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:
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: