Kazakhstan: National tuberculosis protocol transformed

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Since beginning work in the country in 1996, MSF has focused on the treatment of tuberculosis (TB), a disease on the increase partly due to poverty and lack of medicines. A pilot TB control and treatment program began in 1996 in the city of Akshy, near the capital Almaty, and in 1998 in the southern districts of Baidabeck and Ordabassy. The programs have used a multifaceted approach to detecting and treating the disease and have promoted the DOTS (Directly Observed Treatment Short Course) protocol. In addition to treating patients directly and furnishing medicines, MSF has worked to improve laboratory techniques and train medical personnel. Beyond the hospital world of the TB patient, MSF seeks to support patients' families during what can be a long and difficult hospitalization. However, improving social support for the poorest, especially ex-prisoners, is difficult because of the lack of government financial support. In June 2001, the pilot project in Akshy ended after DOTS was adopted as Kazakhstan's national TB control protocol. The project in the south continues, and MSF hopes to extend treatment to people with multi-drug resistant TB. CAPTION: Ainaev Musa, of Muynak, Uzbekistan, holds a photograph of himself in a rowboat on the Aral Sea. He caught his first fish there when he was 13. "In the end," he says, "there were no more fish to catch." The sea level has dropped 50% since 1960, exposing contaminated dust. MSF is conducting research into the link between these harsh conditions and the health problems of people in the Aral Sea area. International staff: 8 National staff: 30