A place to finish treatment: how a unique shelter is helping patients beat TB

November 23, 2021

Ulukbek takes a sip of warm tea as he tells Evgeni about his plans for the future: get a job in a security agency and work as many shifts as possible to earn money and find a flat of his own. Meanwhile, Ulukbek lives with five other men in the center of Bishkek, and they take turns with the daily chores. There’s no sign of dirty dishes in the kitchen, and a freshly cooked soup is on the stove. There’s an action movie playing on the T.V., but the men are busy laughing and talking about big dreams.

This apartment, however, is far from being ordinary: funded by the UNDP / Global Fund project and headed by the TB People Public Foundation, it offers temporary shelter to TB patients in difficult life situations, giving them the possibility to finish their treatment and get back on their two feet.

 “I got TB in prison”, says Ulukbek. “But when I was released, I had nowhere to go. My relatives sold our house and I was left alone, in the streets. I’ve been living here for one month. The guys here help with everything: they take us to the hospital, bring us our treatment, they give us food, help with clothes, and doctors come here every week.”

Maxim, another client, jumps in to add: “They also help with documents. For example, I don’t have a passport, so I can’t find a job. And without a job, I can’t find a place to live in.” He came to the center fifteen days ago, after having spent his first months of treatment in the Karabalta TB hospital.

Ulukbek, a client of the shelter. Photo: Marion Biremon / UNDP Kyrgyzstan

The only shelter for TB patients

Everyone here has their own story to tell, but they all understand that without a roof on their head and food on their plate, they won’t be able to beat TB. “We’re on good terms with each other here, and we understand each other,” explains Ulukbek. “We get together and decide what we’ll cook for the day. We chat, we each talk about our illness. Where we got TB, how long we’ve been on treatment, which drugs we take, and so on. We share shampoo and soap with each other.”

This solidarity comes as additional support in a particularly difficult time in their lives. Opened in March 2021, this temporary housing center is the only of its kind in Kyrgyzstan for people with tuberculosis, and it has already received more than 70 clients.

 “No other shelters accept tuberculosis patients. So, if someone has TB, they become an outcast. And they have nowhere to go,” adds Evgeni, one of the social workers of the center. 

A client speaks with Denis, the psychologist. Photo: Marion Biremon / UNDP Kyrgyzstan

“Most of the people who come here have nothing else but the clothes they are wearing. How can they take their treatment for TB if they don’t even have anything to eat?” says Dilshat Haitov, director of TB People in Kyrgyzstan. “In the past, we always faced the same problem: patients wanted to get TB treatment, but they didn’t have anywhere to live. This year, thanks to an agreement with UNDP and the Global Fund, we were able to open a temporary housing center for patients with tuberculosis in difficult life situations. And we can now help these people recover and start a new life.”

The center welcomes people in difficult life situations, for example ex-detainees, homeless people, or patients who have nowhere to take their treatment due to family conflicts or stigma. There is also one room for women and children, which can house families who come to the capital for diagnosis.

Comprehensive care

Actually, the center offers much more than housing, warm food and personal hygiene services: here, TB patients receive medical care, psychological support, social and legal assistance. They are in constant contact with the staff, who do everything in their power to help their clients beat TB.

“Here, we do everything to help them finish treatment,” says Evgeni. “People here receive information on TB in a simple language. They can talk about their problems, about side-effects from the treatment, and we help them. Doctors and psychologists come here every week to check up on the patients. We support them, help them find relatives and look for a job. For example, one guy stayed with us during four months. He obtained all of his documents, reached out to his relatives, found a place to live in and moved out.”

Inside the shelter. Photo: Marion Biremon / UNDP Kyrgyzstan

“People here are under constant control, and they receive essential life services. This way, we help increase adherence to treatment,” explains Denis, who works as a psychologist for the project. “If this shelter didn’t exist, then these people wouldn’t be able to take their treatment, since they would have nowhere to live.”

Too often, tuberculosis falls on the shoulders of the most vulnerable, since the illness develops when one’s immune system is particularly weak. And it is extremely difficult for people to beat the disease if they live in poverty and distress, even though modern treatments against tuberculosis are now highly effective.

“One man came to live here after being released from the hospital. He is from Talas, but he couldn’t take his treatment there due to family issues, given the local mentality. He completed his treatment here, we helped him get a passport, and, with our support, he got on good terms with his relatives and went back home. We explained that they shouldn’t be afraid of him, that he wouldn’t infect them,” says Denis.

Denis, a psychologist at the shelter. Photo: Marion Biremon / UNDP Kyrgyzstan

As describes Evgeni, the staff of the shelter also helps resolve administrative and legal issues: “We mostly work with key population groups, among which there’s an acute problem with documents. Some have expired passports, some don’t have any passport at all. Some of our clients have nothing else but a discharge certificate. So it’s hard for these patients to be hospitalized, to get allowances, disability support pensions, to find a job and an income…”

Psychological support

Another important task of the center is to provide psychological support to its clients. “We organize group consultations, where we mostly talk about adherence to treatment. We explain that they shouldn’t despair, that TB is treatable. And we also hold one-on-one consultations, during which patients can talk about everything they have on their mind – problems like the ones everyone encounter: problems with their relatives, issues of stigma and discrimination, self-appreciation…” Denis gives the example of one patient, who wasn’t able to go back home to his family because of TB. “At first, I thought that he was scared of infecting them. But in fact, he was scared of their judgment. He self-stigmatized. We worked with him on this issue, then his wife came, and after some time, he decided to go back home.”

“We explain to our clients that after being released from prison, they can start their life from scratch. Just don’t repeat the mistakes of the past, and everything will be fine. We focus on TB treatment, and adherence, and we tell them that if they finish their treatment, then they can return to a normal life. Our task it to make them believe in themselves,” adds Denis.

Evgeni, a social worker. Photo: Marion Biremon / UNDP Kyrgyzstan

And to do so, there’s nothing more effective than peer-to-peer support. All of the employees of the shelter are peer consultants as well, meaning that they have been through the same situations as their clients, be it tuberculosis, HIV, drug addiction, homelessness, prison, or other difficult circumstances. With this experience behind them, they are able to find the right words and give themselves as an example of success.

“Peer-to-peer support is important because a person, who hasn’t experienced this themselves, isn’t able to understand and help. It’s easier for peer consultants. When people find out about their illness, for example, and are left to their own devices to cope, it takes them half a year to accept the situation; and if the person has a weak character, it can lead to suicide. But with a peer-to-peer consultant, this process takes a month,” continues Denis.

Evgeni, for example, spent one year in a shelter after being released from prison, and has had tuberculosis twice. “I perfectly understand what these people are going through. And I’m convinced that if you’re determined to live, then you’ll beat TB and you will live; but, if not, if you don’t care, then regardless of how many pills you will take, there won’t be any result. A person’s psycho-emotional state is what’s most important in treatment. Here, we make our clients feel that we are needed. And we help them become stronger.” Evgeni is not only perfectly healthy now: he quickly bounced back, and, after volunteering, made peer assistance his profession.