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Being Present

project because it was at a crossroads of traditional Afar migratory routes and offered adequate grazing land and water for their camel and goat herds, since it was at the confluence of the Mille and Awash rivers.

Labhadore is the most common Afar name for TB, a term that literally means "a disease which chooses the strong men." This is an interesting perception, as many of our TB patients were women, children, and older, weaker individuals. Other Afar names for TB relate to specific symptoms, such as sangalé b-yaak—"a disease with a hard pain in the chest and weakness," or mudunta—"a severe, breath-taking pain after coughing." A newer term, tash, comes from the French word tache, for the white spots seen on TB patients' x-rays.

The characteristic of labhadore accepted by all the Afar is its incurability by afar dayla, their traditional medicines, and daylabeena, their healers. But by now nearly all the Afar know TB is treatable and curable using faranji (foreign) medicine, and most of them knew about the Galaha TB center.

Labhadore is also related to the jinn of Islamic belief, supernatural beings also called ginny by the Afar. These beings are believed to cause certain diseases that affect behavior or are not curable by traditional means. Often related to the wind, ginny are implicated in such diseases as polio, meningitis, and TB. But the Afar attach no stigma to the disease—unlike their Somali cousins, who believe that TB is a punishment for wrongdoing. While Afar TB patients prefer to not reveal their diagnosis outside the family, there seems to be no discrimination against those known to have the disease. Perhaps this is because it is so prevalent among the Afar; even their leaders and strongest warriors are vulnerable to it, as the name implies. That they came to Galaha in such numbers seeking treatment suggests the positive influence that biomedicine and MSF have had in the region, among a people long suspicious of outsiders.

Above, a member of the medical staff making "daboyta-DOTS" rounds in the village. Below, local staff preparing the weekly milk rations for the TB patients.

Central to the Galaha project was the construction of a "patient village"—a collection of daboytas near the hospital. It could hold up to 400 daboytas, arranged in three sectors based on patients' contagiousness.

Yet the area's vastness and remoteness make it hard for the Afar to get access to and adhere to the TB treatment regimen. Patients must travel daily to a clinic to be observed taking their medicine. This is part of the World Health Organization strategy to control TB—it's called Directly Observed Treatment Short-course, or DOTS. Caregivers watch patients take theirmedications both to monitor for side effects of the drugs and to ensure that they're actually taken, since missing a dose can lead to treatment failure and the emergence of drug-resistant strains of TB.

To maximize the chance that our patients would complete their regimens, MSF

adapted an approach (called Manyatta) first used successfully in Kenya to treat TB among seminomadic peoples. MSF has learned that nomads are willing to stay in one place for a length of time if

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