World TB Day - Vienna Regional Office Focus
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Tuberculosis, especially its multi-drug resistant strains, is a major health concern in Eastern Europe, Central Asia and the South Caucasus. This entirely curable disease poses a threat to the millions of migrants in the region. Migrant workers face health hazards throughout the migration process. They often have limited access to health services, which leads to late detection of the disease, as well as to irregular medication and unfinished treatment courses. The latter causes a low cure rate, relapses and increasing numbers of patients with multi-drug resistant tuberculosis.
IOM is perhaps best known for helping to bring refugees from temporary camps and settlements to new homes and new lives in peaceful countries where they can live without fear of persecution or peril. There are many stages in this journey, from preparation, learning a new language, to hearing about a new culture, and being pronounced “fit for travel”. Most countries that take in refugees have to ensure that they are TB free.
We have built state of the art TB diagnostic laboratories and treatment centres in the most remote locations in order to ensure that people being resettled can meet the requirements of their new host countries. More than that, we then find ways to extend these services to local people in the catchment area.
This serves two purposes. It contains TB, as there is always contact between populations in refugee camps and people living nearby. It also ensures there is no resentment, and that everyone has the same access to better treatment. In this way, IOM has become one of the biggest TB diagnosis and treatment agencies in the world.
The second reason that we are active in TB work is because TB travels with people. If we fall ill in our own country, we seek advice and more often than not we receive simple treatment and get well again.
But consider the migrant; often young, confused, perhaps unable to speak the language of his or her new country. They fear getting ill and being unable to work as they have large extended families back home depending on them. They have no idea that (at least in theory, in most countries) they have same right to healthcare as the citizens of that country.
IOM works with governments to ensure that migrants know their rights, and can receive life-saving information in time. This makes absolute sense, as it keeps migrant workers healthy, often doing the low-paid and dangerous jobs that local people don’t want to do. More than that, it ensures that all communities are protected, and that migrants are not stigmatized as spreaders of disease.
Global tuberculosis report 2017. Geneva: World Health Organization; 2017.
The Russian Federation is the only country in the region listed among the WHO 30 high TB burden countries. At the same time, this country is the main country of destination of labour migrants in the region. The issue of higher concern is multi-drug resitant tuberculosis (MDR-TB), as eight countries in Eastern Europe and Central Asia are ranked among the 30 WHO high MDR-TB burden countries, with up to 27% of new TB cases being MDR-TB:
Many of these high-MDR TB burden countries are of origin of labour migrants heading to the Russian Federation, generally there is a high mobility in the whole region. These numbers clearly highlight why enhancing cross-border activities is the key to combating tuberculosis and its multi-resistant strains.
IOM currently runs TB projects in Armenia, Azerbaijan, Georgia, the Russian Federation and Tajikistan.
IOM’s TB projects in Eastern Europe and Central Asia focus on migrant workers heading to the Russian Federation or coming from Afghanistan, by engaging the respective governments and fostering dialogue and capacity building of state tuberculosis programs or NGOs for health assessments. Projects also often have an awareness raising component, such as the TB prevention campaigns among diaspora members in the countries of destination and development of specific information materials in the languages of the diaspora members. The aim is to implement the Minimum Package for Cross Border TB Control and Care to ensure continuity of care.
The USAID TB control programme in Tajikistan has been running for more than years, with yet two more years to come. Being part of the consortium of the partners lead by Project HOPE, IOM addresses the issue of migrants’ access to TB services. The focus lies on innovative approaches to promote migrants’ health-seeking behavior, pre-departure TB screening, and active TB detection. One of the pillars is to engage the diaspora for cross-border TB control, building on the capacity of the migrants’ network. Peer educators conduct information session and volunteers are engaged to refer migrants with TB presumptive symptoms to the nearest TB testing facility.
Accompanying measures such as psychosocial support and income generation grants are pivotal, as one of the most difficult part of TB care is to achieve longterm compliance of patients, especially concerning the treatment of multi-drug resistant TB. IOM Tajikistan provides psychosocial support to TB patients through building the capacity of the primary health care and social workers in the community. The social workers found that a calendar distributed by IOM to the TB patients is a very useful tool to enhance TB treatment adherence.
“You might not believe it, but I fell in love with this calendar. It may seem to be just a piece of paper, but it forces me to take the treatment more responsibly. The most interesting thing is that I, an adult person, is secretly checking the calendar several times a day without my family knowing and count the number of days remaining until the end of the treatment. Where were you before, my dear helper? Today I can’t understand, why I never thought about using a calendar before." TB patient from Danghara.
IOM staffer explains the calendar for taking tuberculosis drugs to a beneficiary, © USAID TB Control Program
The majority of the returned migrants with TB are men, traditionally the breadwinners in their families. But sickness, lack of job opportunities in the home community, as well as financial problems negatively impact the mental health of the TB patients and weaken the adherence to TB treatment. Women on the other hand, are sometimes faced with gender based violence, when the husband or mother-in-law expel the woman from home because of the confirmation of TB. Then the woman loses the financial support provided by the husband, returns to her parent’s home and has to support herself.
To empower TB patients, IOM provides income generation support to the most vulnerable TB patients in the four target districts in the Khatlon Oblast. TB patients received in kind grants such as cattle, cow with calf, welding machine, sewing machine for women, drill, angle grinder, cordless drill, and chain saw. The income generation support contributes to increasing the rate of successfully completed TB treatments. From 18 TB patients, eight of whom had MDR-TB, 12 people successfully completed their TB treatment, 4 patients continue the treatment, one patient died and one patient interrupted TB treatment.
The piloting of the new approach was possible thanks to project “Empowering victims of trafficking, vulnerable migrants, their families and communities in Central Asia” supported by the Norwegian Ministry of Foreign Affairs in a synergy with the USAID TB Control Program.
In the South Caucasus countries of Armenia, Azerbaijan and Georgia, HIV/AIDS and Tuberculosis, particularly high rates of multi-drug resistant and extensively drug resistant (XDR) TB forms represent a great public health concern, factoring into the increased migration in the region and beyond. Rates of interrupted treatment courses are substantial in this region, representing the main drawback in effective TB and HIV/AIDS control in the region, including the main countries of destination for outbound labour migration such as Turkey and the Russian Federation. Hence, the project builds on the formation of viable partnership frameworks with and between government counterparts of all three South Caucasus countries leading to increased commitment to establish and maintain migrant-oriented healthcare services in the region.
Regional and country-specific information, education and communication (IEC) materials were developed for a health promotion campaign focusing on the importance of preventive screening and treatment adherence. Voluntary testing and counseling is offered to migrants and IDPs, and with the help of a survey, the project aims to explore the health-seeking behavior of migrants.
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