OLDER ADULT: MULTIDRUG-RESISTANT TUBERCULOSIS
Posted on Feb 1, 2012
As women age, they often battle chronic diseases while playing an important role in the care of their families. Partners In Health is working to address chronic diseases through regular visits and accompaniment of community health workers.
A grandmother survives multidrug-resistant tuberculosis in Kazakhstan.
In December 2012, Gulmira Shunshaliyeva and her family will finally be free of drug-resistant tuberculosis (DR-TB), a disease that has ravaged the family for the past three years. The battle has been difficult, the challenges overwhelming. With support from Partners In Health’s program in Kazakhstan, run in partnership with the country’s Ministry of Health, Gulmira defeated the disease and is now caring for her family as they, too, fight for their health.
Gulmira and her family left their small home in the seemingly endless grasslands that cover much of central Kazakhstan in 2009. In search of work, they moved east to Karagandy, an industrial coal-mining city and regional capital of Karagandinskaya Oblast.
Traveling with her husband, their two daughters, a son-in-law, and three grandchildren, the family found themselves renting a small adobe hut in a remote, poor region of the city. The hut lacked both a toilet and heating system. Despite living in a city of a half-million people, the family spent their days scavenging the streets for firewood. in a region where temperatures regularly drop to -5 F on winter nights, they spent what little money they had to buy coal in a desperate attempt at heating their makeshift shelter.
Unable to find permanent employment, Gulmira and her two adult daughters spent their days moving between various temporary jobs.
And then the family’s difficult life got worse.
Gulmira became sick with drug-resistant tuberculosis (DR-TB), a deadly strain of TB that takes upwards of two years to cure. An intensive, daily-dose drug regimen and unpleasant side effects make completion difficult.
Surviving a deadly disease
Around this same time, in mid-2010, Partners In Health launched a new partnership to combat drug-resistant tuberculosis in Kazakhstan. Because of PIH’s track record of curing and curbing the spread of drug-resistant tuberculosis in Russia, the Kazakhstan Ministry of Health invited PIH to help fight one of the highest rates of drug-resistant TB in the world.
Gulmira was one of the new team’s first patients.
In Kazakhstan, most TB patients must travel to regional dispensaries to receive their medication. Too often the poorest and most isolated patients, like Gulmira, are unable to afford the cost of travel. As a result, many of these patients do not complete treatment. Many die needless deaths. And failure to complete courses of antibiotics fuels increased drug-resistance.
This is where PIH steps in. Working with the local government, PIH trains nurses to accompany patients through treatment. These nurses visit patients in their homes multiple times a week, ensuring that they take their drugs and connecting them with valuable social services. Most importantly, they treat them like family. As a result of this practical and emotional support, patients are significantly more likely to complete their drug regimen.
Gulmira was lucky not only to have been diagnosed early, but also to have been accompanied throughout her treatment. In a country with one of the world’s highest TB infection rates, only 82 percent of cases are diagnosed. And only three of every five people whose cases are diagnosed complete treatment for this deadly disease. The numbers are even worse for the country’s poor, people like Gulmira and her family.
From patient to caregiver
Early in 2011, as Gulmira was entering the second year of her own treatment, her two adult daughters also became ill with DR-TB. A health worker noted the symptoms during a home visit. Soon Gulmira’s daughters were also on treatment.
The same team of nurses and health workers continues to visit the family, providing care, food packages, and warm winter clothes.
Yet it is Gulmira who has shouldered the brunt of her family’s burden. Having been in treatment for nearly two years, she helps her daughters as they move through the most painful phases of the drug regimen. She has also taken an active role in ensuring that the rest of her family does not contract this potentially fatal disease.
“All three women are responding well to the treatment and are expected to make a full recovery,” said Dr. Askar Yedilbayev, program director for PIH-Kazakhstan. PIH is working with the local government to find them permanent employment and better living conditions.
As of April 2012, Partners In Health’s project in Kazakhstan was providing technical assistance to 511 people living with drug-resistant tuberculosis.