Uzbekistan isn't a place I ever planned to spend Christmas in. Initially when MSF asked me to come to work here in the TB treatment project, I was a bit hesitant. I had never been to central Asia before - all my overseas experience had been in Africa - and a quick internet search confirmed the daunting prospect of winter temperatures that can drop to minus-30.
But I wanted to work with TB patients and after some thought I found myself arriving in Nukus in early October. Our project is actually based in Karakalpakstan, an autonomous republic within Uzbekistan with its own unique language and way of life.
Although TB is often thought of in Ireland as a disease of the past, it is estimated to have caused 1.5 million deaths globally in 2014. Normally TB takes about six months to treat with daily doses of oral medication. However Uzbekistan has one of the highest rates of multi-drug resistant (MDR) TB in the world, with MDR contributing to about a quarter of new TB cases, and over 60 per cent in those who have previously been treated.
MDR TB is really difficult to treat, requiring anything from five to eight different drugs per day, usually for between 20 and 24 months, including painful daily injections for the first eight months. These drugs come with a range of nasty side effects, and even after all that only about three in five patients are treated successfully.
New and better drugs have been needed for MDR TB for a long time, but developing these has not been a priority for the pharmaceutical industry which sees little profit to be made from making drugs for a disease that generally affects the poor and marginalised.
The project is a bit different to what we normally do in MSF. There is no acute emergency in Uzbekistan, and we work in partnership with the local ministry of health in implementing a sustainable comprehensive TB treatment programme for all in Karakalpakstan. As well as medical care, this community-based approach includes providing psychological and social support to patients and their families as they try to cope with the long and difficult treatment.
It always takes some time to adjust to new surroundings and a new job. After a couple of months, I now feel I am finally settling in and getting to grips with the work. I have got to know our staff, many of the patients and at least a few words of Karakalpak. I don’t think I will ever fully acclimatise to the cold though.
Christmas Day is not a holiday in Uzbekistan so work will carry on as normal. Though no two days are the same, for me it will probably involve leaving Nukus at 8am in the ubiquitous MSF land cruiser with my medical liaison officer Aynua (who acts as my interpreter and generally organises everything for me) and one of our MSF drivers.
We will travel about one and a half hours over some bumpy roads to Kanlikul, one of the Rayons (districts) in Karakalpakstan that I work in. There we will visit one of the SVPs (local health clinics) where TB patients attend daily to receive their medications. Together with another doctor I will review the patients and provide technical advice and guidance, particularly on the challenging cases, as well as seeing how the overall programme is performing in that clinic.
We will probably visit the homes of some patients who are too ill or live too far from the clinic to come for treatment and instead receive home-based care. For lunch we will enjoy some traditional Karalpak food such as plov in a local home restaurant.
Our social workers are organising some small New Year celebrations for patients in Kanlikul town so we will try to make it along to some of that. At about 4pm we will travel back to Nukus, I will try to postpone any office based admin work for the day. That is the plan at least, but with MSF you learn to always expect the unexpected.
In the evening many of the expat staff will gather together for a dinner. About 18 people including doctors, logisticians and laboratory scientists will gather from all over the world, from Kenya to Myanmar and Australia to Sligo. We will enjoy some food and a couple of glasses of the finest quality Uzbek wine.
In recent years I have spent every second Christmas away from home. There always is a certain sense of loneliness and I will miss my girlfriend, my family and my dog Chips. On the other hand, I have many happy memories that will last a lifetime from previous Christmases in Zambia and South Sudan, and I am sure this year in Uzbekistan will be no different.
Cormac Donnelly, a GP from Co Galway, is one of 25 Irish professionals who worked overseas for MSF in 2014. See msf.ie
