Patients with drug-resistant TB are cured after two years of treatment
At Zugdidi, in Georgia, nine patients suffering from the resistant form of tuberculosis have completed their treatment after two years of daily medicine-taking. Jocelyne Madrilène, head of mission, explains why these recoveries are satisfying, for both patients and the entire medical staff.
For over two years, in Georgia's Samagrelo region, MSF has been caring for patients suffering from resistant tuberculosis. When this project was opened in November 2006, MSF was the only medical organisation in Georgia providing treatment for such patients. Since then, the health ministry has opened two other programmes to treat sufferers of resistant forms of tuberculosis.
Nine patients finish treatment. One of the numerous coercive aspects associated with treating this illness concerns the length of treatment: on average, patients undergo treatment for close on two years.
In July 2008, after 20 months of daily medicine-taking, the first patient arrived at the end of his treatment protocol. Although it is still too early to officially declare the patient "healed", given the risks of relapsing, the fact of finishing with medicine-taking is in itself an event…
"The patient, a young man, came in one morning", explains Jocelyne Madrilène, head of mission in Georgia. "When we told him we were stopping his treatment and that no future appointments were needed, just a two-monthly follow-up medical check, he couldn't believe it. He came back the next day saying there'd been a mistake, that he was still ill. After two years of daily medicine-taking, patients find it hard to realise that their treatment is finished…".
Officially, a patient can be declared healed two years after the end of treatment.
In total, nine patients completed their treatment at the beginning of January 2009.
"These first recoveries are a very satisfying factor for the 93 patients currently undergoing treatment, and also for all the medical staff. For doctors, nurses and all care staff, it's a daily struggle to ensure that patients retain the strength to continue their treatment", continues Jocelyne Madrilène. "The first patients healed live in Zugdidi, therefore they have been coming in quite frequently to the hospital to visit in-patients. They give them tips on how to stay the course, and emphasise the need to continue fighting the illness."
At Zugdidi, 153 patients have been admitted onto the programme over the last two years. In that time, 14 patients have died, representing approximately ten percent of all patients. This death rate is far lower than on many other programmes aimed at countering resistant tuberculosis. Often what happens is that up to a half of patients starting then interrupt their treatment. Tuberculosis, in its resistant form, remains a deadly illness, particularly difficult to treat, notably on account of a critical lack of suitable fast diagnostic tests, not to mention effective treatments.
Social and economic support essential in helping patients maintain treatment.
An essential factor in ensuring that patients adhere to treatment is the social and economic support provided by MSF and Georgia's national tuberculosis plan. Often isolated and unable to work, patients need daily support: firewood and clothes in winter, proper nutrition, travel costs …
"Thirty per cent of the our patients live below the poverty line. If we didn't help them, they would not follow their treatment correctly and certain of them would probably prefer to quit", concludes Jocelyne Madrilène.
Once patients return home and continue their treatment as outpatients, MSF undertakes rehabilitation of their homes in order to remove risks of transmission of the illness to their entourage. These measures, combined with follow-up of each patient, are essential factors in preventing interruption of treatments or programme drop-out's.
In August 2008, the war between Georgia and Russia led to severe concerns concerning the follow-up of patient-treatments. However, while the Zugdidi region was bombarded, two-thirds of patients continued to take their treatment daily, which for some meant getting in to the nearest treatment station to their home.
Throughout 2008, the Zugdidi programme witnessed an intense admission rate averaging six or seven patients a month. The trend is expected to be confirmed over the coming months. However, by the end of March, around ten more patients are expected to reach the end of their treatment.