A woman cooks outside her home in Carabayllo, Peru. Overcrowded living conditions and poor sanitation also contribute to the spread of MDR-TB. |
In 1994 PIH, an international nonprofit providing health care to impoverished communities, began treating TB patients in Carabayllo, a slum in the barren hills near the city of Lima, Peru. Just after they set up, an outbreak of MDR-TB was discovered.
Medical professionals thought that treating patients infected with MDR-TB in low-income areas was nearly impossible and a waste of scarce resources. Dr. Jaime Bayona, director of PIH in Peru, explains, “Starting the treatment for the first group of patients and pursuing what we were convinced had to be done to save [them] wasn’t an easy task.”
PIH began a rigorous treatment course for MDR-TB patients. In order to ensure that the infection is obliterated, MDR-TB patients must remain on the treatment for at least two years. PIH found that patients must be closely watched because the side effects of the treatment are often so severe that many will refuse to finish. However, when patients try to end the treatment before being completely cured, they can become contagious again and spread an even more resistant strain to neighbors and family. Patients must take up to seven different antibiotics per day, all of which have very harsh side effects. Along with nausea, persistent headaches, blindness, hallucinations, deafness, blackening of the skin and psychosis, “[Patients] may find themselves crying constantly, feeling they will never get better, [and] that life has no purpose,” says Lorena Mestanza, a nurse with PIH. “They can also have changes in personality. … The calmest, most passive people can become aggressive [to the point that] they attempt suicide. … They want to refuse treatment, but this is their last chance.” |
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A boy holds a baby outside of his home in Carabayllo.
MDR-TB patients must take up to seven antibiotics each day for two years. |
The disease becomes active when a person's body is no longer able to keep the bacteria at bay, which is sometimes due to improper diet, overcrowding, poor access to medical care, substandard living conditions or an HIV infection. |
| Living in poverty, individuals may also stop their treatment because of a lack of resources, support and nourishment. Medications are not as effective if a patient is malnourished. On an empty stomach, the nauseating effects of the antibiotics make them very difficult to keep down. Rachel Ross, PIH Peru project manager, explains, “In some families with children, we found that
if you give a mother a food basket because she has
TB and her kids are starving, [she would] share that food with her children. Then, she wouldn’t have enough for herself, [which in turn] perpetuates the cycle of the disease. In those families, we [give] food baskets for the whole family, not just [to] the patients.” In addition to food baskets, PIH also supports their patients by providing financial assistance. |
Many years ago, my sister suffered from tuberculosis. She received treatment, but she had other problems, and her lungs filled with liquid. She died in 1995, when I was 11 years old. After that, my other sister, my aunt and uncle got sick too, one after the other. It was obvious that TB was going around the house.
TB attacked me because I had sick people in the house with me, and I didn't nourish myself well. I studied and worked and since I didn't feel any pain in my body, I thought, "First, I have to study. . I cannot [fail any classes]; I have to move forward." I put my health aside.
I was lucky to join the program. . PIH helped me a lot. They gave me medicine, food and paid for what I needed to survive. When you begin the treatment, they warn you that you can go a little blind, that it can affect your hearing and a bunch of other things.
. What I will never forget is the nausea that I felt when I took the medicine. Even though I took the pills, I ended up vomiting them back up, and I had to take them again. That was the worst. At the beginning of the treatment, I had to go to the hospital in Vitarte, [a district of Lima], which was very difficult for me because not only did I have to take two buses to get home, I ended up vomiting the pill on the bus. Sometimes, I could contain myself until I got home where I ended up vomiting in the bathroom. I felt like I was a wasted effort for PIH; they had a meeting and decided to give me a nurse at home. She would bring my treatment to the house day and night; it was like that for six months.
One day, [a PIH worker] said to me, "You're going to get better." I jumped on one foot in happiness. "Wow! How wonderful!" There are people who don't want their treatment to end, not because they like it, I doubt anyone likes it, but rather, because their self-esteem is so low and there is always the fear that they will relapse. I had many ambitions in life, and then, when I got sick, I couldn't realize them. Now, I am conscious of the fact that before I can work or study, I have to get well.
excerpt from: "venciendo la tb-mdr: 20 testimonios de expacientes con tuberculosis multidrogorresistente," or "conquering mdr-tb: stories of 20 former multidrug-resistant tuberculosis patients." published by: partners in health, peru, 2006. translated into english by tiffany enriquez linaldi. |
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