For over two years in Georgia's Samagrelo region, Médecins Sans Frontières (MSF) has been caring for patients suffering from drug resistant tuberculosis.
When this project was opened in November 2006, MSF was the only medical organisation in Georgia providing treatment for such patients. Since then, the ministry of health has opened two other programmes to treat others with resistant forms of TB.
Nine patients finish treatment
TB in its drug resistant form, remains a deadly illness, particularly difficult to treat, notably due to a critical lack of suitable fast diagnostic tests and effective treatments.
In August 2008, the war between Georgia and Russia led to severe concerns concerning the follow-up of patient treatments. However, while the Zugdidi region was bombarded, two-thirds of patients continued to take their treatment daily, which for some meant getting in to the nearest treatment station to their home.
One of the numerous difficult aspects associated with treating this illness is the length of treatment: on average, patients undergo treatment for almost two years. In July 2008, after 20 months of daily medications, the first patient arrived at the end of his treatment protocol. Although it is still too early to officially declare the patient "healed", given the risks of relapsing, just finishing the medication period is in itself an even.
"The patient, a young man, came in one morning", explained Jocelyne Madrilène, head of mission in Georgia. "When we told him we were stopping his treatment and that no future appointments were needed, just a two-monthly follow-up medical check, he couldn't believe it. He came back the next day saying there'd been a mistake, that he was still ill. After two years of daily medicine-taking, patients find it hard to realise that their treatment is finished."
Officially, a patient can be declared healed two years after the end of treatment. In total, nine patients completed their treatment at the beginning of January, 2009.
"These first recoveries are a very satisfying factor for the 93 patients currently undergoing treatment, and also for all the medical staff. For doctors, nurses and all care staff, it's a daily struggle to ensure that patients retain the strength to continue their treatment", continued Madrilène. "The first patients who came to the end of treatment live in Zugdidi, so they have been coming in quite frequently to the hospital to visit in-patients. They give them tips on how to stay the course, and emphasise the need to continue fighting the illness."
At Zugdidi, 153 patients have been admitted into the programme over the last two years. In that time, 14 patients have died, representing approximately ten percent of all patients. This mortality rate is far lower than on many other programmes aimed at countering drug resistant TB. In treatment, often up to a half of patients starting will stop taking their treatment.
Social and economic support essential in helping patients maintain treatment
Essential to ensuring that patients adhere to the treatment is the social and economic support provided by MSF and Georgia's national TB plan. Often isolated and unable to work, patients need daily support: firewood and clothes in winter, proper nutrition, travel costs.
"Thirty per cent of our patients live below the poverty line. If we didn't help them, they would not follow their treatment correctly and certain of them would probably prefer to quit," said Madrilène.
Once patients return home and continue their treatment as outpatients, MSF undertakes rehabilitation of their homes in order to remove risks of transmission of the illness to those they are living with. These measures, combined with follow-up of each patient, are essential factors in preventing interruption of treatments or programme drop-outs.
Throughout 2008, the Zugdidi programme witnessed an intense admission rate averaging six or seven patients a month. The trend is expected to be confirmed over the coming months. However, by the end of March, around ten more patients are expected to reach the end of their treatment.