Public Health

Love In The Time Of TB: A Young Family Fights An Ancient Foe

Oxana and Pavel Rucsineanu walk to the tuberculosis hospital in Balti, Moldova. Oxana and their new baby live in an apartment, but Pavel still has to stay at the TB ward, fighting for his life. i i

hide captionOxana and Pavel Rucsineanu walk to the tuberculosis hospital in Balti, Moldova. Oxana and their new baby live in an apartment, but Pavel still has to stay at the TB ward, fighting for his life.

Jason Beaubien/NPR
Oxana and Pavel Rucsineanu walk to the tuberculosis hospital in Balti, Moldova. Oxana and their new baby live in an apartment, but Pavel still has to stay at the TB ward, fighting for his life.

Oxana and Pavel Rucsineanu walk to the tuberculosis hospital in Balti, Moldova. Oxana and their new baby live in an apartment, but Pavel still has to stay at the TB ward, fighting for his life.

Jason Beaubien/NPR

Oxana and Pavel Rucsineanu fell in love under the drug-induced haze of powerful tuberculosis medications. It was the summer of 2008. They were both in their late 20s, and they should have been in the prime of their lives.

But instead, Oxana and Pavel had a version of TB that is resistant to most drugs. They were living in a crumbling hospital in the Moldovan city of Balti. The TB ward was a version of hell for Oxana. The air was hot and sticky. Neither of them wanted to be there.

"For how long," Oxana asks, "can you stay and swallow these pills, watching the walls and doing nothing?"

The treatment for drug-resistant TB takes a minimum of 18 months, but it can last for years. Boredom eats away at you, patients say, the same way the TB bacteria eat away at your lungs — slowly, day after day.

Pavel Rucsineanu, who is fighting a deadly form of tuberculosis, holds the batch of pills he swallows after lunch. He takes more pills in the evening, and some days he also gets two injections to fight the infection. i i

hide captionPavel Rucsineanu, who is fighting a deadly form of tuberculosis, holds the batch of pills he swallows after lunch. He takes more pills in the evening, and some days he also gets two injections to fight the infection.

Jason Beaubien/NPR
Pavel Rucsineanu, who is fighting a deadly form of tuberculosis, holds the batch of pills he swallows after lunch. He takes more pills in the evening, and some days he also gets two injections to fight the infection.

Pavel Rucsineanu, who is fighting a deadly form of tuberculosis, holds the batch of pills he swallows after lunch. He takes more pills in the evening, and some days he also gets two injections to fight the infection.

Jason Beaubien/NPR

Oxana says the tedium on the ward drives TB patients crazy. "There are drunk problems there. People are having fights," she says. "This is again because they are not doing anything. It's terrible." The two-dozen pills she was taking made her nauseous, she says. The medicines fogged her brain and sent her "into the cosmos."

TB is on the decline globally, but drug-resistant, hard-to-treat forms of the disease continue to hold a tenacious grip, particularly in countries of the former Soviet Union, like Moldova.

Pavel says he first met Oxana when he came into her dormitory to fix a faulty telephone jack. But Oxana remembers it differently. She says they first met in the common area of the ward, where they commiserated about the terrible side effects of the TB medications.

However it first happened, Oxana says what was important was the connection the two found with each other.

"It really helps when you find someone who has your same problems, who understand all your thoughts, who understand all your fears," she says. "All the people live in fear while having TB because it's really difficult." Once on medications, people have about a 50 percent chance of surviving MDR-TB, according to the World Health Organization.

Oxana and Pavel were still in treatment when they decided to marry in 2009. Their doctors gave them permission to have a small open-air wedding in a park — despite the fact that active TB infections spread through the air.

Oxana was cured in 2010. Pavel, however, is still sick, and his doctors say his form of the disease has evolved to be incurable. Pavel has extremely drug-resistant TB, or XDR-TB, a version of the infection that has become a growing problem around the world, particularly in India, Eastern Europe and Southern Africa. Pavel's doctor, Tetru Alexandriuc, refers to XDR-TB as an "infectious cancer."

Earlier this year, Oxana gave birth to their first child, David. But Pavel remains ill, and can't live at home with his new baby.

The tuberculosis hospital in Balti, Moldova, where Oxana and Pavel Rucsineanu fell in love. i i

hide captionThe tuberculosis hospital in Balti, Moldova, where Oxana and Pavel Rucsineanu fell in love.

Jason Beaubien/NPR
The tuberculosis hospital in Balti, Moldova, where Oxana and Pavel Rucsineanu fell in love.

The tuberculosis hospital in Balti, Moldova, where Oxana and Pavel Rucsineanu fell in love.

Jason Beaubien/NPR

Instead, he stays in room No. 5 on the third floor of a drab, Soviet-era TB hospital on the edge of Balti. There's one toilet on his ward that's shared by 40 men. The showers are being renovated and haven't worked for months. Pavel goes to Oxana's flat once a week to bathe.

When he visits Oxana and their baby, Pavel wears a pale blue surgical mask to try to protect them.

Oxana says she won't accept that Pavel's case is hopeless. "He is planning to get cured," she says. Then she corrects herself, "We are planning to get cured, even if there are cases where they're saying there is no use of swallowing the drugs because there is no cure."

Oxana has the slightly weary appearance of a sleep-deprived new mother. As she rocks David, she says TB has dominated her life for five years. "Sometimes we are talking to TB and trying to convince it to just leave us," she says, "because we deserve a second chance."

Even now, although Oxana has rid herself of the disease, TB keeps her husband away. She says she feels at times like a single mother. But, she adds, "We are not giving up. We have a good reason to move on." She nods toward her baby. "This is David."

Even Pavel's doctor, Alexandriuc, says the baby is a new force in Pavel's treatment. The baby has strengthened the father's will to live, the physician says, and that commitment could prolong Pavel's life.

What It Takes To Cure Multidrug-Resistant TB

Treating regular tuberculosis requires months of medications (left). But curing drug-resistant TB (right) takes years, and the toxic drugs can leave patients with permanent hearing loss.

  Tuberculosis Multidrug-resistant tuberculosis
Treatment 2 months with 4 drugs

Followed by 4 months with 2 drugs
8 months with 5 drugs and a shot

Followed by at least 20 months with 5 drugs
Total drugs consumed 854 pills swallowed 13,664 pills swallowed, 244 shots taken
Drug cost $20 $2,500 to $3,000
Possible side effects Rashes, nausea, liver failure Permanent hearing loss, permanent dizziness, kidney damage, psychosis, liver failure, nausea, rashes
Side effect rates 5 to 10 percent have mild to serious side effects At least 33 percent of patients have serious side effects

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