TB in Belarus: Two steps forward, one step back

At an MSF tuberculosis project in Belarus, German psychotherapist Christian learns how to be patient with progress...

MSF counsellor with a patient

Many MSF employees are in this tuberculosis (TB) project from a few months up to half a year.

As a mental health activity manager this is different, you usually stay one year. In a management position in the project, it is important to build trust with local staff and colleagues in local institutions.

That does not work within weeks, that takes months. It is hard enough for my colleagues in Belarus to get used to new international colleagues again and again.

Continuous evolution

It sounds crazy – there’s still quite some time left until the end of October – but I'm already starting to prepare for the handover to my successor.

This is extremely important because despite the change of personnel there should be stability in our activities.

This will only work if we document well, train conscientiously and work sustainably

It makes sense that every new international team member constantly produces and realises new ideas, however, there is still a need for some stability alongside this continuous evolution.

A sustainable system

From my wonderful predecessor, I have adopted a clear core concept that I have transferred into concrete measures and instructions during my time at the project.

We have now systematised our patient work, creating processes and manuals to which all employees adhere.


MSF doctor Begimkul in TB institute, Minsk

I have regularly trained all psychologists in behavioural therapy methods to work effectively with addiction patients who have tuberculosis. And, we have also set up a patient database for the psychosocial team, which is a prerequisite for the reliable evaluation of our activities.

All of these innovations have been undertaken not only by my staff, but the staff in the institutions of the ministry of health, too. This is enormously important because one day MSF will finish our project and hand over our work to the ministry of health.

This will only work if we document well, train conscientiously and work sustainably.

Pulling the breaks

At some point in June, we noticed that we have so many new ideas that we cannot implement them all.

Numerous other tuberculosis projects have expressed interest in our concepts, so we have made preparations to set up a research project based on our interventions.

However, it’s easy to lose sight of everyday life.

I will practise a new discipline – patience

I admit that in the last few weeks I've been frustrated every now and then because we've lost pace and not everyone seemed involved. But then I looked back and understood how much we have achieved in a short time.

Half of my team has only been here for half a year, and when I see what we achieve here every day, I am incredibly proud of my team.

So, we pulled the brakes and focused clearly. Now, we do not implement any other necessary but not urgent changes to our work.

We are stabilising what we have achieved, refining the procedures, working on details here and there, and continuing to persuade in many places.

Two steps forward, one step back

While we have already reached a kind of routine in the tuberculosis clinic, there is still a great deal to do in the outpatient tuberculosis centres around the city.

Sometimes it's like the hopping procession in Echternach, Luxemburg: two steps ahead, one step backwards.

So, I will practise a new discipline – patience.

I can benefit from the successes of my predecessors, but I will not see the results of my own initiatives without it.

This is part of the reality in MSF’s long-term projects.