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Being Present

effective treatment, food, and housing are available. 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.

Other incentives for TB patients to stay in Galaha for the duration of their treatment were a weekly ration of food (milk, flour, lentils, and oil), clean water, a daboyta for each patient and his or her family, and a small mosque. The village became a safe and supportive community. MSF also hired skilled translators who spoke Afar, something lacking in most other health-care facilities in the region.

Every morning at 6:00 a.m., the TB outpatients would visit the TB-DOTS treatment center. They would be checked for jaundice and then observed taking their medicines. For the first four months after their diagnosis, all TB patients received treatment under this close supervision. After that, they were discharged and given a three-month supply of medication to take on their own. They were instructed to return to Galaha after finishing all the drugs for a final TB sputum test. The compliance rate was remarkably high, thanks to frequent classes, especially for newly diagnosed patients, and careful tracing of no-shows and defaulters.

Very ill, hospitalized TB patients received their medications in the IPD. And each day about a dozen patients in the daboytas would feel too ill or weak to come to the morning DOTS clinic; a team would make daboyta-DOTS rounds to bring such patients their medications.

The success of the Galaha TB program represents a remarkable accomplishment. In an isolated desert setting, we were able to accurately identify and diagnose TB patients and provide six to nine months of effective treatment using multiple drug regimens and a modified WHO DOTS

Above, TB patients lining up early for the morning DOTS clinic. Below, patients lining up again, after the clinic, to receive their food rations.

protocol. The cure rate, based on either negative sputumtests at the conclusion of treatment or documented "treatment completed" status for cases of extra-pulmonary TB, was 86%of the 3,000 TB patients seen in the six years the program operated.

Except for emergencies, Sunday was a rest day in Galaha. Or at least part of Sunday. Aftermorning rounds in the IPD, I would enjoy a few hours of R&R, explore the village, read a good book, perhaps walk to the river and look for fossils. One Sunday, though, I stayed in my tukul trying to shake a virulent respiratory infection that had laid me low for several days. It was only my third week in Afar, but it seemed like a lifetime and sleep was still not coming easily.

I lay on my bunk and stared absently across the desert, lost in my thoughts. It was nearly noon and the sun was high in the sky; its heat sent ripples through the air as I looked westward toward the river. A few hundred yards away, numerous

gray humps on the otherwise flat desert floor marked the area that served as Galaha's cemetery. Three graves were always kept open so any newly deceased patients could be buried before sunset, according to Muslim and Afar tradition.

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