Nurses play a key role in the treatment of tuberculosis (TB): for up to two years, they are the ones who administer the prescribed treatments to patients on a daily basis, watching them take all of the pills and keeping an eye out for side-effects. The time and care that nurses dedicate to each patient can literally save their life: by warning doctors if patients skip treatment or badly tolerate it, or by organizing financial, social and psychological assistance for those in need, they help each and every patient beat TB.

Recently, 46-year-old Yryskul helped a mother and her children get admitted to a TB sanatorium in Cholpon-Ata, on the north shore of Lake Issyk-Kul. “They all have TB in the family; the youngest is only one year old. And they live in bad conditions: they rent an apartment that doesn’t even have any windows. The children have very low levels of hemoglobin since they cannot afford balanced diets.” Yryskul, who actively fights for each of her patients, helped them continue their treatment in the hospital, where they can enjoy free housing and meals and get back on their two feet.

Yryskul, a TB nurse in Novopvolovka, shows particular devotion to her work and patients. “You need to spend at least half-an-hour with each patient every day. You shouldn’t just give them their medications: you have to talk to them, to convince them and explain, so that they’ll continue taking their treatment for two years.” Treatment for drug-resistant tuberculosis is particularly long and difficult, and, to be efficient, requires being taken every single day. This is where nurses come in, and help patients win their fight.

“Some patients have problems at home or in their families. I take the time to know them, to gain their trust, and when I see that a patient has difficulties, I turn to the village administration or to NGOs for help. Sometimes, patients don’t even have money for the daily bus ride to the hospital.”

Life-saving support

Despite her small salary, Yryskul loves her job: “I like helping people, and I try to support all of my patients,” she says. Where there’s a will, there’s a way may well be her motto. With her relentless determination, she was able to get a young woman from a poor family back on treatment: “She didn’t come to the hospital for a long time. We went to her home, but no one answered when we knocked on the door. We went there in the mornings and in the evenings. Finally, one day, we found her, and were able to persuade her to take her pills. When we asked her why she didn’t come, she said that she didn’t even have any shoes.” Yryskul got her the support she needed and even brought the pills to her home. “Now she’s been taking treatment for 16 months and her analyses show great improvement.”

“Patients really need support. You need to at least ask them how they are doing,” says Yryskul, who’s already received several gratitude letters and certificates for her excellent work. “If you’re in a bad mood and rudely give them their pills, they may not come back. But if you talk to them, they’ll understand how important treatment is, and even if they move, they’ll come every day to take it.” Yryskul always tries to motivate her patients by showing them their analyses and the improvement in them. She sometimes shows them the X-Rays of cured patients, or even puts them in contact with each other for encouragement.

Yryskul wishes that people would learn more about TB and treat patients with love and understanding. “Because of stigma, some patients are afraid or ashamed to say that they have tuberculosis and ask for help. They may not even tell their loved ones, and they have no one to talk to except for us. They are truly dear to us. Patients and health care workers need to be like relatives,” she says.

“Good words also cure”

A feeling shared by Begayim, a TB nurse in the capital: “When patients come, we talk to them like we would talk to relatives, to family or to friends. It’s important to ask patients about their health, since many don’t take the first step.” Begayim has been working in the Bishkek TB Center for the past 23 years. She looks with concern at the young woman who’s just left the room with a toddler in her arms. “We ask them how they take their treatment, how they feel. If they complain about anything, we send them to the doctor. It’s crucial to identify side-effects early on.” Side-effects are one of the main reasons why patients stop treatment, risking their own lives and others’, too.

Begayim remembers how surprised she was when one of her patients, a retired soldier, “perfectly adequate”, started acting strangely. “He came to take his treatment every day. He never skipped it, he was never late. But one day, he told us that he saw a grandpa constantly walking by his side – it turned out that he was having hallucinations because of one of the medications. We immediately told the doctor, who changed his treatment. And after a while, we asked him if this grandpa was still visiting him, to which he said ‘no’.”

Begayim and her colleagues always make sure that patients take their treatment systematically, and look for the right words to help them find the strength to do so, day after day. “Of course, it’s really hard for them to take all of these pills for two years. We try to convince them, to support them like we can. After all, doctors can’t force them; they can’t just grab them by their collar and force the medication down their throat.” Nurses, who are in daily contact with the patients, have to carefully monitor patients’ treatments, convince them and encourage them to go on. “I tell them to take treatment, that two years will go by quickly. Many stop treatment or categorically refuse to take the pills, and even young patients die. But tuberculosis is treatable. Every patient needs support, and this is part of our job. Good words also cure.”  

Photos: Marion Biremon / UNDP Kyrgyzstan