Médecins Sans Frontières - INT - HEALING CARE

Unique Identifier Code / URN MSB151186

Date taken / Date Recorded 22/08/2023 3:34 PM

Country Tajikistan

Commissioning section MSF-NETHERLANDS

Photographer / videographer / producer Zdenek Chaloupka

Copyright Zdenek Chaloupka/MSF

Usage Rights (MSF) External Media, MSF Fundraising, MSF Publications, Social Media

Formal Consent Copy available yes

Editor's rating ★★★ (F)

Video format dnxhd (DNXHR HQ)

Duration 23m3s

Maximum Size 1920px × 1080px 30.34 GB

Additional Information / Shotlist 1
00:00:57,040 --> 00:01:03,320
The Paediatric Tuberculosis Hospital is located
in the centre of Dushanbe, the capital of Tajikistan,

2
00:01:03,320 --> 00:01:06,760
and several dozen children
are treated for tuberculosis here.

3
00:01:07,440 --> 00:01:12,680
One of them is eight-year-old Mohamed,
who is regularly visited here by his mother.

4
00:01:15,800 --> 00:01:23,480
I‘d never come across TB before so,
when they first told me, it was a shock.

5
00:01:23,800 --> 00:01:30,720
No one else in the family
had been ill – my son was the first.

6
00:01:41,280 --> 00:01:48,000
When a child comes for diagnosis,
we do sputum induction.

7
00:01:48,400 --> 00:01:57,880
We take the sputum and send it to the laboratory
to find out the exact diagnosis.

8
00:01:58,400 --> 00:02:09,280
During treatment, we repeat sputum induction
to see if the patient is still infectious.

9
00:02:15,880 --> 00:02:20,160
In childhood, it can be hard
to make a diagnosis

10
00:02:20,440 --> 00:02:26,040
because children have different
symptoms from adults.

11
00:02:26,600 --> 00:02:34,360
The disease appears as
an inflammation, like bronchitis,

12
00:02:34,560 --> 00:02:38,520
which only later
turns out to be TB.

13
00:02:47,960 --> 00:02:51,640
At first I thought
it was the flu.

14
00:02:51,760 --> 00:02:58,640
But his temperature didn‘t go down,
so we went to the hospital.

15
00:02:58,840 --> 00:03:00,880
But first we treated it
like the flu.

16
00:03:01,320 --> 00:03:06,640
Children stay here until their sputum
is no longer contagious.

17
00:03:07,080 --> 00:03:20,680
When their test results are good,
they can go home.

18
00:03:21,000 --> 00:03:24,000
This usually takes
three to four months.

19
00:03:29,520 --> 00:03:32,560
He’ll definitely be here
for three months.

20
00:03:32,720 --> 00:03:39,400
Then they get tested and when their sputum isn‘t infectious,
they can be treated at home.

21
00:03:55,000 --> 00:03:59,960
There is a lot of stigma,
even within patientsʹ families.

22
00:04:00,120 --> 00:04:08,360
Because of the disease, people lose their friends,
families fall apart, men leave their wives.

23
00:04:08,800 --> 00:04:13,400
Sometimes a woman
leaves a man.

24
00:04:13,520 --> 00:04:18,360
In my work, I came across one young
woman who left her husband.

25
00:04:18,520 --> 00:04:28,720
She told him she wouldnʹt live
with someone with TB.

26
00:04:28,720 --> 00:04:32,840
They had two children,
but they got divorced anyway.

27
00:04:32,840 --> 00:04:36,440
Unfortunately such
things happen.

28
00:04:38,080 --> 00:04:41,000
Seventeen-year-old Mahina
is also treated here.

29
00:04:41,480 --> 00:04:43,920
She is the oldest patient
in the hospital.

30
00:04:45,320 --> 00:04:49,400
I‘ve had TB for
over a year now.

31
00:04:49,400 --> 00:04:54,280
They operated on me and found out
that I had intestinal TB,

32
00:04:54,280 --> 00:04:57,680
which then turned
into pulmonary TB.

33
00:04:57,680 --> 00:05:00,920
I had a fever,
I felt sick and weak.

34
00:05:01,080 --> 00:05:03,040
I lost about 20 kg.

35
00:05:04,120 --> 00:05:07,280
Mahina has lost many of her friends
due to her illness.

36
00:05:07,560 --> 00:05:11,000
They reacted pretty badly.

37
00:05:11,080 --> 00:05:15,120
They told me I wouldn't recover
and everything would go wrong.

38
00:05:17,840 --> 00:05:23,400
They didn't know
how the disease is spread.

39
00:05:23,520 --> 00:05:29,120
They thought they’d get sick
and so they stopped seeing me.

40
00:05:32,520 --> 00:05:35,800
Then I didn't want
to see them anymore.

41
00:05:45,760 --> 00:05:58,240
Everything‘s fine now. I'm taking pills. Sometimes I have
side effects, but then they subside.

42
00:05:58,240 --> 00:06:03,400
The pills are split up: I take 10 tablets in the morning
and three in the evening.

43
00:06:07,920 --> 00:06:11,760
I want sick people
to recover

44
00:06:11,760 --> 00:06:15,720
and other people to treat them
like they’re healthy.

45
00:06:15,720 --> 00:06:19,760
They shouldn‘t think they'll get infected
and stop seeing them.

46
00:06:20,360 --> 00:06:30,440
Sick people need happy
and positive things in order to heal.

47
00:06:31,040 --> 00:06:38,480
So please be nice to other people
and other people will be nice to you.

48
00:06:43,600 --> 00:06:48,320
If children are not contagious, they do not have to stay
in hospital and can be treated at home.

49
00:06:49,120 --> 00:06:52,640
However, they must have a caregiver
who can take care of them.

50
00:06:53,320 --> 00:06:57,960
That’s why MSF started a program called
F-DOT - Family Directly Observed Treatment -

51
00:06:57,960 --> 00:07:01,000
- that enables children
to be treated at home.

52
00:07:01,920 --> 00:07:05,120
Mostly by their parents who have been
trained to provide such care.

53
00:07:06,520 --> 00:07:12,440
Tuberculosis is such a complicated disease
that requires a lot of medications

54
00:07:12,440 --> 00:07:17,000
and long treatment up to two years
and that can be very difficult

55
00:07:17,000 --> 00:07:20,200
for patients to cope with.
And even the families.

56
00:07:20,200 --> 00:07:26,360
Especially because we start with paediatric
tuberculosis, the whole family is affected.

57
00:07:29,000 --> 00:07:33,840
Surayo lives in the countyside with her family,
far from the closest hospital.

58
00:07:34,760 --> 00:07:38,400
MSF provides her with the necessary
medication for her children.

59
00:07:41,480 --> 00:07:45,720
It is important to include the caregivers especially,
because we have children,

60
00:07:45,720 --> 00:07:51,880
and without our caregivers being involved the children
wouldn’t be successful in their treatment.

61
00:07:51,880 --> 00:07:57,320
So we have this Family Directly Observed Treatment
programme, the F-DOT programme

62
00:07:57,320 --> 00:08:01,440
that we are really using to support
our families and the communities.

63
00:08:01,440 --> 00:08:05,360
So if they are not severe enough to where they
have to be hospitalised,

64
00:08:05,360 --> 00:08:07,400
we put them
on this programme.

65
00:08:07,400 --> 00:08:10,760
Or after they are discharged from the hospital
and can go back home,

66
00:08:10,760 --> 00:08:14,160
we try to transition them
into this F-DOT programme.

67
00:08:14,160 --> 00:08:20,440
We then identify one primary caregiver whom
we will educate about tuberculosis disease,

68
00:08:20,440 --> 00:08:27,920
treatment, side effects of medications,
how to help cope motivating their children.

69
00:08:27,920 --> 00:08:34,360
And we really try to choose and select the caregiver
that the child has the closest relationship with.

70
00:08:34,360 --> 00:08:39,640
So then they may be more motivated because of that
– to listen and take the medications,

71
00:08:39,640 --> 00:08:42,400
even if they’re experiencing
any side effects.

72
00:08:46,480 --> 00:08:50,640
F-DOT has been very helpful
to both families and doctors.

73
00:08:52,720 --> 00:09:00,880
Mothers have been trained
to know which pills to give.

74
00:09:01,240 --> 00:09:11,160
This has helped a lot
in the treatment of paediatric TB.

75
00:09:16,040 --> 00:09:22,600
My father got TB so I left the children
with my ex-husband.

76
00:09:22,760 --> 00:09:29,480
But then I couldn't stand it anymore and after
three months I brought them here.

77
00:09:29,480 --> 00:09:35,120
Someone from MSF came to us and helped us
do an X-ray and other tests.

78
00:09:35,120 --> 00:09:46,000
When I found out that my children
were sick, I couldn't believe it.

79
00:09:50,560 --> 00:10:01,320
The main source of infection is a patient
who infects other family members.

80
00:10:02,240 --> 00:10:23,720
Young children are in close contact with their parents
or grandparents, who can infect their other children.

81
00:10:35,000 --> 00:10:43,800
We have started using
new drugs to treat

82
00:10:43,800 --> 00:10:53,840
multidrug-resistant TB – bedaquiline, delamanid
and other new products.

83
00:10:54,520 --> 00:11:02,040
We found out how they work and these
new drugs have had very good

84
00:11:02,360 --> 00:11:10,920
without major side effects.

85
00:11:10,920 --> 00:11:18,600
All the help we have received
has helped us a lot.

86
00:11:19,040 --> 00:11:24,760
As well as getting the drugs
we needed, we also received food.

87
00:11:25,080 --> 00:11:32,560
And everything was free.

88
00:11:43,680 --> 00:11:52,840
When we started providing treatment,
children needed to stay in hospital.

89
00:11:53,560 --> 00:12:01,920
Many parents refused
as it was difficult for them

90
00:12:02,240 --> 00:12:09,080
to go backwards and forwards
to visit their children.

91
00:12:12,080 --> 00:12:18,400
We also had instances where a mother
did not have the money to visit her child

92
00:12:18,560 --> 00:12:35,840
so MSF helped by paying for transport
twice a month so she could visit her child.

93
00:12:35,840 --> 00:12:50,720
We think that if a child can take medication
at home, why shouldn't they be at home?

94
00:12:51,320 --> 00:12:54,400
They feel better surrounded
by their families.

95
00:12:54,400 --> 00:13:02,280
At home they have friends and playmates,
many more than in the hospital.

96
00:13:02,840 --> 00:13:11,800
Children also eat differently
when they are with their parents.

97
00:13:11,800 --> 00:13:18,160
In hospital they may lose
their appetite completely.

98
00:13:18,960 --> 00:13:28,000
When we were able to start treating patients
at home, these problems disappeared.

99
00:13:40,480 --> 00:13:47,640
TB is still connected with stigma and many
patients don‘t want to admit they are ill.

100
00:13:48,640 --> 00:13:51,560
They also can have problems
with their neighbours.

101
00:14:14,120 --> 00:14:18,760
I started vomiting
blood in February.

102
00:14:19,120 --> 00:14:24,960
Someone from MSF used to
come to see my children.

103
00:14:24,960 --> 00:14:29,160
They had been coming to us
for about a year and a half.

104
00:14:29,160 --> 00:14:33,480
They asked me why I was so weak
so I told them what had happened.

105
00:14:33,480 --> 00:14:37,160
They told me to go
to the doctor right away.

106
00:14:37,160 --> 00:14:41,480
They paid 70 somons
for my trip to the hospital.

107
00:14:41,640 --> 00:14:50,560
There I had various tests
and was started on treatment.

108
00:14:50,560 --> 00:14:56,440
My children finished treatment
last year and then I got sick.

109
00:15:01,520 --> 00:15:05,400
Unfortunately there is also a lot of
misinformation about tuberculosis

110
00:15:05,400 --> 00:15:08,280
and some people believe
that it is not curable.

111
00:15:08,280 --> 00:15:13,600
And therefore if a daughter-in-law
brings tuberculosis into the family,

112
00:15:13,600 --> 00:15:17,800
or had it before, they may
always be affected by it.

113
00:15:17,800 --> 00:15:26,280
This is the fear that maybe potential suitors
and potential in-laws may have:

114
00:15:26,360 --> 00:15:30,480
that even if this patient is cured,
they may still always have it.

115
00:15:30,480 --> 00:15:34,520
There is also a lot of stigma about
tuberculosis itself in the community:

116
00:15:34,520 --> 00:15:43,160
that maybe this family, there is something wrong
genetically with them, they may be weaker somehow.

117
00:15:43,160 --> 00:15:51,360
So the community may start to spread gossip.
So there is a lot of stress and fears that can occur.

118
00:15:55,000 --> 00:16:02,520
People laughed at me and didn't want
their children to play with mine.

119
00:16:02,520 --> 00:16:08,000
They said it was
an infectious disease.

120
00:16:15,520 --> 00:16:21,000
When it's a little cooler,
I'll be able to breathe better.

121
00:16:21,000 --> 00:16:27,320
Even a healthy person has difficulty
breathing in this heat.

122
00:16:35,760 --> 00:16:38,840
Come here, Abubakr.

123
00:16:38,840 --> 00:16:42,280
Why don't you want to eat,
aren't you hungry?

124
00:16:42,280 --> 00:16:50,320
Where is Asmya?
Call her and come.

125
00:16:55,280 --> 00:16:58,520
You are tired, my dear mother,

126
00:16:58,520 --> 00:17:01,400
sit next to me for a while.

127
00:17:01,400 --> 00:17:06,720
Let me kiss your neck
and play with your hair.

128
00:17:06,720 --> 00:17:11,600
I'll give you a soft pillow
and hot tea.

129
00:17:11,600 --> 00:17:14,240
You are tired, my dear mother,

130
00:17:14,240 --> 00:17:16,680
sit next to me for a while.

131
00:17:16,680 --> 00:17:21,240
Tell me what you want?
What can I do for you?

132
00:17:21,240 --> 00:17:23,600
What do you want to eat,
what can I cook for you?

133
00:17:23,600 --> 00:17:26,080
Where should I go and
what should I bring you?

134
00:17:26,080 --> 00:17:28,280
You are tired, my dear mother,

135
00:17:28,280 --> 00:17:30,720
you are a cure for my pain

136
00:17:30,720 --> 00:17:33,080
you are my compassionate caregiver,

137
00:17:33,080 --> 00:17:37,480
Sit and sleep, my dear mother,

138
00:17:37,480 --> 00:17:40,280
don't be tired anymore.

139
00:17:49,840 --> 00:17:53,280
City of Hissor is about one hour
drive from Dushanbe.

140
00:17:53,680 --> 00:17:56,880
Dilrabo lives in a small house
with her two sons.

141
00:17:57,200 --> 00:18:00,800
All of them had tubercuosis and they
all have been succesfuly cured.

142
00:18:00,800 --> 00:18:04,120
Even though the begining of treatment
was very difficult for them.

143
00:18:13,120 --> 00:18:17,760
When I was in hospital,
I realised

144
00:18:17,880 --> 00:18:24,640
that my two sons,
Ahror and Asror, were also sick.

145
00:18:24,760 --> 00:18:31,920
I was shocked, I couldn‘t open my mouth
for two days and take my medication.

146
00:18:31,960 --> 00:18:42,680
After they got sick, my life lost its meaning.
Honestly, I wanted to die.

147
00:18:42,680 --> 00:18:49,720
I didn't want my children
to suffer like me.

148
00:18:49,720 --> 00:18:55,800
I went to hospital in Machiton
in November.

149
00:18:55,800 --> 00:18:59,920
I was in another hospital before
and then I was transferred to Machiton.

150
00:18:59,920 --> 00:19:06,760
The other boys used to play outside, but I used to
sleep the whole time. I couldn't play at all.

151
00:19:06,760 --> 00:19:15,000
Nurses Nasiba, Maysara and Zulfiya came to me
and gave me courage and hope.

152
00:19:15,000 --> 00:19:19,720
We came up with a solution for Dilrabo
to take her medication at home.

153
00:19:19,720 --> 00:19:24,520
The grandmother was in charge
of making sure

154
00:19:24,520 --> 00:19:30,880
that Dilrabo and Asror always
took their medication on time.

155
00:19:30,880 --> 00:19:34,360
We came every week with
new supplies of drugs.

156
00:19:34,360 --> 00:19:38,160
Sometimes we came three times
a week to see Dilrabo,

157
00:19:38,160 --> 00:19:43,800
because she was very weak after being
released from hospital in Machiton.

158
00:19:43,800 --> 00:19:56,800
She didn't cope well with the situation;
she couldn't accept what was happening to her.

159
00:19:57,160 --> 00:20:01,920
It can definitely be a compounded
situation of several factors.

160
00:20:01,920 --> 00:20:07,000
In addition, some pre-existing issues of
domestic violence, pre-existing issues

161
00:20:07,000 --> 00:20:14,080
of family conflicts and poverty
and malnourishment and all of these things.

162
00:20:14,080 --> 00:20:20,040
When you have tuberculosis on top of it,
it really can create such a heaviness

163
00:20:20,040 --> 00:20:24,240
on a family system that it is
really, really difficult.

164
00:20:26,240 --> 00:20:32,960
We hear from our patients that it is really difficult
to necessarily trust other systems

165
00:20:32,960 --> 00:20:41,440
or to know who to turn to for help, so they really
appreciate our teams coming to them in their homes,

166
00:20:41,440 --> 00:20:48,680
in the hospitals, and calling, making phonecalls,
on a regular basis to really check on them.

167
00:20:48,680 --> 00:20:53,760
That has been for them the most
meaningful part of our treatment.

168
00:20:53,760 --> 00:21:01,560
They really believe that our teams care.
So there is healing in the care.

169
00:21:01,560 --> 00:21:05,800
She cried every time
we visited her.

170
00:21:05,800 --> 00:21:09,600
That's why we started
calling her the "crying patient“.

171
00:21:13,600 --> 00:21:18,080
I'd never seen her smile.

172
00:21:19,840 --> 00:21:35,960
She cried every time we left. She had
no idea what she would do without us.

173
00:21:36,560 --> 00:21:52,600
When she started treatment, she was very skinny.
She only weighed about 40 kg.

174
00:21:52,600 --> 00:21:56,680
After she recovered, I met her at the
TB treatment centre in Hissor.

175
00:21:56,680 --> 00:22:02,400
And suddenly I saw
a beautiful woman coming.

176
00:22:02,400 --> 00:22:09,240
When she came even closer,
I saw that she was smiling.

177
00:22:09,240 --> 00:22:12,800
It was a beautiful feeling
to see her laugh.

178
00:22:12,800 --> 00:22:18,080
When I saw her like that,
I was so happy.

179
00:22:26,000 --> 00:22:32,440
For us, the best gift
for our support and care

180
00:22:32,440 --> 00:22:43,080
is the healing and the laughter of these patients
who are getting treatment under our control.

181
00:22:47,840 --> 00:22:58,360
TB is a treatable disease
but it must be treated in time.

182
00:22:58,360 --> 00:23:04,840
If a person doesn‘t contact
a doctor in time,

183
00:23:04,840 --> 00:23:13,200
it can develop into a form
of the disease that is difficult to cure.

184
00:23:13,200 --> 00:23:24,160
Therefore, it is necessary to contact a doctor
in time and also to start treatment in time.

185
00:23:24,160 --> 00:23:38,480
If anyone starts coughing and feeling weak,
they should see a doctor quickly.

186
00:23:44,760 --> 00:23:51,280
If they ever feel like they are not so sure
about what to do, they should go to their doctors,

187
00:23:51,280 --> 00:23:57,800
go to the Ministry of Health and contact them
and ask about what they can do to get support.

188
00:23:57,800 --> 00:24:01,840
Not to be afraid to get support
because it is better to ask for help

189
00:24:01,840 --> 00:24:08,520
versus staying sick
and getting progressively worse.

190
00:24:08,520 --> 00:24:15,200
What I think is really important is that they know
their lives are important and valuable.

191
00:24:15,200 --> 00:24:18,040
Every person’s life
is valuable and important.

192
00:24:18,040 --> 00:24:22,880
Because they have TB does not make
them less than anyone else.

193
00:24:22,880 --> 00:24:27,080
We want them to be just
as healthy and happy

194
00:24:27,080 --> 00:24:30,440
and have as much of a positive
future as anybody else.

195
00:24:30,440 --> 00:24:36,520
And that the stigma is just a stigma,
it is not the truth of who they really are.

196
00:24:36,520 --> 00:24:40,320
So having tuberculosis does not mean
that they are bad people

197
00:24:40,320 --> 00:24:43,920
or they are not equal
to everybody else.

198
00:24:43,920 --> 00:24:48,040
It just means they have an illness
and like any illness, there is a treatment for it,

199
00:24:48,040 --> 00:24:51,320
and so they should seek it
and they can get cured from it.

200
00:24:51,320 --> 00:24:54,680
And that’s also important,
that they know that it is curable.

201
00:24:54,680 --> 00:25:00,000
Seeking medical treatment sooner
will help them get healthier faster

202
00:25:00,000 --> 00:25:02,400
and get back to
their normal life.

203
00:25:02,400 --> 00:25:07,720
And hopefully then they can move on
and not have to think about it again

204
00:25:07,720 --> 00:25:12,200
and have the kind of future
they would like to have.

Special instructions This documentary is momentously only available for MSF events use. Under embargo for external media publication.

INT - HEALING CARE - TB 23 min documentary

INT - HEALING CARE - TB 23 min documentary