SSRC Pre-Dissertation Fellow Hannah Reiss
Social Contexts of Treatment and Care: Tuberculosis in New Tajikistan
University at Time of Fellowship: University of California - Los Angeles
University of California, Los Angeles doctoral student Hannah Reiss, studies social contexts of illness in the day-to-day lives of tuberculosis patients in Tajikistan. Tajikistan has the highest incidence rate of tuberculosis in the WHO’s European Region. It is also one of the highest burden countries in the world for multi-drug resistant tuberculosis (USAID 2009; WHO 2011) with high frequencies of treatment failure, default and death in non-drug resistant cases (WHO 2009, 2011). The goal of this research is to understand why an illness with effective treatment continues to persist with such high incidence rates and what the social contexts of illness and care are that promote or impede successful treatment. To address these questions, Reiss spent the Summer 2012 in Tajikistan working in treatment clinics, attending training sessions for healthcare providers, and visiting the main tuberculosis in-patient hospital. This research explores the organization of current tuberculosis treatment in Tajikistan and works to investigate the social forces, practices, and understandings that promote or impede treatment as patients and their families navigate tuberculosis illness and therapy.
The family is increasingly the nexus of social life and social control, and family members are deeply involved in each other’s lives (Harris 2004). While women’s social lives have become more circumscribed in recent years, their responsibilities have increased due to men’s migrant work patterns. More than one million Tajiks work as seasonal migrants in Russia (Mughal 2007). Over 20% of patients in the tuberculosis hospital were seasonal migrants who had contracted tuberculosis in Russia. As they return to their families in Tajikistan to seek treatment and care (Ayé, et al. 2010b), they put their family caregivers at risk. The current political climate and geographical positioning between Russia and Afghanistan, as well as the growing influence of Islam, have brought issues of contagion, infectious disease, stigma and hygiene to the forefront. Issues of purity and contagion have a profound influence on people’s daily lives.
The countries of the former Soviet Union and Eastern Bloc are witnessing rapidly increasing infection rates of tuberculosis and troublingly low levels of treatment success. These countries share a recent history of breakdown in health delivery, increasing rates of tuberculosis, and the emergence of new multi-drug resistant strains. As WHO’s recommended strategy, DOTS has been implemented worldwide as the most widely-used tuberculosis treatment. Tuberculosis therapy must be meticulously followed to prevent the emergence of virulent, multi-drug resistant strains. After 20 years, DOTS remains the most widely implemented strategy to ensure successful completion of the challenging treatment regime. However, low success rates in countries of the former Soviet Union, like Tajikistan, where there are the highest frequencies of treatment failure, default, and death (WHO 2009, 2011) suggest that a better understanding of the experience of treatment will have important consequences for controlling the epidemic. This research examines the day-to-day exigencies imposed by poverty, the changing social world and the structural realities of a transitioning healthcare system as they impinge upon the treatment of tuberculosis in Tajikistan.
Knowledge about social support during tuberculosis treatment is limited, but it has been shown to be a crucial determinant of adherence and success. To improve the efficacy of these programs and of health care delivery, it is critical to ground global health initiatives in a better understanding of local realities of illness. Tajikistan is a vivid example of this epidemic’s broad threat to the public health. This research examines the impact of DOTS on communities already strained by the hardships of daily life. This research will directly contribute to sociomedical work that seeks to improve the low success rates in countries of the former Soviet Union.
Read Hannah’s Policy Brief, based on her Pre-Dissertation Award funded research- Social Contexts of Treatment and Care: Tuberculosis in New Tajikistan [.pdf, 115kb] Policy Brief #2013-02
Hannah Reiss is a PhD student at UCLA where she studies medical and linguistic anthropology. She has studied Tajik in Samarkand, Uzbekistan and Dushanbe, Tajikistan. Her research explores the social contexts of treatment and care for tuberculosis patients and their families in Tajikistan. She is interested in how social forces, conditions, practices, and understandings promote or impede treatment as patients and their families navigate illness and therapy.