"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 are the victims of not only the infection, but also of the health system that is 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.

Richard Mowll, August 2003