Treating TB patients in the middle of Ethiopia's desert

To maximize the chances that the nomads complete their treatment, MSF adapted a program used successfully in Kenya that was designed specially for nomadic populations. Its central idea is the construction of a "patient village" consisting of houses built in the vicinity of the health center.

The region's only health facilities are found mostly in towns along the main roads, far from the Afar's pasture land and water sites. The area's remoteness makes it difficult for the Afar to access TB treatment and adhere to the requirements of standard treatment.

Most patients diagnosed with TB must travel daily to a health clinic to receive and be observed taking their medicines. This is part of the WHO strategy to control TB called Directly Observed Treatment Short-course, better known as DOTS. Supervising patients taking their medication is done to avoid having them miss treatments which can lead to treatment failure and to the emergence of resistance to TB drugs.

MSF opened this TB center in 2001 with the aim of providing quality TB treatment adapted to the Afar way of life. Galaha is a crossroads for nomads bringing their herds to the local river. To maximize the chances that the nomads complete their treatment, MSF adapted a program used successfully in Kenya that was designed specially for nomadic populations.

Its central idea is the construction of a "patient village" consisting of houses built in the vicinity of the health center. MSF has learned that nomads are willing to stay in one place for a length of time if effective treatment is available and food and housing are supplied. MSF also has staff that speak the nomads' native language, something often lacking in other health facilities.

The Galaha TB center has a capacity for 400 huts which are arranged in three sectors, depending on the risk of contagion. Patients visit the nearby health center daily to be directly observed taking their medicines and then are free to carry on their lives in the village.

Patients testing positive for pulmonary TB receive treatment under close supervision for the first four months. After that, they are discharged and provided with a three-month supply of medication, which they administer on their own. They are instructed to return to the center after finishing all of the drugs for a final TB sputum test that will show whether they are cured.

"For nomads, this is a good, adapted approach," explains Dr. Ayub, the program's medical coordinator. "They have direct observation for a longer intensive period, but a shorter treatment course. This allows us to guarantee better their recovery before we discharge them to continue treatment on their own. And they can return to their lives to take care of their animals and earn a living sooner."