Episode: "Nomad M.D."
TB Treatment for Afar Nomads: A Problem of
Migration and Market Failure
In this episode, Dr. Helmy Mekaoui’s mission
takes him far off the beaten path, to Galaha, a dusty outpost in
northeastern Ethiopia. The region is populated only by Afar nomads
– roving herdsmen for whom cattle are the lifeblood of economy,
society, and survival.
Helmy is working on an MSF tuberculosis (TB) treatment
project, and the migratory lifestyle of the Afar people makes his
job much harder. The best available treatment for TB requires a
rigorous four-month course of daily medication that has to be directly
observed by health workers. In other words, it requires nomads who
have contracted TB to stay put during treatment– a bitter
pill for people who adopted constant migration long ago to survive
northeastern Ethiopia’s parched climate.
But TB treatment for the Afar is a necessity. Their
rate of TB infection is dangerously high. The constant movement
of the Afar has led many to dismiss the possibility of containing
TB among the nomad communities. MSF’s goal is to develop a
successful model for treating the nomads and in doing so, convince
the Ethiopian government and other health agencies that devoting
more medical resources to the Afar is not a lost cause.
MSF opened its project in Afar in 2001, and has tailored
the program to the dual challenges of attracting the nomads to the
Galaha medical compound for testing and retaining them for treatment.
Regular meetings with Afar community leaders increase awareness
of the program and encourage people to be tested. The Kenyan treatment
regime MSF uses, known as “manyatta,” was specifically
designed for nomads, and requires a four-month course of medicine
instead of the standard six months.
In order to make even a four-month stay at Galaha
feasible, MSF built the compound on the meeting place of two rivers,
ensuring a year-round water supply for the Afar’s livestock.
Recently, MSF added a mosque and a 60-bed hospital is under construction
to provide for the treatment of malaria and non-tubercular respiratory
infections, in addition to TB.
As of August, MSF’s Galaha project offers treatment
to approximately 400 people infected with TB, with an estimated
cure-rate of approximately 90%. The MSF team also conducts roughly
2,000 consultations per month.
But MSF’s fight against TB in Galaha presents
just one extreme example of a larger challenge in Ethiopia and beyond:
how to treat tuberculosis among displaced or migratory people who
have adopted constant movement out of habit or necessity. The problem
is only partially attributable to migration. If better TB drugs
were developed, four to eight months of directly observed treatment
might not be necessary, allowing migrant people to be treated all
at once or take their medication with them.
Unfortunately, because TB disproportionately affects
the poor, drug companies do not find it an attractive market for
drug development: virtually no new research is being conducted to
develop new treatments.
To read more about MSF in Ethiopia click here:
To learn more about the crisis in research
and development for TB drugs, click here: