Nurbek’s fight against tuberculosis has been long and difficult, but he is finally winning his battle. His treatment ends in less than a month, and he already feels well, ready to get his life back into his hands. It took him a long time to see this light at the end of the tunnel: he’s had tuberculosis since 2016, but abandoned treatment twice before. “I had strong side-effects from the drugs and I couldn’t do anything while I was on treatment. But I had to work to feed my family, so I had to make a choice.”

This time, Nurbek made it thanks to video observed treatment, an innovative, patient-friendly treatment approach supported by the UNDP. Treatment for drug-resistant forms of tuberculosis takes up to two years, during which patients have to take their pills every single day under the control of a nurse. This is important to make sure that they take their treatment regularly, since it is only efficient if all of the drugs are systematically taken, as prescribed by the doctor, and to watch out for side effects. But on video observed treatment, Nurbek no longer has to go to the hospital every day to take his treatment during the opening hours: he just has to record a video on his smartphone when he is taking the pills and send it to his nurse on WhatsApp.

“Now, I take the pills before going to bed,” says 29-year-old Nurbek. Thanks to this innovative treatment approach, he can sleep through the side-effects and stay available during the day to work.  This is for him extremely important, since he has to accept any job he can get. Nurbek lives with his two children, who are 7 and 4 years old, and his pregnant wife in a small, empty house he built outside of Bishkek, the capital. Having no documents on this property, Nurbek and his family live in terrible conditions, with no running water, and no heating system of any kind. They sleep on bare ground and barely have any furniture in the house, and sometimes, no pennies left for tomorrow’s bread. “We survive like we can,” says Nurbek, who is the only bread-winner in the household. They live on his small pension for group 2 disability, on the 1000 soms he gets each month from the UNDP / Global Fund project for treatment adherence, and on the two cents he gets from day work.

Patients under video observed treatment can take their pills when it is most comfortable for them, and do not have to waste time or money on going to the hospital every day. “It saves them a lot of time. They don’t have to go to the hospital every day; instead, they can go to work. And they don’t have to spend money on transport. Some patients are in very difficult financial situations, and they need to work while taking their treatment,” says Begayim, a nurse in Bishkek.

Video observed treatment

Under the UNDP / Global Fund project, the National Red Crescent Society provides alternative treatment methods to patients with multidrug-resistant tuberculosis in difficult life situations, in the city of Bishkek. These include video observed treatment, but also case management, social, psychological, and legal support. This comprehensive assistance is meant to help every patient complete their treatment for tuberculosis, despite all of the difficulties they may be facing.

Inessa, who is now 37 years old, is also a client of the Red Crescent. She lives with her mother and her 8-year-old daughter in a shabby, tiny rented flat in a basement; they share a narrow bed and have to stock the few items and clothes they have on it due to a lack of space. Their only source of income is her mother’s small retirement pension; because of tuberculosis, Inessa cannot work at the moment.

She was also switched to video observed treatment in January. Her case manager, Sainagul, supports her the best she can and controls her treatment on a daily basis. “She sends her videos ideally. She’s never skipped a single day,” says Sainagul.

“My brother died of tuberculosis, so I know how serious it is,” explains Inessa, who wants to beat TB despite her hard life. “It’s not easy, but my daughter is young, and I need to take care of her,” she says. She’s grateful for the material assistance she sometimes gets from the Red Crescent , but “cannot make the ends meet."

“We were evicted from our accommodation, which was in a critical condition, but we weren’t given anything in exchange, we don’t receive any aid whatsoever. We were left with nothing. I wish we could receive a small loan to have a decent place to live in…”

Psychological, social and legal assistance

In addition to video observed treatment and case management, the Red Crescent offers psychological, social and legal assistance for TB patients in need, under the UNDP / Global Fund project. Ruslan, for example, was helped by a psychologist. He was diagnosed with tuberculosis in Krasnodar, where his family lives, but had to come back to Kyrgyzstan for treatment. After a few weeks, however, he felt down and wanted to give up.

“I wanted to finish treatment, but I just couldn’t take the pills. I felt that something was wrong.” Ruslan turned to Ainuraiym, a professional psychologist, who met him several times and referred him to a psychiatrist for further treatment. “I understood that this was all a side-effect of his treatment. He wanted to finish his treatment, he is responsible, but some of the drugs had a negative psychological effect on him,” she explains. With this help, Ruslan now feels much better and has almost finished treatment; he is impatiently looking forward to reuniting with his family in Russia. 

“Patients like Ruslan have a high risk of interrupting treatment,” explains Ainuraiym. “I talk to them and try to understand why they are feeling this way; whether it’s because of the treatment or because of other difficulties in their life. And we try to help accordingly, to make sure that they are able to complete their treatment.”

Gulnaz also hasn’t had it easy these past months, but Kumarkul, a social worker from the Red Crescent, is helping her overcome many difficulties. Her husband died of TB last year, and she had to leave the in-law’s house in the region of Toktogul with her four children, now aged 9, 6, 4 and 1 year old. She was herself diagnosed with TB in September, not long after her baby’s birth.

Gulnaz had to build her life back from scratch, and Kumarkul has been of great help to her. She helped her get into a free professional program for vulnerable women at the Red Crescent, where she learned how to sew. Kumarkul also had her three older children sent to the TB pediatric hospital in Cholpon-Ata, where they can receive treatment and recover in better conditions, while their mother takes care of herself and of her youngest child in a small rented apartment in Bishkek.

“I miss them, of course. I want to take them home. They don’t have a phone, but they borrow one from the other children from time to time to call me,” says Gulnaz. “Treatment is difficult, but I have to finish it for my children. Doctors say you need to live in a good environment to fight TB, but we have bad living standards. I’m grateful to Kumarkul for all she does to help us.” Despite the tears in her eyes, Gulnaz has a broad smile on her face. Thanks to the assistance she receives, Gulnaz can stay strong for the future, and hopes that life, one day, will smile back at her.  

*The names were changed at the request of the patients.