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Georgia: love trumps fear in the fight against tuberculosis

22-03-2010 Feature

People who are unlucky enough to catch tuberculosis, or TB, in a country like Georgia generally don't advertise it. Fear, a lack of understanding and a Soviet legacy of isolating the infected have led to a sort of taboo about the disease. The ICRC's Anna Nelson traveled to Tbilisi with renowned Afghan/Swiss photographer, Zalmaï, to meet two men who are helping to shatter the stigma of TB.

   
  ©ICRC/ A. Nelson    
 
Alexander Kvitashvili is Georgia’s Minister for Health and has fought a successful personal battle against TB.    
       
  ©ICRC / Zalmaï / V-P-GE-E-00667    
 
Vano leans on Tina for emotional support when the physical and psychological burden of his TB treatment gets to be too much. Patients often suffer from side effects including psychosis, hearing loss and liver problems.    
       
  ©ICRC / Zalmaï / V-P-GE-E-00670    
 
Venera (left) and Vano (right) Vardosanidze walk with Tina Karanadze (centre) from the Georgian Red Cross, which works with TB patients to encourage them to stick with their treatment until they are cured.    
       
  ©ICRC / Zalmaï / V-P-GE-E-00669    
 
Forty-year-old Vano and Tina (left) both believe that love offers a secret weapon in helping people fight TB.    
      

At first glance, Vano and Alexander would seem to have very little in common.

Vano Vardosanidze, a cabinetmaker by trade, lives in downtown Tbilisi in a rundown old factory building with Venera, his wife of 24 years, and their teenage son and daughter. Dressed casually in a black tracksuit, Vano is quick to laugh and loves to toss an affectionate arm around just about anyone’s shoulder.

Alexander Kvitashvili is Georgia’s Minister of Health and works in a spacious office a couple of kilometres from Vano and Venera’s apartment. If it weren’t for his grey suit, red tie, tight schedule and officious manner, he could easily be mistaken for a muscular football or rugby player.

Sitting next to either man in a restaurant or on the bus, it would be impossible to tell that they have fought a hard and common battle against TB – a highly contagious disease, which spreads through the air and kills almost two million people each year worldwide.

Although Kvitashvili was completely cured several years ago and Vardosanidze is almost finished with his long and painful treatment, both men continue to share a mutual desire to tell their stories in the hope of breaking the stigma and shame so often associated with TB in Georgia. 

 Total surprise  

“I was diagnosed with TB during a routine medical check-up while applying for a green card to study in the US back in 2002 ,” explains Kvitashvili. “I had already passed the peak of the illness so the scars were starting to heal when they found it. The doctor was really surprised, as was I.”

At the time of his diagnosis, Kvitashvili was the picture of perfect health. He watched what he ate, took good care of himself and to this day, has no idea when or where he picked up the disease.

“It got me thinking about the perception that TB only affects the sick or people who live in poor conditions. If I could get it, anyone could.”

Today, as the man in charge of the country’s well being, he’s working to challenge public stereotypes about the disease and raise awareness about its dangers and the need for prevention and thorough treatment.

“We’ve made a lot of progress in fighting this disease in recent years and I’m really happy with how our national TB strategy has developed. We now have a good, modern treatment hospital and decent diagnostics, but the stigma attached to the disease is still a major problem,” says the minister.

“Not having proper information makes people fear it. Also, there is still the Soviet legacy of dealing with infectious diseases, which saw people isolated in curative centres and moved far away from the general public. This compounds the fear. I’m not saying someone who’s contagious should ride around on public transport, but when you isolate someone, it feeds the stigma, so we need to keep working on this while continuing on the medical side.”

According to the World Health Organization, Georgia has one of the highest prevalence rates of drug-resistant TB in the world. Multi-drug resistant TB, or MDR-TB, is a form of the illness that is difficult and expensive to treat and does not respond to standard, “first line” drugs.

“A lot of people think it’s the pati ent’s fault or the system’s fault when someone gets MDR-TB,” says Nana Deisadze, a TB specialist for the ICRC, which has spent the past 15 years working with the authorities to eradicate the disease in Georgian prisons, which are breeding grounds for the disease.

“The common assumption is that they got regular TB, went off their medication and became resistant. But the scary truth is that MDR-TB can be passed on from person to person just as easily as any other strain of the disease. You only have to be within breathing distance of someone who is contagious to get it,” adds Deisadze.

 Rough ride  

Forty-year-old Vardosanidze knows this better than anyone. Like Kvitashvili, he has no clue how he wound up with tuberculosis. Unlike the health minister, Vardosanidze was struck with the deadlier, multi-drug resistant kind, which requires 24 months of medication that must be taken at precisely the same time everyday.

He and his wife openly admit it was tough at first.

“At the very beginning, when the drugs had serious side effects, he didn’t feel well. A couple of times he was tempted to drink alcohol, which interferes with the treatment,” says Venera, who has stood by her husband every step of the way.

“There were some periods, two or three times, when I wanted to give up. I was tired of it, but then I thought about my daughter and son and somehow, I managed to get through it… Plus, there was Tina,” adds Vano, shooting a loving look at the other woman in the room.

 Contagious compassion  

Tina Karanadze is a treatment adherence consultant for the Georgian Red Cross and by all accounts, a literal lifesaver. Decked out in hot pink ra in boots, green eye shadow and a Red Cross vest, Tina is a sprightly woman, who seems to light up every room she enters. Each month, she crisscrosses Tbilisi, visiting families affected by TB, offering encouragement, advice and a steady shoulder to lean on.

Three or four times a week, she calls Vano to “stay on his case” about taking his drugs. When the going gets rough, she comes by the apartment to remind him there is hope and that someday soon, he should be fully recovered.

“Tina says I’m almost finished and I have to hang on. I respect her very much. Her words are like the law for me and I carry them with me in my heart,” says Vano, who, in turn, has helped fellow TB sufferers make it through some very dark moments.

Vano has survived the worst of the nightmare that is TB and is now focused on getting back to “normal” – cheering on his teenage son as he stacks up more karate awards, watching his doe-eyed daughter grow into a young woman, returning to his woodworking and enjoying his wife’s homemade cooking.

Both he and Venera staunchly agree with the minister of health that “sticking to the treatment schedule and following the doctor’s advice” is essential to becoming cured. But they also believe that love offers a secret weapon in combating TB.

“When we learned he could spread it, I tried to protect the kids but I always hoped and believed that our love would give me some sort of immunity. I never treated him any differently and I think that’s helped,” says Venera.

Karanadze nods in agreement. “I’m currently working with 50 people who are fighting a daily struggle to get better and I can say from experience that love always makes life easier.”

If only her kind of compassion were as contagious as tuberculosis.