Yet, in this end of the world, life still goes on

Dear friends, Sometimes, I think that I am working at the end of the world: Cherrati is a small town in the Somalia area, this area is one of the neglected parts in Ethiopia. At the same time, Ethiopia is one of the poorest and neglected countries in the world. The Ethiopians dislike the Somali people because they think that they do not belong to Ethiopia and the government does not want to invest in infrastructure or a health care system. Yet, in this end of the world, life still goes on. At the end of world, story continues: "Congratulations! You have TB." For the man with ascite, as you remember, he lived in the bush before and he has no accommodation in Cherrati. Therefore, since the day of admission, he has lived in our health centre. (There are three rooms for TB patients in the centre and we are going to build a TB building.) He did not have any more chest symptoms or fever since the anti-TB treatment started. Although he developed the ascite gradually again, his general condition improved a lot. I drained the fluid for the third time last week but I still could not confirm if he had TB. "Could you help me? Four of my children are dying." A woman with two health centre out-patient consultation cards came to our clinic one afternoon. She had cards for two of her children, one 14-year-old and one 4-year-old. They visited the health centre three months ago because of multiple dilated lymph nodes over the neck and prolonged fever. They were from the bush that was 55km away and had no relatives in the town. They walked half a day in order to get to the health centre. They were suspected to have lymph node TB. They were prescribed antibiotics and were asked to come back to the clinic after two weeks to see the effect. However, three months afterwards, only the mother came. She told me that the two children were too sick to walk to the centre. She had eight children all living in the bush and four of them had similar problems. One of them could hardly walk. She asked if we could send a car to pick them up and treat them in the health centre. She had no relatives in the town and she was too poor to provide any food to the children. There was also no place for the children to stay. Besides that, she had to go back to the bush to take care of the remaining four children. After discussing with other health care staff, we found that we could not treat her children: we could not provide food and accommodation for her four children and there was a very high chance that the four children could not complete the 6-month course (It is a treatment that lasts for 6 months for children and 8 months for adult. For patients living far away or who have poor social support, the rate of default treatment will increase. Once the patient has incompleted treatment, he or she will develop drug resistance. This will lead to drug-resistance TB which is more difficult to treat.). However, it was a very painful decision and I felt very sad to tell the mother that we could not offer any help to her four dying children. The mother went away with tears covering her face. For the frontline doctor or nurse, it is very hard and painful to refuse to treat a patient who is asking for help. It is really a dilemma: we do not treat them because they are living far away and have poor social support, but in fact they are the group that needs the treatment the most. Yours, Ben

Dr. Ben NG started his first mission with MSF in January 2006 on a tuberculosis treatment and basic health care programme in Cherrati, Ethiopia. In the following sharing, he shares his feeling and what he encounters in this mission.