Ismael grew up in a migrant community in Somalia. He first began experiencing symptoms of illness in November 2007, when he was 12 years old. The same month his symptoms began, Ismael was diagnosed with TB. Ismael successfully finished treatment in 2008, but two years later tested smear-positive for TB. Ismael was treated as a relapse case and hospitalized for three months. After leaving the hospital Ismael defaulted on his re-treatment. He was working as a bus conductor and could not leave work to receive his directly observed treatment.
In July 2012, Ismael’s sputum was tested for resistance to rifampicin using the GeneXpert system. The result came back positive and Ismael was diagnosed with DR-TB, but there is currently no treatment for DR-TB in Somalia. Even though GeneXpert improves Somalia’s clinicians’ capacity to diagnose DR-TB, they are limited in their ability to treat DR-TB patients once they are diagnosed. Ismael is still waiting for second-line drugs to initiate treatment.
Ismael now knows the importance of treatment adherence and desperately wants to be treated for DR-TB. Ismael cannot work and faces discrimination from his own family. His siblings fear him and keep a distance. Only his father offers support. He feels weak and is losing hope: “I don’t know if I can survive for the next three months. I have suffered for a long time.”