Along with medical staff, social workers and psychologists are an integral part of the MSF TB team in Armenia
In the drug-resistant tuberculosis (DR TB) program Doctors Without Borders/Médecins Sans Frontières (MSF) supervises in Armenia, the adherence of patients to treatment is a major issue. Among the patients admitted to the program in 2007, one in five failed to complete the regimen.
Treatment can last up to two years and patients must take a daily cocktail of toxic pills, injections and granules. Side effects are often severe and pre-existing medical conditions can be aggravated, particularly those associated with the kidneys and liver.
Along with the medical staff, social workers and psychologists are an integral part of the MSF team. They fulfill a vital role by encouraging patients to see their difficult treatment through to the end. “If a patient is not healthy psychologically, it will be very difficult for him to overcome this disease,” says Hasmik Hakopjanyan, the MSF psychological support supervisor.
Tuberculosis patients are profoundly stigmatized in Armenia. The feelings of isolation caused by the disease, the hospitalization it requires and the follow-up treatments have to be addressed for the patient to be successful. “It’s common for people to be depressed, stressed and have a lack of confidence,” says Hasmik, who with her team of psychologists, visits patients during their hospitalization and after, when they receive home-based treatment and attend a clinic six days a week to get medication.
Relationships within families can often change dramatically, and patients often need counseling to help them adjust. “If the patient is male and the only one who works in the family, he can develop feelings of uselessness,” says Hasmik. “We have a patient who now does not work, and he says that he now cannot say anything to his children because they have to support him.”
Patients usually start out motivated to complete the treatment, but once side effects begin they can get deterred. “When they start to take the drugs they start with the hope that they will be cured,” says MSF social worker Margarita Zalibekyan. “Suddenly, they face the development of side effects which cause problems in their body [and] they can start to become hopeless, thinking that maybe the drugs will not work.”
Many patients also need practical assistance in coping with the disease. Social workers help patients complete the paperwork required for admission and help provide them with hygiene kits and food supplements both during and after their hospitalization.
For those who need it, MSF provides coupons for food and fuel in the winter. Patients may also receive a transport allowance that helps them get to the clinic after they’re discharged from the hospital. Given the difficulties in completing treatment, every patient cured is a cause for celebration. “Of course I am happy when a patient gets cured,” said Zalibekyan, the social worker. “It’s the combined work of the whole team to see the patient through to the end of treatment.”