I have had so many “new” experiences here that I don’t even know where to start!
Perhaps the New Year would be a good place – here it is called ‘Nowruz’ – the Persian New Year – and it celebrates the arrival of spring! Rejoicing in the flowers and the fertility of the land. Being able to be a part of this, my hope is also renewed. We all need to complete cycles and start new ones, and anniversaries are always a good opportunity to do so. With this new Persian year, I hope for a better future for all.
I am far away, but I´m seeing from a distance that Brazil faces political crisis and it’s also dealing with the zika virus and chikungunya.
Here, in Uzbekistan, the epidemic is still tuberculosis. As I am a pediatrician, I see so many young people having to deal with the side-effects of the treatment, and this treatment can last up to two years! Different suffering, different realities.
But my hope remains the same: a better future for all, free access to health and equal treatment, regardless of nationality, religion or financial status. So, let’s hope spring brings with it the possibility of fair treatment for everyone who needs it.
About a month ago, I did a home visit to see a little girl who had just left hospital. She has MDR-TB, which means long months ahead taking injections several times a week. After the beginning of the treatment, which was carried out in the hospital, she was released to keep on with her treatment at home.
I was very well received by the sister of the child. Their mother died last year, she was also being treated for tuberculosis. The girl has a little niece, the daughter of this sister who is taking care of her. They were also screened, but were healthy.
The form of tuberculosis contagion occurs frequently within the family environment, so health education is very important, to try and stop the spread of the bacterium. In all my visits and every new contact with my patients and their families I always ask what they know and try to inform them a little bit more about the disease.
But back to my little one: She was throwing up every day, even on medications against vomiting. She had lost weight since leaving the hospital. She, with a beautiful smile, asked about one of our counselors. I was very happy to see that the relationship between the MSF team and our patient is so effective. They need more than medication to be treated.
At that point, my little one was amidst a complicated family situation: her father working in Russia, her sister going through a divorce and her niece needing care. She has been living with her sister and niece in a house with just three rooms, sharing a bed with her older sister in a room with a wood stove. It’s the only warm room in the house (here, in winter, the temperature is often below zero, and the house has no heating).
Taking all this information into account, we talked to the doctors of the local health system, and decided to admit this patient again, to improve the management of side effects and ensure continuity of the treatment.
This decision is never easy. We have a lot to consider before deciding what is best for the patient. Medicine is not an exact science; the human factor is not predictable, it’s not a constant. And with that, the result is never the same, even if things are done in the exact same way. Therefore, for each patient we face a different challenge. And that's what I love most about medicine and it’s what inspires me to keep learning.
We had a Nowruz celebration at the hospital for patients. At that celebration was the first time I saw the little girl in the hospital. She was dressed as a traditional local dancer. She was beautiful, with neat hair, a beautiful dress, already gaining weight and with a very, very happy face.
At the end, she asked to take a picture with me. What a delight, a picture with my little one and one important thing settled in my mind: “yes, we had made the right decision”. To see patients in a better condition is definitely priceless.
When I graduated in Medicine I made a promise: ‘primum non nocere’, it means: ‘first do no harm’.
It took me a while to understand that this promise means that although I cannot cure all cases, I should always try to lessen the pain and suffering of my patients and their families. And I always rethink that promise with every patient I see and when I need to make a decision.
The diagnosis of TB for children is quite complex, which may delay correct treatment for a long time. But also, diagnosing a child with drug resistant TB means putting the child in treatment for about two years, with potential side effects.
Because of this, every day I think about a long treatment with possible side effects versus a delayed diagnosis which could expose the child to less chance of success in their treatment. Primum non nocere. When I see my little ones complaining of injections, vomiting and not being able to go to school, my heart hurts. But it hurts even more when I think of them disabled, without the correct treatment.
The decision is difficult, but the goal is always the same: to see them healthy again and fully recovered.