International Activity Report 2012
MSF in Kyrgyzstan, 2012
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Kyrgyzstan has one of the highest burdens of drug-resistant tuberculosis (DR-TB) in the world, but treatment is hard to obtain. Severe budget constraints over past decades have resulted in a deterioration of health services in general. DR-TB treatment takes p to two years and often causes severe side effects. It is expensive, and in Kyrgyzstan it is prescribed selectively, according to criteria set by the country’s DR-TB Consilium, because of a chronic shortage of drugs. In October 2011, a further decrease in supply led to the suspension of the initiation of DR-TB treatment.
Decentralized model of care for DR-TB
In February, Doctors Without Borders/Médecins Sans Frontières (MSF) began offering comprehensive, free medical care for people with DR-TB and people co-infected with both HIV and TB in the district of Kara Suu, Osh province. The rate of DR-TB is particularly high in this region, as is the number of patients waiting for treatment. The program is a model for decentralization: staff screen for TB, DR-TB and HIV throughout the district. Those who are diagnosed then receive the drugs and medical care they need, as well as psychosocial support to encourage adherence. Most people are treated as outpatients and only the most seriously ill are admitted to hospital. MSF helped renovate the TB facilities in Kara Suu to improve infection control.
High DR-TB prevalence in prisons
An MSF team is working across the capital Bishkek’s detention system, screening inmates for TB. Those diagnosed with the disease are referred to the TB centre for detainees, where MSF provides treatment, counseling and social support. The team also offers nutritional support, and when patients are released – some 30 per cent are released while still on treatment – makes sure they receive psychosocial support and can continue treatment in public medical facilities.
Infection control is vital to reducing TB rates. MSF conducts awareness-raising activities and advocates for improved ventilation and living conditions, as well as early detection of TB, among prisoners. MSF also supports the national reference laboratory with technical capacity, supplies and staff supervision and training.
Mukhtar, 44 years old
In February 2011, I felt bad, exhausted, had fever, dizziness. After many tests the doctors discovered TB. I was on treatment for six months, then they told me to go to Bishkek for treatment. I didn’t have the financial means. Nobody was working at home; we were living on my mother’s pension. I had other tests, and was told that I needed nine more months of treatment. But there was no free place, so I was told to go home. One day someone told me about the MSF project in Kara Suu. I decided to go.
On 29 June I was hospitalized. Before hospitalization I weighed 67 kg, but in hospital I reached 82 kg. I did more tests and the results were very good. On 14 September I moved to outpatient treatment, and I have since gained another 6 kg.
At the end of 2012 MSF had 117 staff in Kyrgyzstan. MSF has been working in the country since 2005.