Episode: "Nomad M.D."

Ethiopia

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:
(http://www.doctorswithoutborders.org/news/ethiopia.shtml)

To learn more about the crisis in research and development for TB drugs, click here:
(http://www.accessmed-msf.org/campaign/tb01.shtm)