In Sadr City, a district of the Iraqi capital, Baghdad, Ihsan Ali sits with his four children at home, where the 44-year-old father is enjoying the company of his family after weeks of isolating himself from them.
Ehsan has had tuberculosis twice before, but doctors have recently diagnosed him with MDR.
TB patients usually have severe symptoms that affect their lives, including cough, chest pain, severe weakness, sudden weight loss and fever.
TB, which does not have complications, can be cured, but patients must endure months of treatment with strong and harsh medicines. However, tuberculosis infection can develop into drug resistance, thus turning the disease into what is known as multidrug-resistant tuberculosis.
Drug resistance occurs when TB medicines are not used properly, when health care providers make mistakes in prescribing them, when medicines are of poor quality, and/or when patients do not comply with the treatments prescribed to them as advised by doctors.
Until recently, the treatment of multidrug-resistant tuberculosis was based on strong drugs taken orally and injected, so that the treatment program can take up to two years, and these treatments may lead to patients being exposed to serious side effects such as deafness and kidney damage, as well as severe psychological problems.
Médecins Sans Frontières teams working in Iraq are supporting the National Institute for Tuberculosis Control in screening and diagnosing patients with both common and multidrug-resistant tuberculosis.
MSF has also worked to introduce an innovative program for the treatment of MDR-TB patients, based on two new drugs, “bedaquiline” and “delamanid”.
This new program, which is recommended by the World Health Organization, relies on medicines taken entirely by mouth, eliminating patients from the need for painful injections.
These new drugs have also been shown to improve patients’ compliance rates with treatment programmes, and achieve greater 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 injuries with daily injections that were causing me a lot of side effects. I had severe itching and bruising on the skin. But I feel better since I started taking the oral pills, they are much better. The tablets give me some stomach ache, but the side effects are much less than the injections.”
Hamida is among the first Iraqi patients to make a full recovery from the disease after completing the new treatment programme.
Another testimony is provided by Faten, a mother of one boy and three girls who lives in Baghdad.
“In July 2020, I had a persistent cough and a fever and was tired all the time,” says Faten. “I went for medical advice and the doctors referred me to the National Tuberculosis Institute, where I was diagnosed with MDR-TB. The results of the tests did not surprise me, as I was aware of the nature of this disease and used to its symptoms.”
She continues: “The disease and the nature of its treatment were not strange to me, as my daughter had contracted tuberculosis earlier, and the treatment regimen that my daughter followed was interrupted by injections and oral medications, and she used to take an injection every day for 8 months. She suffered both until she recovered, as 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 get tests and get medicines.”
But Faten’s treatment was different: “When I was diagnosed with MDR-TB, I did not receive any injections, but took a full oral regimen. At first, I was very tired. I had to stay in bed all the time. It’s not easy at all. In addition to the physical suffering, I had to isolate myself and not see my family and wondered how I could do my duties as a housewife. But thank God, my oldest daughter helped me with the housework.”
After a month and a half of taking the medication, Faten started noticing a big difference, describing it: “My life is finally back to normal. I no longer need to isolate myself as the disease is no longer contagious. However, I have to keep my personal items out of reach of others such as plates and cutlery. I should also 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,” says Hemant Pangti, medical advisor for the MSF project in Baghdad, who is supervising the MDR-TB patients group. oral”.
In 2020, MSF began implementing the new program to treat MDR-TB patients in Iraq in cooperation with the National Institute for Tuberculosis Control. Later that year, the new program was officially approved to treat all MDR-TB patients in the country. Those diagnosed with this form of tuberculosis have a full oral treatment program, with few exceptions due to certain medical requirements.
“When they told me that I had MDR-TB, the doctors at the National Institute for Tuberculosis Control told me about the new treatment program that is based on oral medications. I agreed right away because I didn’t want to have the painful injections again every day. About 10 months and I’m doing really well. These pills I take are a blessing compared to the injections.”
Reducing daily suffering
Tuberculosis patients in all its forms face many challenges in their daily lives due to their health status. They also transmit the infection in the early stage of infection and must isolate themselves to avoid infecting others, which usually affects their mental health and livelihood.
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 many things.”
Ibrahim has MDR-TB 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 porter,” he continues.
Médecins Sans Frontières also provides support for MDR-TB patients to ease the financial burden of treatment and encourage them to attend follow-up sessions recommended by healthcare providers. This support includes a transportation allowance to go to and return from the National Institute for Tuberculosis Control, 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 a step further in treating MDR-TB patients 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 have had to come here to get their medicines and follow up on their condition. But we want to This reality is changing. Overcoming TB by itself is difficult and painful enough, and treating the multi-drug-resistant form is even more difficult. That’s why we want to make treatment procedures easier for patients as much as we can, and we have taken great strides in cooperation with the National Institute for Tuberculosis Control in this trend.”
It is noteworthy that MSF has been cooperating since June 2021 with the National Tuberculosis Control Program and the International Organization for Migration to train health care staff in several governorates in Iraq to improve their capabilities to detect MDR-TB early and provide treatment and follow-up for patients.
“Decentralizing will help patients save time and money as they will be able to access high-quality care services close to their homes. We hope that all these steps will help alleviate their suffering and contribute positively to their treatment and their daily lives,” Bangti concludes.