Support 150 Tuberculosis Patients in Moldova

by Speranta Terrei
Valentin Inside House
Valentin Inside House

“I would say that without our involvement, he could not finish the treatment,” Liudmila states assuredly, “he needs constant supervision and control.” Liudmila is speaking of her neighbor, Valentin, for whom she has been a moderator (treatment supporter) for 7 months of his lengthy treatment for multi-drug resistant tuberculosis (MDR-TB).

Liudmila and Valentin live in Gidirim village in the Ribnita district of Transnistria, a breakaway region on the left bank of the Dneistr River in Moldova. Thanks to the generosity of Global Giving donors, Speranta Terrei restarted community treatment support for TB patients in Transnistria and sustained this critical service in our hometown, Balti. Valentin exemplifies why TB patients may be unable to follow drug regimens without a moderator. He suffers from epilepsy, alcoholism, and psychiatric conditions and lives alone in his deceased parents’ house. In the bitter cold of last February, the entire interior of the house and the roof burned due to an electrical fire (photo of Valentin in charred house).

Valentin had been treated previously for TB, the first time when his brother died of TB after a stint in prison. That was 10 years ago. In 2015, Valentin was diagnosed again with TB, this time a more serious case of infiltrative, pulmonary MDR-TB. Because he interrupted treatment, the TB dispensary requested Speranta Terrei to give him Directly Observed Therapy (DOT) at home. Liudmila and other neighbors had been watching over Valentin, giving him food and clothes, and Liudmila agreed to be his moderator. Her visits with TB drugs (photo of them in the rundown garden of the house) enabled Valentin to complete treatment in December. He is grateful, saying “To receive treatment at home is very convenient, I do not have to go so far every day.” 

Unfortunately, Valentin broke the law recently and he is in detention awaiting a decision on his fate. This is the reality of vulnerable patients Speranta Terrei assists with community DOT and this is why there is a constant need for moderators to help patients regain health and to stem TB transmission.

Our most experienced moderator, Galina, has done much to counter this reality, as Speranta Terrei’s previous Global Giving project reports show. We at Speranta Terrei are overjoyed that Galina was awarded the prestigious Kochon Prize for her contribution to end tuberculosis! (Photo of Kochon Foundation Chairman Kim giving prize to Galina.) Galina exemplifies the 2016 Kochon Prize theme, “Unsung Heroes Working to End TB”, as she makes daily rounds to persuade homeless, addicted, unwilling, and even combative patients to complete treatment. Please see official announcement at http://www.stoptb.org/global/awards/kochon/awardees/2016.asp

We thank you for helping us to improve the reality of vulnerable TB patients and we send you many good wishes for a healthy New Year.

Valentin and Liudmila in Garden
Valentin and Liudmila in Garden
Chairman Kim Gives Galina Kochon Prize
Chairman Kim Gives Galina Kochon Prize
Play Therapy
Play Therapy

Maria is an irrepressible woman who shares Speranta Terrei’s concern for children with tuberculosis. She and her husband, Valerii, started a residential home for children who were contacts of TB patients or who had TB themselves. Maria collaborates with a church in Norway to assist Moldovan children with TB. The Norwegian donors gave funds to establish the children’s home on the outskirts of our hometown, Balti. Maria and Valerii alone look after the children, cooking and cleaning, transporting them to school and doctors, supervising homework and visits to the TB dispensary, and purchasing food and clothes. The nine girls and one boy live at the home with the permission of their families, who faced difficulties taking care of them. 

Since June the children have been visiting Speranta Terrei’s Center for Tuberculosis Patients for counseling and activities. Enter another irrepressible woman, Alla, our child psychologist. Through play therapy, speech therapy and handcraft making, she elicits the children’s feelings about their circumstances and shows them how to respond to these feelings with positive effect. Little Tatiana (seen with Alla during play therapy) was 2 years old when her mother died. She was placed in an institution for the hearing impaired because her caretakers thought she could not speak. After being in Maria’s home for a year, Tatiana began to utter words. Thanks to Alla’s therapy, Tatiana’s speech has improved tremendously and she is learning to read. Tatiana says of the Saturday visits to Speranta Terrei, “I love playing games here and I love Alla.” 

On a recent visit to our Center, our elderly friend Liudmila showed the children how to make needlework with beads (photo). At the ripe age of 84, Liudmila makes patterns of flowers and animals and relishes sharing her hobby with youngsters. After the morning’s activities, everyone sits down to lunch (photo).

Maria says running the home is gratifying, though she is exhausted at the end of each day. She is especially gratified the children are free of TB. In a house full of children, she and her husband experience the ups and downs of a large family, the travails of adolescence and youngsters competing for attention. She says the teenagers have a mind of their own whereas the younger children are more attentive to her instructions. The younger children say to her, “You embraced so-and-so more times today than me so you must love her more!” Maria says the interactions with Alla have helped the children in their recovery and she sees how much they benefit from Alla’s techniques. 

Speranta Terrei’s Center for Tuberculosis Patients was renovated with your contributions and we and the children are grateful for the sense of community it offers to those tuberculosis has affected.

 

Tatiana with Figures
Tatiana with Figures
Liudmila Teaches Bead Needlework
Liudmila Teaches Bead Needlework
Lunch Together
Lunch Together
Vitalie and Ecaterina
Vitalie and Ecaterina

Music strengthened Vitalie’s resolve to overcome tuberculosis, music’s healing power saw him through to the end of two years of treatment for multi-drug resistant tuberculosis (MDR-TB). He recounts how much music helped him, “Playing calmed me, the rhythm settled my anxiety and my doubts about fighting off this disease.” Vitalie is a master of the hammered dulcimer, an instrument very much a part of folk music in Central and Eastern Europe. In Moldova, the hammered dulcimer is called tambal and Vitalie has been playing it for 14 years. Its sound has mesmerized him ever since he first heard it as a child. 

Vitalie’s story is symbolic of Moldova’s TB epidemic, a mix of prime working age adults leaving the country to find jobs, of alcohol’s stranglehold during socioeconomic decline, and of the effects of stigma against TB patients. When jobs for musicians became scarce, Vitalie went to Russia as a construction laborer and may have contracted TB while he was a migrant worker. Upon returning, he started TB treatment in Moldova in September 2013, when he was 28 years old. He could not find a steady job and played the tambal at weddings and in cafes to earn money. Alcohol was plentiful and within easy reach while he played late into the night. 

Back at Balti’s Music School “Gheorge Enescu” a decade ago, Speranta Terrei’s patient coordinator, Galina, taught Vitalie music history and theory. Galina still teaches at the music school and she remembers Vitalie as a good student! As a TB patient, he was referred to Speranta Terrei because alcohol addiction put him in a risk group for abandoning treatment. Ecaterina was his moderator and she gave him Directly Observed Therapy (DOT) daily. She has given treatment support to 8 TB patients and is herself an unemployed graduate of laboratory medicine from Balti Medical College. Vitalie and his wife, Mariana, say Ecaterina guided them during the long treatment, answering their questions on preventing transmission, especially to Mariana and a baby to come (see photos taken at Balti TB dispensary of Ecaterina and Vitalie speaking and Vitalie placing a sputum sample). Last November, Vitalie finished TB treatment and his family, including one-year old Sorina, is healthy. He has a job playing the tambal in an orchestra and he avoids alcohol.

Vitalie attends TB Club at Speranta Terrei’s Centre for Tuberculosis Patients and talks openly of his struggles, encouraging other patients and praising his moderator, Ecaterina. Stigma against TB patients is so strong that Vitalie does not want us to show photos of his face or his prized tambal. Speranta Terrei’s staff and patients thank our many donors, who have been supporting us to control TB behind the scenes. Vitalie is a symbol of how much community treatment support matters to vulnerable patients.

 

Vitalie Placing Sputum Sample
Vitalie Placing Sputum Sample
Alexandr Shows Photos
Alexandr Shows Photos

Speranta Terrei marked World Tuberculosis Day this year with a photo exhibition on TB and distribution of TB information at the market. World Tuberculosis Day on March 24 commemorates Dr. Robert Koch’s announcement in 1882 of his discovery that Mycobacterium tuberculosis causes TB. For Speranta Terrei, it is a day when we highlight how the disease affects patients and how it is diagnosed and treated. 

As Speranta Terrei’s photographer, Alexandr has had his lens trained on tuberculosis patients and their emotions as they undergo treatment. Alexandr’s collection of photos were exhibited at Balti Municipal Art Gallery “Antioh Cantemir”, with the opening on World Tuberculosis Day. Alexandr says, “I was gratified to see officials from City Hall as well as former patients at the exhibition.” In the attached photos, Alexandr shows and explains the context of his photos to visitors.

Alexandr’s photos are a glimpse into the variety of people to whom our moderators give treatment adherence support. Attendees at the exhibition saw photos of a boy’s puzzled look as he takes a series of anti-TB drugs and of an elderly, bedridden woman overcome with tears of joy at completing treatment with the assistance of a moderator. Among the photos were the anxious expressions of men who had not been outside in months and who appeared drained from the unaccustomed lack of activity.

Speranta Terrei’s translator, Irina, organized a group of students from her Ion Creanga High School classes to hand out TB information to market vendors. On a rainy World Tuberculosis Day, 10 students gathered at the entrance of Balti’s central market with TB pamphlets (see photo). They fanned out to speak to vendors (photos) and shoppers, explaining TB symptoms and encouraging people to be tested if they experience symptoms.

The students said they realized the heavy toll TB takes on their fellow Moldovans and learned from the questions the market vendors asked them. One of the students, Radmila, said, “Some people seemed to be so worried about a neighbor who was coughing for several weeks, they realize how important it is to make a medical test.” Another student, Lia, was heartened that, “People understand they are responsible for their own health and kept asking us questions what to do and where to go for a TB test.”

Alexandr’s photos and students raising awareness were a fitting way to honor the critical discovery of Dr. Koch. Speranta Terrei thanks our generous donors for allowing us to continue the long battle against tuberculosis. 

 

Alexandr and Visitors at Exhibition
Alexandr and Visitors at Exhibition
Irina & Students in Front of Market
Irina & Students in Front of Market
Student Explains TB to Meat Vendor
Student Explains TB to Meat Vendor
Cheese Vendor Learns About TB Disease
Cheese Vendor Learns About TB Disease
Liudmila takes anti-TB drugs from Galina
Liudmila takes anti-TB drugs from Galina

For Sergei and Liudmila, the past year brought them together and it brought a large dose of misfortune. They were diagnosed with drug-susceptible tuberculosis, the stove in their one-room house caught fire, vagrants kept entering through the unlocked door at night, their few clothes were stolen from the outdoor laundry line, and Sergei was injured badly when he fell riding a borrowed bicycle. Through these misfortunes, Galina and Igor of Speranta Terrei have been there, a constant and reassuring presence offering hope.

Sergei and Liudmila met at the TB dispensary in Balti. Sergei was under TB treatment when Galina brought Liudmila, who was homeless at the time, for a TB test. After Sergei broke his hand and leg in the bicycle accident in April, he could no longer go to the TB dispensary. Doctors asked Speranta Terrei’s patient coordinator, Galina, and moderator, Igor, to give Sergei Directly Observed Therapy (DOT) at home. Galina and Igor found Sergei bedridden on a small divan in a decrepit house, without electricity or gas. Sergei was unemployed, having been retrenched from his job at the railway station. He had neither a pasaport (residency document) nor a health insurance card and, therefore, could not get medical care following the bicycle accident.

Galina and Igor, accustomed to poor and addicted patients, knew DOT was only the beginning. Liudmila suffers from alcoholism and Galina must use her characteristic stern touch to ensure Liudmila sticks to TB treatment. The attached photos show Liudmila taking anti-TB drugs from Galina and Galina checking the repaired stove, the only source for cooking and heating. Sergei has been cured of TB, but he cannot walk on his own. He has a pasaport and a health insurance card and can obtain medical care. Liudmila is ineligible for these documents because she is a Russian citizen, though she is eligible for free TB treatment in Moldova. Liudmila eats lunch periodically at Speranta Terrei’s Centre for Tuberculosis Patients (photo) and takes food for Sergei to eat at home. Sergei and Liudmila say Galina’s daily presence has been critical, “She is our protective angel, never abandoning us and showing us how to renew our lives.”   

This month Speranta Terrei introduces its new logo on the Global Giving page! The logo’s designer is John Gravdahl, owner of Propeller Press (http://www.propeller-press.com) and professor at Colorado State University (http://art.colostate.edu/people/profiles/gravdahl/). The logo incorporates elements of traditional Moldovan artistic forms and features a double spiral, symbolizing balance and renewal. John selected the strong red colors to represent energy and the vitality of life.

We thank John for this vibrant logo and all that it represents for our patients and our organization. We thank our donors for their generosity so that we may give TB patients a chance to recover and regain the vitality of life.

Galina checks Sergei & Liudmila
Galina checks Sergei & Liudmila's stove
Liudmila (foreground) eats soup at Centre
Liudmila (foreground) eats soup at Centre
 

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Organization Information

Speranta Terrei

Location: Balti - Moldova, Republic of
Project Leader:
Feodora Rodiucova
Balti, Moldova, Republic of

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