02 Aug 2011

IAR 2010 - Armenia

Tags: Armenia, Asia, IAR 2010, International Activity Report

In Armenia, Médecins Sans Frontières (MSF) is working with the staff of the national tuberculosis (TB) programme in tackling drug-resistant tuberculosis (DR-TB).

Larisa * “ When I found out it was drug-resistant TB I was shocked. I didn’t expect it.

But it was a fact and I had to go to the hospital and get treatment. When I heard that hospitalisation alone was to last two months, I couldn’t imagine being there for such a long time.

It was very difficult for me to get used to it. I thought first of all, that’s it, I will die. It was very difficult physically and psychologically. Most patients find it difficult taking the tablets every day, starting the day with pills.

“ But going to the clinic and seeing smiling faces helped. They told me there is no expression, ‘I can’t’ or ‘I don’t want to.’ It gave me strength to go ahead, to fight.” The patient’s name has been changed.

In the 1990s, as a result of patients not completing TB treatment or using drugs incorrectly, resistant forms of tuberculosis emerged. In 2005, an MSF team started working in Yerevan, Armenia’s capital, assisting doctors with diagnosis and treatment of the various forms of DR-TB.

Regular TB treatment involves around six months of medication. Drug-resistant forms of TB require up to two years of treatment, which is expensive and is not always easily available. Treatment usually starts with a period of hospitalisation, where patients are closely monitored. Once they return home, patients must continue a gruelling treatment regimen. Many of the drugs are toxic and, for some patients suffering from side effects such as headaches, vomiting or dizziness, the regime can become unbearable.

It can be very difficult to complete the cycle of treatment. The severity of side effects is one of the most significant factors, but other patients stop their treatment because they begin to feel better. MSF tries to help patients cope with the side effects by providing individual or group counselling and offering food vouchers to ensure an optimally healthy diet. In some cases, MSF assists in the renovation of patients’ homes to ensure adequate infection control.

Improving ventilation and sunlight in a house increases the chances that any TB bacteria is killed or removed from the home. In 2010 the MSF team received intensive MSF training on patient education and counselling, and revised procedures have been drawn up to attempt to further improve adherence.

Some elements of the TB programme in Yerevan were handed over to national bodies: the Armenian Red Cross has taken over the provision of social support in some districts, and the national TB programme is now responsible for providing drugs for TB patients.

Reaching rural areas

In 2010 MSF expanded the TB project into Lori and Shirak, two rural provinces in the north of the country. Working in a rural setting poses additional challenges, as some patients live long distances from clinics that they must attend on a regular basis.

As a result, the MSF team has introduced new approaches to treatment and care that are more convenient for patients and enable them to live at home. This also makes it easier for patients to adhere to the treatment regime.

A total of 559 patients have started TB treatment since 2005, and 246 patients are currently receiving care.

At the end of 2010, MSF had 68 staff in Armenia. MSF has been working in the country since 1988.

MEDECINS SANS FRONTIERES

IAR 2010 - Armenia

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