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A breath of fresh air: New treatment regimens giving hope to XDR-TB patients in Chechnya

Photograph by Lana Abramova
MSF doctor Animesh Sinha at the the Republican TB Dispensary in Grozny, Chechnya

MSF has been running a joint tuberculosis (TB) diagnosis and treatment programme together with the Chechen Ministry of Health since 2004. MSF’s activities are focused on patients with difficult-to-treat extensively drug-resistant tuberculosis (XDR-TB) and co-morbidity diabetes and TB. MSF supports diagnostics and treatment providing medicines, laboratory equipment and supplies, as well as adherence counselling and psychosocial support to patients and their families. MSF medics and other specialists work in collaboration with their Ministry of Health counterparts.

MSF doctors Animesh Sinha and Milana Khusainova in the corridor of the XDR TB department at the Republican TB Dispensary in Grozny, Chechnya

MSF doctors Animesh Sinha and Milana Khusainova in the corridor of the XDR-TB department at the Republican TB Dispensary in Grozny, Chechnya.

Elena, 35, from Grozny city, is an XDR TB patient in the Republican TB Dispensary. She was first diagnosed with tuberculosis back in 2001. She underwent treatment, but has suffered several relapses. In December 2013 MSF diagnosed her with XDR TB. In the absence of drugs for this form of tuberculosis, she was put on standard treatment for MDR-TB. She was in a really severe condition, had difficulties breathing and had suicidal thoughts as a result of the medication.

Elena, 35, from Grozny city, is an XDR-TB patient in the Republican TB Dispensary. She was first diagnosed with TB back in 2001. She underwent treatment, but has suffered several relapses. In December 2013 MSF diagnosed her with XDR-TB. In the absence of drugs for this form of TB, she was put on standard treatment for multidrug resistant TB (MDR-TB). She was in a really severe condition, had difficulties breathing, and had suicidal thoughts as a result of the medication.

Movsar, 49, from Novye Atagi, is an XDR TB patient in the Republican TB Dispensary. In 2010 he was first diagnosed with TB and then in 2011 with MDR TB. I was told that if I followed treatment – I would get cured, he says. So I tried to follow the treatmen;, I took medicines, I had intravenous fluids. I followed the treatment strictly. But the medicines produced side effect:, all my bones ached because of these pills, I had allergies. Movsar was diagnosed with XDR TB in July 2014.

Movsar, 49, from Novye Atagi, is an XDR-TB patient in the Republican TB Dispensary. In 2010 he was first diagnosed with TB and then in 2011 with multidrug resistant TB (MDR-TB). “I was told that if I followed treatment – I would get cured,” he says.” So I tried to follow the treatment, I took medicines, I had intravenous fluids. I followed the treatment strictly. But the medicines produced side effects, all my bones ached because of these pills, I had allergies.” Movsar was diagnosed with XDR-TB in July 2014. In August 2014 he became one of the first patients to start treatment using the new drug bedaquiline. He tolerates the treatment well and despite being diabetic and having an extensively drug resistant form of TB, Movsar’s condition has improved considerably.

Malika, 48, a journalist from Grozny, was first diagnosed with TB in 1994. In 2009 she had a relapse. In 2013 she was hospitalised again. In July 2014, MSF started her on a new treatment for XDR TB containing Bedaquiline. First she felt nauseous, but after a month felt better. She is very lonely and during the two years that she has spent in hospital nobody has come to visit her.

Malika, 48, a journalist from Grozny, was first diagnosed with TB in 1994. In 2009 she had a relapse. In 2013 she was hospitalised again. In July 2014, MSF started her on a new treatment for XDR-TB containing bedaquiline. First she felt nauseous, but after a month felt better. She is very lonely and during the two years that she has spent in hospital nobody has come to visit her.

Malika, 48, a journalist from Grozny and an XDR TB patient, walking across the premises of the Republican TB Dispensary in Grozny, Chechnya

Malika walks across the premises of the Republican TB Dispensary in Grozny, Chechnya.

Ilyas, 59, a pensioner from Zavodskoy district of Grozny and an XDR TB patient on ambulatory treatment. He’s been following his treatment course for almost two years and is due to complete it in October 2015.

Ilyas, 59, is a pensioner from Zavodskoy district of Grozny and an XDR-TB patient on ambulatory treatment. He’s been following his treatment course for almost two years and is due to complete it in October 2015. Ministry of Health nurse Zarema observes his treatment daily when he comes to the local polyclinic to take his drugs. MSF supports Ministry of Health nurses treating XDR-TB patients.

Ilyas, 59 is a pensioner from Zavodskoy district of Grozny and an XDR TB patient on ambulatory treatment. He’s been following his treatment course for almost two years and is due to complete it in October 2015.

Ilyas was first diagnosed with TB back in 1975 while serving in the army. He underwent treatment several times, had a surgery on his lungs, but had numerous relapses. “Since 1997 I was on treatment every year,” he says. But the treatment didn’t work for him. When Ilyas was finally diagnosed with XDR-TB and admitted to the MSF programme in October 2013 the treatment started to work. By February his tests showed he was negative for TB. At first he experienced side effects from drugs like nausea and weakness, but gradually the side effects disappeared and now he’s feeling well. “The main thing about this disease is to keep calm and follow the treatment regimen,” Ilyas says.

Ruslan U., 43, a welder from Mesker-Yurt, Shali district, Chechnya. In 2013 he was diagnosed with TB in prison.

Ruslan U., 43, a welder from Mesker-Yurt, Shali district, Chechnya. In 2013 he was diagnosed with TB in prison. Several of his family members had TB. In May 2014 MSF put him on treatment for XDR-TB. Now he’s receiving ambulatory treatment at home and feels better with his family supporting him. He says people avoid those with TB and adds that it’s impossible to find a job if employers learn you have TB.

Sultan, 22, from Serzhen-Yurt, Shali district, Chechnya, is on ambulatory treatment for XDR TB. Raisa is a nurse in a local ambulatory clinic. She visits Sultan daily to make sure he takes his TB medicine.

Sultan, 22, from Serzhen-Yurt, Shali district, Chechnya, is on ambulatory treatment for XDR-TB. Raisa is a nurse in a local ambulatory clinic. She visits Sultan daily to make sure he takes his TB medicine. She cares for Sultan as he was at school with her son. Raisa hopes Sultan will get married when he completes his treatment and is cured of TB.

Zargan, 51, from Yalkhoy-Mokhk, Kurchaloy district of Chechnya, is an XDR TB patient on ambulatory treatment. She lives in her home village in a mountainous district with her brother’s family.

Zargan, 51, from Yalkhoy-Mokhk, Kurchaloy district of Chechnya, is an XDR-TB patient on ambulatory treatment. She lives in her home village in a mountainous district with her brother’s family. She first contracted TB 20 years ago during the war, but as hospital treatment was unavailable then she took treatment at home, but didn’t get cured. “After the war I was hospitalised many times, but the treatment didn’t help me, I felt very bad, I was constantly positive for TB. But now this last treatment when they inserted catheter I started to improve, I became negative for TB, I’m getting cured.” When Zargan was admitted to MSF treatment programme she spent first months in hospital and after the tests proved she was negative for TB was discharged to ambulatory treatment.

Yalkhoy-Mokhk village in Kurchaloy district of Chechnya. Zargan, 51, an XDR TB patient, lives here with her brother’s family. “It’s much better here at home than in hospital, there’s fresh air, there’s my family here,” she says.

Yalkhoy-Mokhk village in Kurchaloy district of Chechnya where Zargan, XDR-TB patient, lives with her brother’s family. “It’s much better here at home than in hospital, there’s fresh air, there’s my family here,” she says.

Sapikhat, 53, from Kenkhi, Sharoy district of Chechnya, is an XDR TB patient on ambulatory treatment. She lives with her husband, a teacher, and 3 children in a remote village in mountainous Sharoy district on the border with neighbouring Dagestan.

Sapikhat, 53, from Kenkhi, Sharoy district of Chechnya, is an XDR-TB patient on ambulatory treatment. She lives with her husband, a teacher, and three children in a remote village in mountainous Sharoy district on the border with neighbouring Dagestan. “I don’t know why I got tuberculosis, people here in the mountains don’t get tuberculosis,” she says.

Sapikhat was first diagnosed with TB in 2006, was in hospital several times, had a surgery on her lungs in Moscow, but in 2013 had a relapse.

Sapikhat was first diagnosed with TB in 2006, was in hospital several times, had a surgery on her lungs in Moscow, but in 2013 had a relapse. “I could hardly tolerate the treatment: I was nauseous, I vomited and couldn’t eat. I survived by miracle, I thought I was going to die and was asking my husband to take me home to die. But after 8 months the new drugs appeared and Dr Animesh said: ‘You should take these drugs, you won’t die.’ He’s a good doctor. Thanks to all of them I recovered.”

MSF team on the way to visit an outpatient with XDR TB in a remote village of Kenkhi in mountainous Sharoy district on the border with neighbouring Dagestan. It’s 3 hours’ drive on a bumpy road from the capital – Grozny.

An MSF team on the way to visit an outpatient with XDR-TB in a remote village of Kenkhi in mountainous Sharoy district on the border with neighbouring Dagestan. It’s a three hour drive on a bumpy road from the capital – Grozny.

All photographs by Lana Abramova