will be fine. 

A mobile brigade visits a TB patient. Photo: Marion Biremon / UNDP Kyrgyzstan

Damir started treatment last February, just before the pandemic. Treatment wasn’t easy for him. Because most of the medical facilities were re-profiled in Covid-19 “red zones”, Damir wasn’t able to receive timely medical help and check-ups for side-effects. His hearing suddenly worsened. At this difficult time of his life, he wanted to stop his treatment. He was also scared of stigma and didn’t want to be seen at the health center every day. This is when mobile brigades came in to help.

And although he now knows that the road ahead is still long, he doesn’t give up. His smile tells of newly found hope thanks to the mobile brigade. He already gained more than 20kg and is feeling better every day, but his illness has left him unemployed and he cannot speak to others without the help of an app on his phone. “I don’t know how to find a job now,” he says. Lidya and Salya are helping him get monitored for treatment to make sure everything is going well, but also to allow him to receive the monthly motivational payment from the Global Fund that he is entitled to if he takes treatment regularly – a small financial support that will help him live until he is cured and finds a new job. 

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