Richard Mowll is a civil engineer from Croydon,
who travelled to Western Uzbekistan in January 2002 with
MSF to rehabilitate a 600 patient TB dispensary. He then
went on to prepare a 100 bed facility for multi-drug
resistant (MDR-TB) patients, where he was Project
Co-ordinator of the 16 Médecins Sans Frontières (MSF) staff
programme.
“The dispensary building in Nukus was a mess –
the result of the near collapse of the health service in
this country over many years. Through my work there, one
incident stands out. A minor incident but one which left a
lasting impact…”
To know what new pipework to order, I inspected the
Dispensary room by room to measure sizes and to identify
the fittings. As I was in one open room with just a bath in
it, a thin girl with a headscarf walked slowly past me and
up to the bath. She held on to the side with both hands and
with apparently all the strength she had, she coughed.
Weak, pitiful, tiny coughs. She was clearly beyond just
‘ill’. A friend of hers came into the room and
stood beside her holding her shoulders from the side,
supporting her as she coughed.
What could I do? I’m an engineer who formerly
specialised in road maintenance and concrete construction
– she didn’t seem to need either of those
specialities just then. I couldn’t do anything, but
feel out of place. I left the room. This was a private
moment for them, and I wasn’t helping by being
there.
There were and continue to be so many like her –
six hundred in the Dispensary itself (although in varying
states of illness) and literally thousands of others
throughout Uzbekistan. All of these TB patients were the
victims of not only the infection, but also of the health
system that was not just in a state of decline, but near
total collapse, where doctors earn as little as ten pounds
per month (how could that feed, clothe and warm a family of
four?). How could a health system so under funded help the
population overcome the spread of this disease?
What could I do for the girl? Nothing, by myself. But
the medical staff and the MSF project that I was working on
was trying to improve the system of healthcare for TB
patients by using the World Health Organisation’s
Directly Observed Treatment – Short-Course (DOTS) TB
treatment methodology. This was where it struck me how
MSF’s work was truly a team effort. I know nothing
(or at least very, very little) about treating TB patients.
The medical staff knew very little about rehabilitating a
TB Dispensary building. But this rehabilitation was one
link in the chain, which was improving conditions for the
patients and helping lower the incidence of TB. The medical
staff were more links in that chain.
I never saw the girl again – perhaps she got
better and left, although I kind of doubt that that could
happen. This incident made me realise two things. Firstly
the total need for someone to help this girl and others
like her – MSF are one of the few organisations doing
anything here – and secondly the way that MSF
missions are based so strongly on teamwork. I guess I also
realised a third thing – that I was proud that I was
working for an organisation that was trying to make a
difference.
Today, Richard is back in Uzbekistan working with
another organisation. The TB dispensary is part of a
network of State TB facilities supported by MSF. It will be
handed over to Uzbek Ministry of Health control by the end
of 2003. The MDR-TB programme will start treating patients
in the coming months.
If you would like to contact Médecins Sans Frontières,
you can e-mail them on: office-ldn@london.msf.org
or visit their website:
www.uk.msf.org
Post Script:
Kidnapped: our MSF colleague Arjan Erkel was abducted
more than six months ago in Daghestan, Russian Federation.
We still do not know what has happened to him. Please sign
MSF’s petition to President Putin asking for urgent help to
get Arjan released. Click here and pass it on to your
friends:
