Photo story |

Photo story: Out of Step 2017

4 min
Photograph by Alexis Huguet
Winile stands outside her house in the Manzini region of Swaziland

Winile stands outside her house in the Manzini region of Swaziland with Falakhe, a neighbour’s son. Winile lost her hearing as a result of the toxic side effects of medicines to treat drug-resistant TB.  Falakhe has learned sign language so he can help Winile out. MSF and the Ministry of Health of Swaziland have begun using a shorter treatment course that takes nine instead of up to 24 months. This helps boost people’s resolve to endure debilitating side effects, and see through their often gruelling treatment. The shorter treatment course is included in the guidelines of 45% of countries in the ‘Out of Step’ survey, but none of them have implemented it widely yet.


From Armenia and Tajikistan to South Africa and India, our teams treat people all around the world with TB, an ancient disease. For decades, there was no improvement on the basic treatment available since the discovery of antibiotics nearly eighty years ago. Now things are changing – slowly – but there is a definite sense of change on the way: there are some newer drugs, better ways to test for TB and more effective ways of delivering treatment that is focused on people’s real needs and lives. 

Driven on by the knowledge that 1.8 million people died in 2015 from this curable disease, we and our partners, Stop TB Partnership, set out to discover how far these innovations have been adopted around the world. We asked 29 countries to tell us.  What we found is that many places are not taking advantage of these potentially game-changing interventions that could save many more lives. Read more about our findings.

Charity with the mother Rebecca Achieng
Charity with the mother Rebecca Achieng. Photograph by Susan Sandars

MSF currently treats people with tuberculosis in 24 countries. In 2016, we treated 20,000 people, including 2,700 with drug resistant TB. In our projects we are always working to try to bring treatment closer to where people live and that fits better with their lives.

Aisara Goboevais is a patient of MSF TB project in Kara-Suu district, Kyrgyzstan, where it provides decentralized care for XDR-MDR TB, 2015
Aisara Goboevais at home in Kysyl Ordo, Kyrgystan. Photograph by Helmut Watch

Aisara Goboevais is pictured here proudly at home in Kysyl Ordo, Kyrgystan. Aisara is sick with drug-resistant TB. She takes her daily medicines at home and does not have to stay in hospital. This way of delivering treatment means people can be cared for at home, in their own communities, and they don’t have to take time off from work that they can ill afford or leave families behind. But over a third - 35% - of countries in the ‘Out of Step’ survey still require people with drug-resistant TB to be treated in hospital.

Medical officer, Neisha Mohess scans a sample of sputum for loading into the GeneXpert, an automated molecular TB diagnostic test machine.
Neisha Mohess scans a sample of sputum for loading into an automated molecular TB diagnostic test. Photograph by Jose Cendon

In Cape Town, South Africa, MSF‘s  Neisha Mohess scans a sample of sputum for loading into an automated molecular TB diagnostic test. This test reduces the time that people have to wait to hear if they have TB or not to a matter of hours and not days, and so they can start life-saving treatment faster.  But almost seven years after the World Health Organization recommended countries start using this test, barely half – 47% - of the countries in the ‘Out of Step’ survey have managed to make it widely available. 

Hanif is 25 years old, lives in Mumbai, and is one of only a handful of extensively drug-resistant TB (XDR-TB) patients in India lucky enough to be able to have acesss to the new drugs. After having failed treatment for the fourth time, Hanif was referred to the clinic of Medecins Sans Frontieres (MSF) / Doctors Without Borders, an international medical humanitarian organisation who since 2006 provides free diagnosis, treatment and support to patients with drug-resistant TB in Mumbai.
Hanif is taking his daily TB medicines at home in Mumbai, India. Photograph by Atul Loke

Hanif is taking his daily TB medicines at home in Mumbai, India. Through MSF, Hanif is being treated with the newer TB drugs that have been recently introduced in the country. After a few months, he says he feels like he has a new life.  The newer drugs avoid many of the terrible side effects of the older TB drugs and are much more effective.  But in 2016, around the world, less than 5% of people who could have benefitted from them were treated with the newer drugs.

13-year-old Dilbar, is pictured here in paediatric TB hospital playground, Dushanbe, Tajikistan 2013.
13-year-old Dilbar is pictured here in 2013 in the playground at the paediatric TB hospital in Dushanbe, Tajikistan. Photograph by Wendy Marijnissen

13-year-old Dilbar is pictured here in 2013 in the playground at the paediatric TB hospital in Dushanbe, Tajikistan where she received treatment for drug-resistant TB. In 2015 WHO recommended using new medicines that reflect updated dosages for treating children with regular TB. This change means that it’s now much easier to treat these children more accurately than before - though there are still no child-friendly medicines for children with drug-resistant TB. However, two years on, only a handful of countries in the ‘Out of Step’ survey - 14% - have introduced these new medicines widely.