31 January 2018
Gunta Dravniece is a Senior Consultant for KNCV Tuberculosis Foundation (KNCV). She mostly works in countries in the former Soviet bloc and has recently visited Kyrgyzstan to help with the expansion of access to new treatments. For Gunta, every life deserves to be saved.
Text: Marion Biremon in Kyrgyzstan
How would you describe your job?
“It’s exciting, you feel like you’re doing something that is really needed, saving lives. But it’s difficult because we’re working in a field where the treatment requires time and patience, it’s not like surgery where you operate, the problem is fixed and the job is done. Tuberculosis (TB) is also not only about TB infection. You frequently have to deal with the complex circumstances of a patient’s life.”
Do you think it’s possible to end TB?
“Without vaccination, I don’t think it’s possible to end TB. It is possible to achieve a 90% treatment success rate with the available drugs. But it’s not only about using the right treatments. Many more resources are needed to support patients, to make TB programs efficient and sustainable.”
Why do you advocate for new treatment approaches?
“Because this is the best that we can offer at this moment and it makes a huge difference for patients. With the shorter treatment regimen (STR) patients’ lives will not be disturbed with two years of tough treatment, and for patients with extensively-drug resistant TB, the lack of access to new drugs is a death sentence.”
How do you feel when you see that a patient is on the wrong treatment?
“It makes me feel guilty because I cannot save each and every patient. It’s also a feeling of desperation and unfairness, especially if it is a child. In many cases, something more could be done. Not all doctors insist that their patients need better treatment, and this carelessness, this passiveness, drives me crazy. I think maybe they lost hope, maybe they do not know that things can be done differently.”
What would you like to change in TB treatment today?
“I would like to change the attitude of TB doctors. Patients are often left out of the treatment process. They are just told to take this and that pill, and they don’t understand why. If all doctors would speak to their patients like our KNCV clinicians and case managers in Kyrgyzstan, who treat patients as their friends, then everything would change.”
You often say that ‘someone’s life is influenced by each decision’. Why does this matter to you, and why should it matter to others?
“I think it’s very unfair to not do everything you can to save someone, it’s really unacceptable to play god and to let somebody die. Recently I’ve been thinking a lot about a family from Batken, in the south of Kyrgyzstan. The mother of four children was one of our first patients to be enrolled on treatment with new drugs, but she died within a few days because she was critically ill by the time we were able to treat her. If the decision to allow the new drugs into Kyrgyzstan had been taken just a few months earlier, when we actually expected it, their mother would be alive today. But the drugs came too late and she died. A young woman died from a curable disease and her four children are now orphans. They will hurt, they will cry, they will always miss her. It’s irreversible, and all because a decision came too late.”
What surprises you in Kyrgyzstan?
“Stigmatization of TB. I see that patients feel guilty, they feel that they are not normal, that they are ‘dirty’. A lot of patients don’t go home to their villages for outpatient treatment. If they could be open about the fact that they have TB and if they could be supported, there would be fewer treatment interruptions and tragedies. In Central Asia in general, stigma is much stronger when compared to the other countries where I’m working. It has much more serious consequences, for example when young girls can’t get married or mothers/wives with TB are kicked out from the household.”
How is the TB situation in Kyrgyzstan evolving?
“It takes time to change mind-sets, but we are really making progress and the main achievement is that our colleagues from the National TB Program have accepted the new approach. It’s really great to see their trust, and how willing they are to work with us now. The first treatment results, nicely visualized by patient stories, played a crucial role in paving the way for the countrywide access to new drugs and shorter regimens and are inspiring other countries too.”
In the top picture:
Dr. Ainur Soorombaeva in Kyrgyzstan with two of the orphaned children from Batken