Have you ever seen someone so emaciated that you can see their heart beat? The heart, beating as though it wants to escape the chest, kept in place by only a thin layer of skin. Some might know the literal feeling, but have you ever seen it?

I did, as part of a recent field visit to our project in Karakalpakstan, an autonomous republic in Uzbekistan where, since 2003, MSF has been running a program to address the problems of multi drug-resistant tuberculosis (MDR-TB).

With my face partly hidden behind the high infiltration mask I meet Alexey (his name has been changed). He is new at the TB hospital but one look at his emaciated body shows that he should have been here much earlier. What kept him away? Ignorance about free care, the disease itself, and the fact that it is curable? Fear of the long and painful treatment? Or simply the lack of money to get him to the hospital? His sunken eyes look out desperately from their sockets but reveal it is not too late. He is still alive. His heart is beating – and I can see it.

I met Alexey at a TB clinic in Karakalpakstan, but I could have met him anywhere in the world. TB is still prevalent throughout the world, but is particularly present in many central Asian and African countries, in India and China. Why? It thrives where several factors come together, mainly low immune systems and crowded living conditions. What is of particular concern is that the prevalence of drug resistant strains of the tuberculosis bacteria are continuously emerging.

Resistance develop mostly through poor treatment and self-medication. In the past, MDR-TB was mainly a problem for re-treatment cases: for patients who have been sick with TB before and either relapsed or interrupted their treatment. Today, however, an alarming 40 percent of the MDR-TB patients we see in Nukus are patients who never had TB before, which means that the resistant strain is being transmitted! Suffering from drug resistant strains means an even longer, even more painful treatment than the already tedious TB sensitive regimen.

It is a relief when I finally step out of the hospital and free myself of the high filtration mask. I take a deep breath. The beak-like mask fits tightly around your chin and you have to mould the top carefully to adjust it firmly to the bridge of your nose. Because the TB bacteria is transmitted through the air, the mask’s heavy fabric functions like a filter to protect you from breathing it in and infecting yourself. The mask makes talking and breathing difficult  particularly in 43 degree celsius. Welcome to Nukus in June! In July it gets even hotter. I can only imagine what it means for those patients to receive their injections and take the heaps of pills each day, knowing that nasty side effects will creep up in most of them shortly afterwards. These can range from nausea, vomiting and diarrhoea to depression, types of psychosis, hearing loss and hepatitis  amongst others.

Back home a couple of weeks later, I learn that Alexey has lost the fight against this malignant disease. For the other patients in Nukus and our TB programs worldwide, however, the fight continues.