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TB: Perilous journeys to treat an ancient disease
Mark Sherlock is an Irish doctor working in one of MSF's HIV and multi-drug resistant Tuberculosis (MDR-TB) projects in slum settlements outside of Nairobi, Kenya.
“The traffic is bad today Doctor Mark” I’m warned, my heart sinks a little. This is an everyday occurrence while living in Nairobi. Travel to and from the clinic can take up to three hours a day (It puts the M50 at rush hour to shame!). Nairobi is a geographical masterpiece perched high on the East African rift valley; this altitude in the tropics creates an ideal climate for my Celtic heritage.
"Kenya ranks third after Uganda and Ethiopia in her accommodation of asylum seekers. Dadaab in northern Kenya is the largest refugee camp in the world, with a population roughly six times that of Waterford."
During this long drive, the world literally changes in front of my eyes, into one of the most deprived areas of Sub-Saharan Africa.
Slums of Mathare and Eastleigh
MSF has worked in the slum settlements of Mathare and Eastleigh in the east of Kenya’s capital Nairobi for over twenty years. Our projects focus on HIV care, multi-drug resistant tuberculosis (MDR-TB), trauma and sexual and gender-based violence, serving a population of approximately 200,000 people.
Mathare is made up of many nationalities and is also a focal point for refugees fleeing conflict in surrounding countries. As a doctor, my role here is focused on treating people with MDR-TB, now the world’s number one infectious disease killer.
It has bypassed HIV and malaria for this unfortunate accolade. In simple terms, this is TB that is resistant to normal drug treatment, which simply does not work.
Unlike HIV and malaria, there has been limited progress in TB treatment over the last 50 years.
Current treatment is a gruelling two-year rollercoaster with painful daily injections for the first year and up to 12 tablets every day for two years. Side effects are unforgiving, hearing impairment and deafness, severe nausea, vomiting, tingling in the legs, insomnia and psychotic episodes during the treatment are common. Not only do individuals suffer, but families and entire communities bear the burden of this disease.
Despite this, our patients come every day to endure this punishing treatment regime. My day in the clinic, just like the traffic, is varied and full of challenges. Despite the pots of medications that need to be swallowed daily, patients are always ready to interact with a big smile on their face. My limited Swahili introductions and questions of how they slept are always a sure starter to make them laugh.
Unlike my role as a doctor at home, which provides its own challenges, working with MSF requires you to use a much more varied skill set. You are a clinician, a teacher, a manager and a negotiator, frequently flipping between each of these roles. It all lends to an exciting and challenging working atmosphere.
In search of treatment for the world’s oldest diseases
The refugee crisis is not just affecting Europe. The vast majority of people fleeing conflict zones are internally displaced or live in neighbouring countries. Kenya ranks third after Uganda and Ethiopia in her accommodation of asylum seekers. Dadaab in northern Kenya is the largest refugee camp in the world, with a population roughly six times that of Waterford.
Many of our patients here have fled Somalia in search of treatment for TB, one of the world’s oldest diseases. Many have stories of having to put their fate in the hands of unscrupulous people smugglers and take perilous journeys to get here. Many leave from Mogadishu, locked in shipping containers with no food, water or ventilation and travel through Ethiopia and South Sudan, then Uganda before finally ending up in Kenya.
To Somalia and back
One of my patients today is Mohammed, a young man who endured this arduous journey in search of treatment for a disease that would have otherwise killed him. Fortunately, he is responding very well to treatment and is nearing the end of his side effect ridden journey. In broken English he told me of the suffering his community back in Somalia endures from MDR-TB.
"We are working on pioneering new way to treat TB, aiming to decrease the length of treatment from 21 months down to 6 months. This research could save hundreds of thousands of lives around the world."
He explained that once he was finished treatment, he would travel back to Somalia and try to help others living with the disease. He lowered his voice and asked if I could give him drugs with instructions on how to treat it so that he could go to cure the many people suffering in his community. If only it was as simple as this. I wish I could help and I am left feeling helpless.
Hope on the horizon
However, there is some hope. MSF refuses to wait years or even decades for new treatments while thousands of our patients continue to suffer from long, toxic and failing regimens. We are working on a pioneering new way to treat TB, aiming to decrease the length of treatment from 21 months down to 6 months. This research could save hundreds of thousands of lives around the world.
As I finish up with my last patient and prepare for the traffic bullfight that will face me over the next two hours, my thoughts pass to this new hope that is possible for my patients. I then hope I am not confronted with the words “the traffic is bad today Doctor Mark”.