Families Without Fathers

Terry blogs about how broken homes and missing fathers add even more complexities to multi drug resistant TB in Tajikistan...

I am meeting 17-year-old Gulbahor’s mother for the first time. We are on outreach in the south of Tajikistan to assess Gulbahor’s home. She has been in hospital in Dushanbe for 6 months and we recently found out that her TB is XDR: resistant to almost all of the drugs. She is still infectious, but if her home is suitable, and her family understands the infection control measures, we think she would be better off there.

As the end of our conversation draws near, I remark to her mother: “You seem like a very strong woman”.

“What else can I do but go on?” she replies, “but inside I am destroyed”.

She smiles bravely, but wipes at her eyes with the back of her hand.

Gulbahor’s father left the family 12 years ago to find work in Russia. He was to make much more money there and provide for his family in a way that is not possible in Tajikistan. Apparently life was so much better there that he never came back. He found another wife and started a new family. He has stopped sending money to Gulbahor’s mother; only sends a bit once in a while to Gulbahor because he knows she is sick.

The other 3 children, a daughter and 2 boys, don’t get anything. Gulbahor’s mother has 2 rooms in her uncle’s farmstead, and works the land she and her husband were to farm together. The boys stay with her, but her daughter has to live with another family member.

If Gulbahor comes home she will need an isolated room, a luxury that means more sacrifice for the rest of the family. By the time we make this clear, the poor woman tells us that maybe it’s better if Gulbahor stays in hospital.

It’s a shocking scenario that we keep hearing from many of our patients’ parents: Father in Russia, mother left to fend for herself and her kids. Many men don’t come back, or stop sending money, or take a second wife.

To be fair, a recent documentary by Al-Jazeera (English) on this phenomenon highlighted the other side of the story. The Tajiks in Russia are often treated badly, made to work long hours and then told that they will only be paid if they work even longer. They get trapped by an unfair system that makes it hard to be there, but even harder to leave.

This documentary is about such families as we work with every day; it is unexaggeratedly true-to-life.

Another mother we visit has just brought her daughter Nuria home from hospital. She is also 17 but is doing well on MDR treatment and grinning from ear to ear to be back home. However, Mom tells us Nuria will be living with her aunt. Her other daughter is living with another aunt.

“Baroi chi?” Why?

Because Mom is leaving for Russia soon herself, to join her husband. Well, that’s one solution. I feel sorry for Nuria, but she is still smiling.

We have a bit of an issue getting Nuria’s DOTS set up: Mom is suggesting Nuria walk 2km into town every day to get her meds because she is afraid that otherwise people will see the nurse coming to the house and realize Nuria has TB. She wants her to marry soon, and she’s pretty sure that no man will want her if he knows she is sick.

I can’t help myself: I almost hope that the stigma will protect Nuria from the worse fate of what marriage has become for so many Tajik women.