A new project is improving outcomes for Ukrainian refugees in Poland undergoing treatment for tuberculosis.
27-year-old Maryna knew only too well that tuberculosis was serious. Working in forensic medicine in Dnipro, Ukraine, she was regularly involved in postmortem examinations of patients infected with tuberculosis (TB). Ukraine has the second highest burden of TB in the WHO European Region, with 73 cases per 100 000 in the population.
Maryna realized that she was unwell while Ukraine was under a stringent COVID-19 lockdown, which meant that getting a confirmed diagnosis took longer.
After x-rays showed considerable fluid in her lungs, she was admitted to hospital, separating her from her small daughter, who had just started school. Missing her daughter strengthened her determination to complete treatment.
“I told my husband that whatever happens, I need to live for our daughter,” she said. “I had to get strong and healthy again.”
New drugs available
Maryna started treatment, but her health wasn’t improving. Eventually, after several months of treatment, she was diagnosed with drug-resistant tuberculosis (DR-TB).
DR-TB is defined as resistant to at least one anti-TB drug. Multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) are even less responsive to treatment. In the Region, drug resistance is a major obstacle to TB elimination – 22% of the world’s MDR-TB patients are in the Region. In recent years, more effective treatment regimens for DR-TB have been introduced, but the drugs can be very expensive. Due to its high TB burden, Ukraine is one of the countries where the new drugs recommended by WHO have been widely available.
Maryna was admitted to hospital in Poltava, where she stayed for 3 months. Although she spoke to her daughter every day, they both found the physical separation very difficult.
Video-supported treatment
Thankfully, once she started the correct drug regimen for DR-TB, Maryna’s health rapidly improved. When tests showed that she was no longer infectious, she was able to return to the family home in Dnipro and continue her treatment as an outpatient.
“I was overjoyed to finally be with my daughter again,” said Maryna. “When I got home, I knew exactly what I needed to do to be treated as an outpatient. I had a month’s worth of medication with me. I had daily video-supported treatment when I took my medication in front of the doctor and discussed any issues. I submitted my reports as needed and I knew that I had to return to the hospital in Poltava each month to have tests and to pick up my medication.”
But on the 24th of February 2022, Maryna’s life was turned upside down when the war escalated. Travelling to her hospital appointment was no longer possible with blocked roads, missile attacks and public transport not working.
Fleeing from war
Maryna continued her outpatient treatment with the medication she had, sending regular updates to her doctor. But as the situation deteriorated and she saw how missile attacks were affecting her daughter, she made the decision to flee to Poland, leaving her husband behind. She was able to bring just 2 months’ supply of TB medication. As a health professional, Maryna knew that interrupting TB treatment could be deadly.
Once in Poland, with her supplies of medication dwindling, Maryna made the health authorities aware of her condition and requested a routine TB test for her daughter. She was devastated to be told at first that both she and her daughter would need to be hospitalized separately.
“My husband is a policeman and cannot leave the country, so, since I’ve been in Poland, I’ve been a single parent,” she said. “After all we’ve been through, there was no way we could be separated from one another. I would have discontinued the treatment rather than be away from my daughter.”
Caring for refugees with TB
With refugees like Maryna in mind, Doctors without Borders (MSF) and the Polish Government took action to care more effectively for incoming TB patients. Working together with WHO, treatment guidelines were updated, avoiding the need for hospitalization. WHO worked with the Polish Government to procure TB drugs, which had not been previously available in Poland, and donated 100 courses of medication for DR-TB.
Maryna was part of the pilot project and her TB specialist in Ukraine verified that she had taken medication regularly and met the criteria for outpatient treatment. With practical support from Katya, an MSF coordinator, Maryna was referred to a helpful Polish doctor and accessed the medication she needed. She was able to stay with her daughter and successfully completed her treatment as an outpatient.
Maryna is now cured. She has found work in Poland and hopes to be reunited with her husband as soon as the situation improves. She advocates for remote TB treatment and has advice for new patients.
“Don’t give up,” she says. “Being healthy is always better than being sick, particularly as this illness can lead to death. I stuck to my treatment because I knew my daughter needed me. That’s the only way.”