In this project where I am working, there is a new hospital (which was set up by MSF-Holland and Ministry of Health Nukus in Nov 2003) for MDR-TB patients. Patients receive all treatments free of charge. During hospitalization, families of the patients will also receive food parcels. The treatment for MRD-TB lasts for two years. During the first 6 to 18 months, patients will receive in-hospital treatment; the duration depends on the progress of the treatment and side effects of the drugs. When the patients' sputum becomes "negative", they will proceed to ambulatory phase and will continue receiving drug treatment in DOTs conner as outpatients. Due to comparatively long hospitalization and strong adverse effect of second-line TB drugs, patients often have some behavioral problems and a lot of somatic and psychological difficulties such as conflicts between patients, depression and acute psychotic symptoms. All these are unexpected by local nurses and doctors, who don't have the experience and training in managing such psychological and behavioral problems. That is why, here comes a mental health nurse to help and teach them how to handle these situations. Other than providing counseling and assessment to patients in need, the most important task for me is to conduct training for all nurses and doctors in this hospital. The training is focused on counseling skills, introduction to mental illness and management of major psychotic symptoms. I have to assess and provide counseling to patients daily. Sometimes, I have to provide home visits during their ambulatory phase. From these visits, I learn so much about this country. How different it is after Uzbekistan became independent in 1992 and how poor the people are! The situation is even worse in a region called Karakaplastan. Although people's lives are difficult, they never give up and try hard to survive in their way. Sometimes, patients may not know what is good for them. For example, a patient once said to me, "I won't take any drugs after discharge, as I don't have any symptoms. I'm cured." Then I had to tell him a story about how powerful MDR-TB bacteria is and the bacteria can "sleep" in the lung for a long time. "Even if you don't have any symptoms, you still need to take MDR-TB drugs for two year, free of charge! (She had to pay when she was receiving treatment in DOTs)" I said. She started to think more about the importance of completing the treatment. As the project is pretty successful, we are speeding up from targeting 100 patients to minimum 300 patients. The number of beds in hospital will increase from 50 to 75. Moreover, the in-hospital treatment will be shortened so that the period in ambulatory phase (as out-patient) will be longer. The risk to default treatment will also be increased though. To prevent this, I will counsel every patient at least once on admission or before they are discharged to ambulatory phase. Through this project, I truly feel that we are so fortunate to live in Hong Kong. We have too much in our lives that we will take it for granted and easily forget we have that much. Winnie, Choi Wan

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