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In Sadr City, a neighborhood in the Iraqi capital, Ihsan Ali, sits with his four children at home, where the 44-year-old father enjoys the company of his family after weeks of isolating himself from them.
Ehsan has had tuberculosis twice before, but doctors recently diagnosed him with MDR.
Tuberculosis patients usually have severe symptoms that affect their life, including cough, chest pain, severe weakness, sudden weight loss, and fever.
Tuberculosis, which has no complications, can be cured, but patients have to endure months of treatment with strong and aggressive drugs. However, tuberculosis infection can progress to drug resistance, turning the disease into what is called multidrug-resistant tuberculosis.
Drug resistance occurs when anti-tuberculosis drugs are used incorrectly, when healthcare providers make prescribing errors, when drugs are of poor quality, and / or when patients do not adhere to their prescribed treatments. in accordance with the recommendations of doctors.
Until recently, the treatment of multidrug-resistant tuberculosis relied on strong drugs taken by mouth and injected, so the treatment program can take up to two years, and these treatments can expose patients to serious side effects. such as deafness and kidneys. damage, as well as serious psychological problems.
best treatment
The Médecins Sans Frontières teams working in Iraq support the National Institute for the Fight against Tuberculosis in the screening and diagnosis of patients with common and multidrug-resistant tuberculosis.
MSF has also worked on setting up an innovative treatment program for patients with MDR-TB, based on two new drugs, “bedaquiline” and “delamanid”.
This new program, recommended by the World Health Organization, is based on drugs taken entirely by mouth, which prevents patients from painful bites.
These new drugs have also proven their ability to improve patient compliance rates with treatment programs and achieve better treatment success in a shorter period of time and with fewer side effects.
Hamida, a 65-year-old grandmother, says: “I used to treat my previous wounds with daily injections which caused me a lot of side effects. I had severe itching and bruising on my skin. But I feel better since I started taking the oral pills they get much better The tablets give me a little stomach ache but the side effects are much less compared to the injections.
Hamida is among the first Iraqi patients to fully recover from the disease after completing the new treatment program.
Another testimony provided by Faten, a mother of one boy and three girls who lives in Baghdad.
“In July 2020, I had a persistent cough and fever and I was tired all the time,” says Faten. “I sought medical advice and the doctors referred me to the National Tuberculosis Institute, where I was diagnosed with MDR-TB The test results did not surprise me as I was aware of the nature of this disease and accustomed to its symptoms.
She continues, “I was familiar with the disease and the nature of her treatment, as my daughter had contracted tuberculosis earlier, and the treatment regimen my daughter was on was interrupted by injections and oral medications, and she used to inject herself every day for 8 months. She suffered from both until she recovered because I felt very weak she lost a lot of weight. She also lost her ability to study or go to school. We used to visit the institute every month to take tests and get medication. “
But Faten’s treatment was different: “When I was diagnosed with MDR-TB, I did not receive any injections, but followed a full oral regimen. At first I was very tired. I had to stay in bed all the time. easy at all. In addition to the physical suffering, I had to isolate myself and not see my family and I wondered how I could do my homework duties. But thank goodness my oldest daughter helped me with the household chores.
After a month and a half of taking the drug, Faten began to notice a big difference, describing it: “My life is finally back to normal. I no longer need to isolate myself because the disease is no longer contagious. . However, I have to keep my personal items out of the reach of others like plates and cutlery. I also have to avoid getting too close to them, but at least I can sit next to them again.
“We are very happy that six patients have completed the entire new program and have recovered, given that today, in August 2021, a total of 93 patients are still receiving treatment,” said Hemant Pangti, medical adviser from the MSF project in Baghdad, which is supervising the MDR-TB patient group. oral “.
In 2020, MSF started implementing the new treatment program for patients with multidrug-resistant tuberculosis in Iraq in cooperation with the National Tuberculosis Institute. Later that year, the new program was officially approved to treat all MDR-TB patients in the country. with this form of tuberculosis have a comprehensive oral treatment program, with few exceptions due to certain medical requirements.
“When they told me I had MDR-TB, doctors from the National Tuberculosis Institute told me about the new treatment program based on oral medications. I immediately accepted because I did not want to undergo the painful injections. each day. About 10 months and I’m doing great. These pills that I take are a blessing compared to the injections. “
Reduce daily suffering
Patients with tuberculosis in all its forms face many challenges in their daily life due to their medical condition. They also transmit the infection at the early stage of infection and must isolate themselves to avoid infecting others, which usually affects their mental health and livelihoods.
In this regard, Ibrahim Muhammad, a father of eight who lives in Sadr City, says: “I was pregnant before I got sick, but I can no longer work because of my illness. We can’t afford a lot of things.
Ibrahim has multidrug-resistant tuberculosis and is currently in the infectious stage. “Most of the time, our food is the only thing we can afford, thanks to the income of my son who is also a carrier,” he continues.
Médecins Sans Frontières also supports MDR-TB patients to ease the financial burden of treatment and encourage them to participate in follow-up sessions recommended by healthcare providers. This support includes a transport allowance to and from the National Institute for the fight against tuberculosis, in addition to providing meals for those who are unable to work during the illness, as is the case with Ibrahim.
MSF teams are also aiming to go further in the treatment of patients with multidrug-resistant tuberculosis in Iraq. In this regard, Bangti says, “Our current goal is to decentralize treatment so that people do not have to travel to Baghdad to benefit from these services. Until now, all patients from different parts of Iraq had to come here to get their meds and monitor their condition But we want This reality is changing. Beating tuberculosis itself is quite difficult and painful, and treating the multidrug-resistant form is even more so. why we want to make treatment procedures easier for patients as much as we can, and we have made great strides in cooperation with the National Tuberculosis Institute in this trend. “
It should be noted that MSF has been cooperating since June 2021 with the National Tuberculosis Control Program and the International Organization for Migration to train health personnel in several governorates of Iraq in order to improve their capacities to detect TB early. -MR and to provide treatment and follow-up. for the sick.
“Decentralization will save patients time and money as they will be able to access high quality health care services close to their homes. We hope that all of these measures will alleviate their suffering and positively contribute to their treatment and their daily life, ”Bangti said. concludes.
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