Photo Anatomy

A Blog by David Rochkind

In one family, a heavy TB burden

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A table is set with flowers and candy before the funeral of a man who died of MDR-TB.

Mariana Bernofsky lives with her husband in Balti, a small town in Northern Moldova, in a house that has been passed through the family for generations.  She stays at home with their young child while he works as a trash collector, earning less than $200 each month.  Mariana is pregnant and is infected with TB. She expects to successfully complete her treatment in a few months and, after her child is born, will be able to get a final X-Ray that she hopes will show she has been cured of TB.

A few years ago her father died of TB. It was the second time he had contracted the disease and the last time occurred while he was a migrant worker in Moscow.  In this video, Mariana discusses her fathers illness.  She touches on a few themes that are very important when discussing TB: how migration can influence TB incidence and how lack of education can complicate the treatment of TB patients.
 
Walking through the streets of Balti you wonder where all of the young people are.  It seems like everyone between the ages of 20 and 40 are gone. In fact, they just might be.  It is estimated that as much as 25% of the population leaves Moldova to work in neighboring countries, where they can earn more and send money back to their families. There are many interwoven ways that this huge migration affects TB.  The most direct, perhaps, is that migrant workers typically live in poor conditions, work long hours and send most of their earnings home, meaning they have little money for food and shelter.  This lifestyle contains many of the risk factors that can make it easier for people to develop active TB.  In addition, the workers are usually in the country illegally and have little or no access to healthcare.  Because of this, they may wait to see a doctor until their sickness is very serious and, in the case of TB, this can greatly complicate treatment.  Some of the migrant workers travel to countries that also have high rates of TB, like Russia, increasing the changes that they will get sick while away.
 
Mariana also mentions that the fist time her father had TB, he choose not to get an operation that was recommended by his doctors out of fear that he would lose his entire lung.  While it is theoretically possible that his doctor recommended the removal of his entire lung, it is very unlikely.  What is more likely is that her father had heard rumors that this was a possibility, and he was too scared, or did not trust his doctor enough, to get the operation.  Instead, he choose to take the recommended medication as well as some traditional remedies, like badger lard and honey.  It is impossible to know if the operation would have made a difference, but this example does show the lack of education and information that patients have about TB and its treatment. 
 
These are two of the biggest issues with TB:  how to best educate the population about TB and how to treat people who are always on the move and have little or no access to health care.

To see the video, please click over to the Pulitzer Center’s website :  http://pulitzercenter.org/blog/untold-stories/treatments-obstacles-education-and-migration

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Written by rochkind

August 23, 2010 at 9:27 AM

Posted in Uncategorized

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