Fieldset
TB in Belarus: “The blank spot on the map”

Knowing nothing about Belarus, German psychotherapist Christian arrives in Minsk for his first ever assignment with Médecins Sans Frontières / Doctors Without Borders (MSF)

"Belarus, that's somewhere in the east, former-Soviet Union..."

"Tuberculosis has long been eradicated..."

These two points were my only knowledge until the summer of 2018, when MSF offered me an assignment on a tuberculosis (TB) project in Minsk.

Now, I am three months into my one year journey.

Drug-resistant TB

Tuberculosis is a topical issue.

Belarus is a well-developed country with a well-functioning health system, and the treatment of simple tuberculosis infections is not a problem here. Just as in many other ex-Soviet republics.  

But, the treatment of drug-resistant tuberculosis – which does not respond to traditional antibiotics – poses a major challenge for the healthcare system, physicians and patients, as in many other countries.  

Expensive drugs, a complicated diagnosis and a treatment that lasts up to two years, including extreme-side effects such as hearing loss, makes the healing process almost insurmountable for many people. 

Even today, primary infections with multidrug-resistant TB are not unusual.

Expensive drugs, a complicated diagnosis and a treatment that lasts up to two years, including extreme-side effects such as hearing loss, makes the healing process almost insurmountable for many people. 

Alcohol dependence

Socially disadvantaged patients, who, unfortunately, also usually have alcohol dependence, often stop taking the treatment early. This means that new resistance develops, the disease becomes incurable for the individual and thus, inevitably, deadly.

So, you can see that patients need both medical and social-psychological support. At this point I come into play, as a psychotherapist specialising in addiction.  

We know today that regular alcohol consumption or alcohol dependence is the crucial risk factor for our patients stopping their treatment. 

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An MSF team member examines a patient with multidrug-resistant TB in Minsk
An MSF team member examines a patient with multidrug-resistant TB in Minsk

So, I have two major tasks:

The first is to set up a team of psychologists and social workers here in Minsk.

The second is to work in cooperation with the National Tuberculosis Institute and the Ministry of Health. Together we‘ll develop an intervention for tuberculosis patients with addiction issues, plus the training to deliver it for doctors and nurses. 

Arriving in Belarus

At the end of October 2018 I landed in Minsk. My visa, valid for three months, was in my pocket.  

How would that be at border control? What would the reception be like in Belarus?  

The answer: restrained, considerate, friendly. That is my impression of the "Belarusian mentality" summarised in three words.  

Minsk appears to me, like its people. Unpretentious, generous, very quiet and extremely clean for a city with almost two million inhabitants.

The driver did not speak a word of English, but through gestures we were able to communicate. And this is how it goes with many of the people I meet in everyday life here. They are interested, they want to know more, but they do not push themselves.

Getting to know Minsk

Minsk and its people are unruffled, which is sometimes almost depressing to me as a Rhinelander (people from Germany’s Rhineland area are known for their good spirits). But, my colleagues explained this state of mind to me as "Belarusian normal“ – not sad and not euphoric.

Minsk appears to me, like its people. Unpretentious, generous, very quiet and extremely clean for a city with almost two million inhabitants.

The city is not beautiful in the classical sense, but charming and spacious. It has wonderful parks, where in the morning you will meet people and their mostly handbag-compatible dogs. Here you will be safe, and - if you want – you will be left completely alone. You get help if you ask for it.  

There is hardly any wealth, but people do not suffer. The shelves in the supermarkets are full and there is nothing that, as a German in exile, I have to do without. Luxury items are expensive, however. Unfortunately, for many that makes them unaffordable. 

People here love technology, bright lighting, their smartphones and computers. Everything happens online: Order a taxi, get a pizza delivered, buy an opera ticket. I even bought a chocolate bar for the equivalent of 25 cents and paid without any problems by credit card.  

Everyone wants to be modern and participate in progress. And they do so despite their limited resources.

This is a lovable melange that really does not deserve to be a blank spot on the map. I like Belarus!