Zhytomyr TB photographs
Ukraine

Fighting tuberculosis with medication, mental health and social support

In Zhytomyr, Ukraine, our teams works with the Regional TB Dispensary to treat patients who have drug-resistant forms of tuberculosis (DR-TB). They are treated with a short course of DR-TB medication and the possibility of being treated at home most of the time; meaning patients can get back to their lives, families and careers sooner. Yet, completing the new treatments can still be tough.
 
“When I got TB, I lost the will to live. My grandparents had told me that TB was a slow death,” says Natalia Tsopa, a DR-TB survivor. “During the treatment, I felt ill and tired. I lost a lot of weight, too.
 
“I was irritable, I was depressed but my psychologists, Vova and Lesya, counselled me,” says Natalia. “I used to speak with them about my family, my aspirations and how to recover.”

Natalia Tsopa (right), DR-TB survivor “When I got TB, I lost the will to live. My grandparents told me that TB was a slow death. I was irritable, I was depressed but my psychologists counselled me. I used to speak with them about my family, my aspirations and how to recover.”
Zhytomyr TB photographs

Most patients in this programme can be treated with an all-oral course of medication, including the new medicines delamanid and bedaquiline, instead of the painful injections that were previously used and caused serious side-effects. But many patients still struggle to keep taking their medication for the full nine to 12 months.
 
“The goal of eliminating tuberculosis remains unreached, driven by multiple factors, including a lack of patient adherence to treatment,” says Iryna Yakymuk, MSF psychiatrist.
 
Mental health is one of the main reasons for this. Psychiatric and drug addiction diseases, as well as psychological problems such as stigmatisation and self-stigmatisation, isolation and social deprivation, all negatively affect patients' adherence to treatment,” says Yakymuk.

Zhytomyr TB photographs
MSF nurse Oleksandr Oleksandr Vovkogon observes Vitalii Gorbachov, 56, as he takes his DR-TB pills – most patients in this programme can be treated with an all-oral course of medication instead of the painful injections that were previously used and caused serious side-effects. Ukraine, June 2021. 
Oksana Parafeniuk/MSF

Counselling and social support can help patients to continue their treatment even when it is difficult. “If you have the desire then you can be cured,” says Bohdan Cherniv*, a TB patient. “People can lose hope but I don’t want to. I regularly speak with the psychologist in this facility.”

Patients also face practical challenges. In our programme, patient support teams (nurses and social workers) work with DR-TB patients to understand and resolve potential barriers to completing treatment, from unpaid pensions to a lack of gas or heating in their homes.

“Once I came home, I also received food parcels, hygiene kits, soap and detergents as part of my treatment,” says Natalia. “My condition improved, I gained weight and felt even hungrier than before falling ill. I want to tell all patients not to be afraid and to continue treatment.”

Zhytomyr TB photographs
Natalia Tsopa, a DR-TB survivor, with psychologist Volodymyr Lychagin – psychologists work alongside patient support teams consisting of nurses and social workers, who understand and resolve potential barriers to continuing treatment, ranging from unpaid pensions to lack of gas or heating in homes. Ukraine, June 2021. 
Oksana Parafeniuk/MSF

“People are scared of hospitals due to fear of how they will be treated by health workers, family or their community, and/or the high costs of treatment,” says Natalia. “I am now cured but there are still people who look at me differently. I ignore them. I am looking forward to living with my children and family again.”

DR-TB can be cured, but only if patients are able to complete their treatment. Coordinated patient support – including doctors, nurses, TB specialists, psychologists and social workers – should be a central part of their treatment.

*Name changed at request of patient

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Press Release 20 October 2021