March 22, 2010

Having been through it himself, a former TB patient now does what he can to ensure as many patients as possible complete their treatment regimen

With his sturdy build and firm handshake, Tevan* is a picture of health these days, his bout with drug-resistant tuberculosis (DR TB) behind him. After more than two years of grueling treatment, he is now fully recovered. But not long ago, he was in extremely bad shape.

“One day at work, I felt unwell and became very weak,” says the 50-year-old construction manager. “For two days I was sick at home with a high temperature and then I started coughing up blood.” He lost more than 40 pounds before he was diagnosed with DR TB and admitted to the TB program supervised by Doctors Without Borders/Médecins Sans Frontières (MSF) in Yerevan, Armenia’s capital.

Patients stay at the TB program until they are no longer transmitting the contagious disease, a period that usually takes two to four months and sometimes longer. Following hospitalization, patients can return home and get their doses of drugs from an ambulatory clinic.

Tavan, like most patients, had to take the toxic drugs for roughly two years, a task that requires immense strength of will and support from the MSF social work and psychological team. Most of the drugs used to tackle DR TB are antibiotics that were developed in the 1940s and 1950s and that have been found be less effective and more toxic than the drugs now in use for non-resistant TB. The combination of pills, powders and injections frequently has severe mental and physical side effects. “It was really difficult to take these drugs,” he says. “I was unable to explain what was happening to me. I was unable to stand, I was unable to walk. I could not lie down and I felt nauseous.”

If patients have pre-existing medical conditions, the severity of the side effects can become unbearable. A patient experiencing gastritis, for instance, could suffer greater abdominal pain, says Dr. Shahidul Islam, an MSF doctor working on the project. “In that case, sometimes the patient doesn’t want to take the drugs,” he adds. “They stop taking them because of the side effects.”

In the cohort of patients admitted to the MSF-supported program in 2007, around 21 percent failed to complete the full course of treatment, with many saying they couldn’t endure the punishing side effects that came along with the drug regime.

Having been through it himself, Tavan now does what he can to ensure as many patients as possible continue the course of drugs. “During treatment I [shared] my experience so they could see how I was recovering day by day, so they believe in the treatment and become stronger in their adherence,” he says. “I always give good advice and told them my example, in what condition I was when I started treatment. At that time I felt half-dead, and now I am healthy. Some follow, some don’t.”

*Patient names have been changed

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