Yerevan, Armenia. February 2010 — In the MSF-supervised drug-resistant tuberculosis (DR-TB) programme in Armenia, the adherence of patients to the treatment is a major issue. Among the patients admitted to the programme in 2007, some 21 percent failed to complete treatment.

Treatment can take up to two years and patients must take a daily cocktail of toxic pills, injections, and powders. Side effects are often severe, and range from nausea and disorientation to aggravating pre existing medical complaints - particularly those associated with the kidneys and liver - to the extent that doctors are forced to take patients off the drugs and declare them medical failures.

As well as the medical staff treating DR-TB patients, social workers and psychologists are an integral part of the MSF team, as they fulfill a vital role in encouraging patients to see their difficult treatment through to the end.

“If a patient is not healthy psychologically, it will be very difficult for him to overcome this disease,” said Hasmik Hakopjanyan, the MSF psychological support supervisor.

TB carries a huge stigma in Armenia, and the feelings of isolation caused by disease, hospitalization, and follow-up treatment have to be addressed for the patient to be successful.

“Its common for people to be depressed, stressed and have a lack of confidence,” said Hasmik, who with her team of psychologists, visits patients at all stages of treatment from hospitalization to home-based treatment, when patients attend a clinic to take their medication six days a week.

Relationships within families can often change dramatically, and patients often need counseling to help them adjust.

“If the patient is male and the only one who works in the family, he can develop feelings of uselessness,” said Hasmik.

“We have a patient who now does not work, and he says that he now cannot say anything to his children because they have to support him.”

Patients usually start out motivated to complete the treatment, but once side effects begin they can get deterred.

“When they start to take the drugs they start with the hope that they will be cured, suddenly they face the development of side effects which cause problems in their body, they can start to become hopeless, thinking that maybe the drugs will not work,” said MSF social worker, Margarita Zalibekyan.

As well as needing help with psychological issues related to DR TB, many patients need practical assistance in coping with the disease.

Social workers assist patients in getting the correct paperwork to be admitted, help them with hygiene kits and food supplements during hospitalization as well as assisting once they are discharged from the hospital to continue treatment while staying at home.

For those who need it, MSF gives patients coupons for food, as well as fuel in the winter and a transport allowance, ensure patients can come to the clinic to receive their six-day-a-week treatment once discharged following the initial period of hospitalization.

Given the difficulties in completing treatment, every patient cured is a cause for celebration.

“Of course I am happy when a patient gets cured,” said Margarita, the social worker.

“We feel we helped the patient get to the end of the treatment, but it’s the combined work of the whole team to see the patient through to the end of treatment,” said the MSF social worker.