Médecins Sans Frontières
armenia In the capital Yerevan, as well as in more remote areas of the country, Médecins Sans Frontières (MSF) teams are committed to improving access to treatment for drugresistant tuberculosis (DR-TB). Treatment is not universally available, and those who can access it have to adhere to a gruelling regimen, which can involve painful side effects, for up to two years. DR-TB is much harder to cure than drugsensitive TB, and without appropriate support, many patients find it impossible to complete the treatment. The MSF DR-TB programme in Yerevan, Armavir, Kotayk, Ararat, Lori and Shirak provides not only medication but also counselling and social support to help patients adhere to treatment. Renovation and new facilities In 2012, MSF signed an agreement with health authorities to begin improving ventilation in the DR-TB ward of Armenia’s main TB hospital, Abovyan, in Yerevan. Improved ventilation and infection control
Shirak
Lori
Mariam a student from Yerevan
Kotayk Yerevan Armavir Ararat
Regions where MSF has projects Cities, towns or villages where MSF works
Key medical figures: • 216 patients started DR-TB treatment
will help reduce retransmission of the disease among patients. It was also agreed that a palliative care unit will be set up, so that people for whom treatment is failing can still receive care to alleviate their suffering. Focus on children with DR-TB Detection of DR-TB in children is difficult, as they find it hard to cough up enough sputum for laboratory diagnosis. In 2012, MSF began to focus specifically on this issue, and in June launched a three-year study to improve understanding of infection patterns among children with DR-TB. The study has already yielded results: 23 children were diagnosed and began treatment in 2012.
When I was diagnosed with DR-TB, alarming thoughts began to swirl in my head. How could I accept the fact that I couldn’t go back to my husband? That I couldn’t have a baby for many years? I had to take about 15–20 tablets, as well as injections. I had hardly started treatment when I began to feel terribly bad. I was vomiting, losing my appetite. I couldn’t see or hear properly, had strange noises in my ears, felt a heaviness on my back. It was difficult to breathe. The doctors said I had to get used to these feelings if I wanted to be cured. I was thinking this kind of experience couldn’t possibly be ‘treatment’. I wanted to escape from the hospital. Mariam did leave hospital, but she returned and finally completed treatment in September 2012. You can read the rest of her story at blogs.msf.org/tb
No. staff end 2012: 93 | Year MSF first worked in the country: 1988 | msf.org/armenia
bahrain
Despite authorities’ efforts at reforms, recommended by the Bahrain Independent Commission of Inquiry after the violence of 2011, many people are still not seeking medical care in public hospitals. The healthcare system in Bahrain is of excellent quality, but it is still grappling with the consequences of being caught up in political unrest. Médecins Sans Frontières (MSF) had sought to assist people unable to access medical attention, but its first aid post was closed in July 2011. An MSF team remained in the country until March 2012, aware that hundreds of people were still not going to public hospitals for treatment. In March, staff were refused entry to the country, and activities had to be suspended. No. staff end 2012: 1 | Year MSF first worked in the country: 2011 | msf.org/bahrain
28 armenia | bahrain
Hoping to return to Bahrain, MSF staff worked from Dubai, in the United Arab Emirates, submitting proposals for activities to the Bahraini Ministry of Health. These included providing technical support in emergency preparedness and mental healthcare, as well as accompanying patients to health facilities to ensure that they and staff act in compliance with universally recognised medical ethics. In May, MSF held a mental health workshop in Dubai, attended by medical professionals from the Bahraini government and opposition. MSF personnel were allowed into the country from June 2012, but negotiations to launch activities failed. MSF’s principal concerns are comprehensive mental healthcare and patients’ access to services.