MSF: TB in Pakistan - Mafeefa’s journey from despair to hope

21 March 2025 - In the soft light of a Gujranwala morning, 17‐year‐old Mafeefa Naveed stands at her family’s doorstep, a quiet smile illuminating her face as she greets another day. Today, a first-year college student with dreams of studying law, Mafeefa embodies resilience and renewal, a living testament to the possibility of reclaiming life after the relentless grip of drug-resistant tuberculosis.

Just a few months ago, she was completing the final dose of an 18-month treatment regimen at the Médecins Sans Frontières/Doctors Without Borders (MSF)-supported Programmatic Management of Drug-Resistant TB (PMDT) clinic in Gujranwala. In that modest, sunlit ward, medical staff quietly applauded her determination. “I feel like I’ve got my life back,” she recalls. But behind her words lies a story of immense struggle— missed school days, social isolation, and the constant reminder of a disease that threatened to steal her future.

Mafeefa’s journey toward healing was anything but straightforward. When she first fell ill, she assumed it was a seasonal fever. “I had a fever that kept coming back every few hours,” she remembers. “Then it lasted for two straight weeks, along with coughing and night sweats. That’s when we knew it was something serious.”

At the Civil Hospital, she was diagnosed with tuberculosis (TB), a contagious bacterial infection that primarily affects the lungs. It spreads through the air when an infected person coughs, sneezes, or spits. Sitting beside her father in the doctor’s office, she heard the words that changed everything. “I didn’t say anything, but my eyes filled with tears,” she says. “All I could think about was my aunt, who had TB and passed away when I was very young.”

Her father, however, was quick to reassure her. “He put his hand on my shoulder and said, ‘This is just a disease like any other, and it has treatment. You don’t need to worry. We will get the treatment, and you will recover soon.’”

Mafeefa began treatment for regular TB, taking medicine for three months. But she wasn’t getting better. “I wasn’t gaining weight, and my symptoms persisted,” she says. Later, she went to another hospital where a senior doctor took her sputum sample for testing and informed her that she had drug-resistant TB (DRTB). Drug-resistant tuberculosis occurs when TB bacteria become resistant to at least one of the most effective TB medicines, making treatment more difficult and prolonged. The doctor advised her to visit the MSF-supported PMDT clinic in Gujranwala, assuring her that she would receive specialised care. That decision changed the course of her recovery.

“When I arrived at the PMDT clinic, they immediately took my sputum sample, did X-rays, and conducted other tests,” Mafeefa recalls. “I started my treatment right away.” Initially sceptical about yet another set of medicines, her doubts faded when she met TB survivors who had completed their treatment. “Meeting them relieved me a little,” she admits. “The staff assured me that if I followed their instructions, I would recover soon.”

Over the next 18 months, Mafeefa adhered strictly to her treatment plan, despite the challenges. “Taking medicine was difficult at first, but I never missed a dose. I kept reminding myself that this was the only way to get better.”

The stigma surrounding TB proved to be another battle. “At school, I heard people say, ‘Mafeefa is not well.’ Even my teachers suggested I stay home,” she shares. “It was discouraging, but my family always stood by me. I could tell people were uncomfortable with me wearing a mask, but I had enough confidence to ignore that. In the end, I was the one fighting this disease—why should I care what others thought?”

Mafeefa’s battle is part of a much larger fight against TB in Pakistan. The country ranks among the highest in TB burden globally, with more than half a million new infections reported each year. According to the World Health Organization, an estimated 15,000 to 20,000 Pakistanis develop drug-resistant TB annually, yet fewer than 25% receive proper diagnosis and treatment. This gap not only fuels the ongoing transmission of TB but also threatens national health gains.

In response to this crisis, MSF has been operating a dedicated PMDT clinic in Gujranwala since 2021. The centre provides free, state-of-the-art diagnostics and treatment, including rapid molecular tests like GeneXpert, which can detect TB and its drug-resistant variants within hours. But MSF’s work extends beyond medicine—it also provides psychosocial support and community outreach, helping to reduce the stigma associated with TB and encouraging patients to complete their treatment.

Mafeefa is grateful for the support she received. “One great thing I noticed at the clinic was how every department worked wholeheartedly with patients,” she says. “Doctors treated us with care, counsellors listened to us, pharmacists provided medicine and motivated us to take it. Completing 18 months of treatment is difficult, but their support made it easier.”

Now fully recovered, Mafeefa has resumed her education and is pursuing her childhood dream of studying law. She credits her recovery to her own determination, the unwavering support of her family, and the care provided by MSF. “The strongest thing is motivation,” she says. “When you are motivated to get treated, it works wonders.”

Mafeefa reflects on how the words of others impacted her journey. "I wish people understood that their words can be really hurtful," she says. "When you're already feeling vulnerable and sick, harsh comments can make it even harder to stay positive. A little encouragement and support can go a long way in helping TB patients stay motivated and focused on their recovery."

Mafeefa’s journey—from the final pill of her treatment back to the early days of uncertainty—serves as both a beacon of hope and a call to action. Her story reminds us that when modern medicine and compassionate care converge, even the most formidable diseases can be conquered.

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MSF is a global leader in TB care and one of the largest non-government providers of TB health services. The organisation continues to advocate for reduced costs of accurate and timely testing, particularly through the use of GeneXpert technology. Since 2021, MSF has been running the only drug-resistant TB treatment site in Gujranwala, Punjab, in collaboration with provincial health authorities. In 2025, MSF expanded its tuberculosis services with the introduction of childhood TB diagnosis and treatment at the Baldia Rural Health Centre in Karachi. With continued efforts and community support, the fight against TB remains one of resilience and hope.