After the birth of their first child, this young mother started losing weight, coughing uncontrollably, and battling constant fatigue-the classic symptoms of tuberculosis. Her husband, a day laborer, tried to find treatment for her, but they were living in a remote rural village where a handful of trained doctors serve the entire province. Health care is provided by healers with no medical education, so the couple sought help from many healers with no training in TB diagnosis and treatment. By the time their son was eight months old, the young mother was too weak and emaciated to breastfeed him and he died.

Distraught, the husband continued to pay for the ineffective treatment and expensive medicines, until they had no more money. He finally sold their house, a decision that angered their relatives, as they saw all of the family resources disappear. In their eyes she had failed because she was unable to keep their young heir alive.

One night, almost two years after their baby had died, she turned to her husband and whispered that she was dying. Desperate, he took all the money he had from selling their home and put her in a taxi. The driver, sensing their desperation, charged the farmer $400 (rather than the normal $15 for bus fare) to travel to the provincial hospital several hours journey away in Herat. Once in the hospital, the trained staff quickly diagnosed her with drug-resistant TB and began an aggressive treatment plan. Her husband remained by her side during her three-month stay, waiting for her sputum to test negative and for her vigor to return. The personal and financial tragedy this young couple endured could have been prevented. Their plight is not unusual, especially in countries like Afghanistan, where local health services have been devastated due to civil war.

MSH's REACH project, a USAID-funded initiative, is working with the Ministry of Health, WHO, and many private sector partners to improve the opportunities for the people of Afghanistan to access a basic package of health care, including TB-DOTS (Directly Observed Treatment, Short-course strategy backed by the World Health Organization). The program is being expanded to serve rural populations in 13 provinces, including Ghor, where this couple lives.

Special thanks to Dr. Bahman and Dr. Hamidi, Ministry of Health TB Coordinators of Western Region and Herat Province, and Dr. Rasooli, Head of WHO-Herat Office, Dr. Mezzabotta WHO-Kabul, for their contributions to this story.

To learn more about MSH's work in Afghanistan, please visit
http://www.msh.org/programs/afghanistan_reach.html