Medical Doctor – Dushanbe; MSF

Medecins sans Frontieres (MSF) is an independent medical international humanitarian association that delivers emergency aid to people affected by armed conflict, epidemics, healthcare exclusion and natural or man-made disasters. MSF is working in Tajikistan in the field of Tuberculosis based in Dushanbe and Zero TB Project based in Kulob. Our projects focus on providing treatment and support for children suffering from MDR Tuberculosis (TB) and their families, Prison colonies/facilities and Central Penitentiary Hospital.

MSF is currently looking for a qualified, capable, flexible and motivated person for the position of Medical Doctor (Male) for its Dushanbe (Prison colonies/facilities and Central Penitentiary Hospital). MSF offers a package of benefits (25 working days of annual leave per year, medical coverage, training opportunities as required and carrier) and the opportunity to work for an internationally renowned humanitarian organization.

Job Location:  Dushanbe (Prison colonies/facilities and Central Penitentiary Hospital)

Purpose:

Provide and/or ensure the implementation of appropriate comprehensive model of care for the diagnosis, treatment and prevention of TB (DS, MDR, XDR) and co-infections (HIV/HEP C) according to the latest medical knowledge, in line with standard protocols, MSF values and universal hygiene standards to improve the patients/beneficiaries’ health conditions in the penitentiary system with linkage to civil system/society to ensure continuity of treatment after release. Accountabilities Perform active TB case finding to strengthen TB screening activity in different penitentiary institutions at the entry, during their stay, and upon exit. Know different methods of TB diagnostic activity and perform appropriate diagnostic procedure by following national TB guideline Screen all incoming persons into pre-detention center (SIZO) with TB diagnostic procedure to promptly detect active TB cases upon arrival Perform routine mass TB screening activity in penitentiary institutions and actively look for symptomatic TB cases to proceed further diagnostic procedures immediately Make sure persons releasing from penitentiary institutions are screened with proper TB diagnostic methods in order to stop the transmission into the community Regularly perform TB screening among the prison officers and staff to make sure they are protected Work along with other team members of multi-disciplinary team e.g. health promotion, mental health, infection prevention and control, for TB activities to reduce the TB incidence among persons in confined setting Ensure linkage to TB treatment facility and accurate treatment initiation of active and latent TB and co-infections (HIV, HCV), management of opportunistic infections, comorbidities (diabetes, hypertension, malnutrition) according to the latest WHO recommendations. Work in close collaboration with MoJ TB medical doctors/coordinators by actively providing technical inputs thus ensure quality of care is provided for inmates following the standards protocols and increase technical capacity of health care workers Keep the patient and/or his/her family informed about the illness and provide appropriate explanations about the diagnosis, treatment, follow up (whenever deemed necessary). Ensure in cooperation with the treating MoH doctor and the TB consilium that an appropriate treatment regimen is chosen and appropriate adjustments are made for the patient according to the latest WHO guidelines Implement monitoring and reporting system of diagnosis, treatment, and side effects management of DR TB treatment according to the latest Tajikistan DR TB guidelines (ECG, biochemistry, audiometry, CBC…).  Ensure that all side effects are timely medically managed and reported according to the existing protocols and using existing NTP and MSF forms. Improve tuberculosis treatment success rates by addressing various needs of patients including nutrition, counselling and drug delivery model in penitentiary and social support after release in the civil sector. Participate in the collection and analysis of an epidemiological data, checking its validity on regular basis. Support data manager in compiling the programmatic TB data with the MSF TB reporting tool by providing the necessary patient related information in a timely manner. Assess and identify training needs in MoJ medical department; coordinate with your line manager to conduct trainings (on job and organized sessions) to address these needs. Inform the line manager about any problem or complication of the patients’ illness, medical errors and monitor the proper functioning of the department. Ensure that all standard medical procedures and protocols on universal precautions are in place and followed all the time reducing bio-hazard risks and improving infection control. Support the identification of Sexually Gender Based Violence victims and refer them to the medical and psychosocial team, so they can receive the necessary treatment and support. Knows and is aware of the importance and appropriate use of the Post Exposure Prophylaxis (PEP) Kit. Ensure that professional confidentiality is always respected. Perform other medical duties that will be assigned and flexible to fulfil other extra responsibility

A.        Knowledge and skills

1. Seek and learn about the standard practices in TB diagnosis, treatment, prevention and contact tracing activities from the national guidelines and internationally accepted standard literature.

2. Be proactive in updating on the evolving medical literature, critically analyzing the same and exploring ways to implement them in practice in consultation with Project medical referent.

B.        Case finding

1. Responsible for all TB case finding activity in penitentiary institutions such as entry screening, regular mass screening, symptomatic screening and exit screening by following national guideline, procedures, and algorithm, in order to reduce TB incidence among persons in confined setting.

2. Maintain good communication with MoJ health care staff in early case identification (clinical screening, combination of active and passive case findings related to index detainee in prison and civil sector).

3. Explore areas where there is possibility of delayed diagnosis and/or referral of TB patients and work on improving case finding strategies.

C.        Good quality comprehensive TB care

1. Ensure implementation of standard of care in enrolling and starting patients on treatment, especially with attention to timely referral to existing psychosocial team in PS (partners), as well as in advance before start of treatment and thereafter whenever necessary.

2. Facilitate the implementation of current WHO DR TB recommendations in penitentiary system by active participation in ward rounds and consilium taking into consideration the clinical status of the detainee (Short course regimen; injection-free regimen).

3. Clarify questions regarding treatment, follow up and other aspects of TB care to the patients and their family members (if appropriate) and ensure that they understand well.

4. Visit patients on regular basis in ward rounds (as indicated by the individual case scenario) to ensure provision of good quality of care (clinical examination, laboratory investigation and others according to the need)

5. Work hand in hand with MoJ health care staff to encourage participation of all members involved in patients’ care and share knowledge. MSF should strive to support the MoJ medical team in managing the patients and not try to replace the existing system.

6. Ensure that co-infections ( HIV, HCV), management of opportunistic infections, comorbidities (diabetes, hypertension, malnutrition) are managed and treated effectively according to the latest WHO recommendations and country guidelines and they are coordinated by MoJ treating doctor.

7. Ensure that all patients meeting criteria of SAM or MAM are provided with therapeutic food and/or nutrition support according to existing MSF and national guidelines.

8. Ensure patient confidentiality is maintained in all matters concerned- medical, social and others.

9. Ensure that standard universal procedures are followed by all personnel involved in patient care including proper infection control measures by involving concerned staff members like the Infection control officer.

10. Coordinate with Project medical referent, MedCo and other medical staff in updating and revising technical documents, protocols, log frame and program plans with the aim of enhancing knowledge and improving standard model of care afforded to the patients.

11. Ensure adequate post treatment follow up of patients is properly handed over to MoJ medical doctor or NTP TB doctor after patients discharge from the prison.

12. Explore ways to ensure coordinated care to patients with involvement of all specialists dealing with the patient to discuss issues together, as necessary.

13. Encourage and actively assist NTP/RAC and MoH to conduct a once a year mass screening of inmates to identify TB/HIV (including youth and females colonies).

14. Explore innovative approach in treatment support and drug delivery including addressing other social needs of TB patients.

D.        Designing and modifying treatment regimens and course

1. Analyze patients’ profile thoroughly (including information of contacts like Drug Susceptibility Testing results) to design an appropriate treatment regimen, in consultation with the Project medical referent.

2. Ensure that an appropriate treatment is given for HIV positive TB co-infected detainees for the duration of the sensitive TB treatment (Rifabutin, Ritonavir, Dolutegravir).

3. While recommending changes to the regimen during follow up, the same process needs to be followed in consultation with Project medical referent, especially keeping the treating MoJ doctor fully aware of the changes and the reasons behind them.

4. Convey the changes made to the treatment regimen are shared with the relevant doctors and nurses’ team.

5. Maintain the good collaboration with psychosocial support relevant partner with all of the aims.

E.         Data recording and maintenance

1. Ensure that all relevant data on morbidities are collected timely and reported on relevant forms for both MSF and other relevant partners (NTP, RAC, MoJ)

2. Record all essential data meticulously in MSF data tools at a frequency that each individual case demands (not less frequent than once a month).

3. Liaise with the data manager to ensure timely collection and recording of data pertaining to patients in MSF cohort.

F.         Capacity building in MoH

1. Work hand in hand with MoJ TB medical doctors/coordinators by actively providing technical inputs during ward rounds in TB ward of CPH and ensure continuous on job training and coaching towards better patients’ treatment outcomes.

2. Discuss the patient diagnosis and management related decisions in detail with the treating MoH doctor to enhance development of self-sustainable system.

3. Design training materials in coordination with Project medical referent and conduct structured training programs to MoJ health professionals working in PS to improve quality of care of TB patients.

	Requirements
Education	Medical Doctor Degree in Phthisiatry is desirable
Experience	2 years experience minimum as a Medical Doctor or in clinical work.  Previous experience with public health, TB programs and penitentiary system desirable. Working experience in other international medical NGOs desirable.
Languages	Knowledge of Tajik and Russian language mandatory. Knowledge of English and Uzbek is desirable.
Knowledge	Sound knowledge about tuberculosis and its management is mandatory. Knowledge on other infectious diseases and comorbidities desirable Essential computer literacy (word, excel)
Competences	Willingness to work in penitentiary facilities Flexibility Interest in, understanding of and commitment to the humanitarian principles, social mission, and challenges of MSF Good communication skills Patience Willingness to learn and to travel daily to the working place People Management Commitment Flexibility Teamwork

Salary: Gross salary is 7980 TJS.

Please send your CV and cover letter (mentioning the position in the subject line) to:

dushanbe@oca.msf.org or MSF Holland, Bukhoro 5/3 Street, 734025 Dushanbe.

Deadline for applications is 23rd of January 2022, till 17:00.

Kindly note that only short listed candidates will be invited for an interview. MSF does not enter into correspondence with regard to the reasons for non-selection of candidates.