Limited data are available about the challenges of non-national TB patients undergoing long-term treatment courses in an urban setting. This study aimed to understand the financial and social cost of adherence of non-national TB patients in Cairo, Egypt as a means to inform the development of context-specific interventions to support treatment adherence. In 2011, 22 in-depth interviews were conducted with TB patients from Sudan, Ethiopia, Eritrea, Somalia and Djibouti to obtain qualitative data. Analysis was based on thematic analysis that aimed to identify recurrent themes and codes from the narratives. The study identified a number of factors that influence TB treatment adherence. Uncertain financial status due to limited or no employment was frequently discussed in interviews, which resulted in fear of not being able to support family, loss of pride, dependence on family and friends, fear of losing housing, food insecurity and limited food options. Respondents also feared infecting other household members and longed for opportunities to discuss their illness and treatment experiences with other individuals but their social networks were often limited. TB-related stigma was driven by shame and blame of infection. Respondents also believed stigma was based on their foreign origin. Stigma manifested in distancing and exclusion in various ways, resulting in isolation, psychological distress and reluctance to disclose TB status to others. Poverty-related factors and social context with a special focus on stigma should be considered when developing strategies for supporting long-term treatment courses for non-national patients in Cairo and other similar urban settings.
International medical graduates I agree with Natarajan and Ravikumar that overseas doctors have been treated very shabbily. 1 One of the surprising features of the whole affair has been the lack of outcry from UK and EU doctors in protest. The British Medical Association's response has been muted to say the least. But is this so surprising? In medicine, as in life, there are winners as well as losers and the simple truth is that UK and EU doctors are the winners here. Their jobs will be protected. They will not have to prove that they are better than overseas doctors to get a job; they will merely have to be available and be able to do the job. 2 But UK and EU doctors should not become too smug. It is likely that, over the coming years, the large increase in the number of UK medical graduates will make medical unemployment a reality in this country. 3 What will they do then? They could go abroad; but in light of the UK's treatment of overseas doctors they should not count on too warm a welcome. Who will speak up for them? We would do well to remember the words of Martin Niemoller, a German pastor: 'First they came for the Jews and I did not speak out-because I was not a Jew. Then they came for the communists and I did not speak out-because I was not a communist. Then they came for the trade unionists and I did not speak out-because I was not a trade unionist. Then they came for me-and there was no one left to speak out for me'.
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