The weekends in the clinic are boring for the patients. Some start drinking, which means stress for the doctors on duty and especially the sisters.
For a few weeks now, I have been driving to the clinic for a few hours on a Saturday for a few hours to see at-risk patients and to meet with the nurses, and to take some pressure off them in exchange.
Disappointments can be a common theme when working with alcohol-addicted people, but these are all the more dramatic in connection with tuberculosis treatment.
Myths and taboos
Those who suffer from tuberculosis are pushed to the margins of society. If I ask my mother, who grew up in post-war Germany, she can still tell me about the classmates who suddenly did not come to class, disappearing to convalesce from an undefined illness. Everyone knew about tuberculosis, but nobody spoke about it.
Tuberculosis was and is a taboo.
Anyone who drinks alcohol and can put away a good amount is a hero.
Anyone who has lost control of their consumption is weak, a drunkard.
If you really wanted to, you could stop drinking.
None of this is correct!
Like tuberculosis, alcohol dependence is a recognized disease. Both are a taboo. Both are lonely.
Recovering from drug-resistant tuberculosis is usually possible after up to two years of intensive treatment, while alcohol dependence is chronic and requires lifelong awareness.
I would like to share with you some specific stories of the patients that I see every day, but it would do them harm, put their anonymity on the line.
In patients who have developed harmful or even dependent alcohol consumption for many years, the same thing always happens in the first weeks of treatment. Faced with the devastating diagnosis of a tuberculosis infection, they reach for the bottle.
Once they’ve got over the initial shock, then come the good intentions. The treatment is started. Hope sprouts up. But then there’s the dreary everyday life, isolated on the tuberculosis ward.
Loneliness and despair arrive, friends turn away, medication side-effects kick in. At some point your hand reaches to the bottle: here in Belarus, that mostly means vodka.
Although our patients know that drinking alcohol in combination with tuberculosis drugs is a major risk, the craving is usually stronger than thoughts of their health
The team of psychologists already knows the patients by this point. After the promising beginning it’s partly disappointing for them, so it’s my task then to work with colleagues so that they do not lose hope for the patient.
Although our patients know that drinking alcohol in combination with tuberculosis drugs is a major health risk, the craving is usually stronger than thoughts of their health.
If they’re intoxicated, patients frequently miss doses of their tuberculosis medication. Repeatedly missing medication can make the treatment ineffective, and often causes even further resistance of the tuberculosis pathogen to other antibiotics, making it even harder to treat.
In the drinking phase patients consume vodka, a lot, large quantities.
You meet patients, but it is hard to reach them. Promises are given, but not kept. Stopping drinking is often not possible on their own.
Some patients end up in detoxification in the intensive care unit. Not infrequently, due to their poor state of health the TB treatment must be interrupted and everything starts all over again.
The people around our patients: their employers, their families - all lose patience. Job loss, isolation, loss of housing - the social decline leads to disaster for everyone, especially for young people with hopes and ambitions.
Some patients believe that they can control alcohol consumption and that there will be no "next time". After the drinking episode they start again full of hope. They want to forget the last drinking episode, do not want to deal with their dependence.
Patients who feel this way firmly believe in their future, a family, children, a good job, a little vacation. But their relatives may not believe it, and my own experience with many patients who behave in a similar way shows me that, unfortunately, the relatives are often right. Nevertheless, I believe that one patient or another will arrive at some insight.
A friend once told me before I left: "You can't save them all!" My response was, "If I save only one, it's worth the effort." I'm still hopeful.