March 24, 2006
Adrien Marteau is a doctor in the Doctors Without Borders/Médecins Sans Frontières (MSF) tuberculosis (TB) treatment program at Gluprish Hospital in Abkhazia, located within the borders of Georgia in the Caucasus region. He shares his frustrations as a doctor treating drug-resistant forms of this illness. Drug resistance can be avoided if patients initially receive proper treatment for the simple form of TB. He also talks about how difficult it is to treat multidrug-resistant tuberculosis (MDR-TB), an especially long, demanding and toxic process, and how on-going, poor medical practices also lead some patients to abandon any form of treatment.
As a doctor, my primary frustration is seeing tuberculosis patients who received inadequate treatment show up later at MSF's program in Gulripsh hospital. Too many of the patients we treat do not complete their course of treatment or follow a course that is too short, which in the end creates resistance to antibiotics.
Lives Nearly Destroyed For Lack of Proper Treatment
For two years, we've been treating a 27-year-old mother who became ill when she was quite young. She took medicine for three or four years, but the treatments were always incomplete. She even had surgery to remove part of a lung, even though this is a very sensitive medical decision made only as a last resort. When she finally arrived at the MSF program with multiple resistance, she took a second-line treatment. Luckily, she is now recovering and should be able to return home soon to Sochi, a city on the other side of the border in Russia, and be reunited with her children, whom she has not seen for more than two years.
This kind of example is increasingly common among the patients we see at Gulripsh hospital. It's very discouraging to see them in that state. Their lives are nearly destroyed, which could have been avoided if they had received proper treatment. While treating simple TB today is no panacea, it does mean that patients can recover if they are cared for correctly.
"Medicines That Work Like an Atomic Bomb"
It's a different situation treating MDR-TB, which is a very long, demanding, and toxic process. Here in Abkhazia, it has a bad reputation and scares people because of the significant side effects. As a result, some patients refuse to take the second-line treatment or they stop taking the medicine once they feel better. When they stop, the battle is lost because we know what will happen to them. Some day, they will relapse and there will be nothing left to do for them — they'll die.
MSF has organized public awareness campaigns to encourage people to agree to treatment and follow it to the letter. We work with patients individually and emphasize the challenges of what is clearly their last-chance treatment. We explain to patients that to treat MDR-TB, you have to use medicines that will work like an "atom bomb" and clean everything out once and for all. That takes time because the bacteria responsible for TB are vicious and can hide anywhere in the body. When they re-emerge, they are even more vicious. But sometimes nothing helps. Inevitably, there will be people who give up treatment. It's a source of enormous frustration for us.
"We're Afraid for Patients and the People They Might Infect"
Recently, a father stopped his daughter's treatment because he had to go back to Russia. We tried everything, particularly through our Moscow office, to get him to bring her back to Abkhazia, but nothing worked. This father quite simply condemned his daughter and there was nothing more we could do. We feel impotent in cases like that.
Plus there's this dangerous idea everyone has: "I feel better, so I can stop taking my medicine like I did before." We understand that a patient might not be able to swallow 35 pills a day, day after day, or to endure painful side effects. Some patients tell us they would rather die of TB than of the toxic effects of the treatment. But it's difficult to accept that as a doctor, because we know the inevitable outcome. When we hear, "I feel better so I'm going to stop taking my medicine," we're afraid for the patient, but also for all the other people–maybe 10, maybe more, maybe fewer–to whom he could transmit the MDR form of tuberculosis.
© 2013 Doctors Without Borders/Médecins Sans Frontières (MSF)