Focus on former convicts propagating TB

Teshebai, a skinny man of 40, is a petty trader on one of the streets of the southern Kyrgyz city of Osh. His tiny stand - full of chewing gums, cigarettes and a bag with sunflower seeds, along with other small items - is surrounded by many traces of fresh and thick spittle. "I am [constantly] on expectorants," he confessed. "I have chronic bronchitis." But people surrounding him, including his trading neighbours, know that he has TB. They know about it, but do not display their disgust: there are many like him, they have to live and somehow make ends meet. He contracted TB in a strict-regime prison where he served his sentence for stealing cattle. "I started coughing at the end of my term," Teshebai continued, unwillingly. "I expected to get well after imprisonment, but life out of prison did not appear to be sweet: there are no jobs, there is not enough money for a piece of bread and I need a high-calorie diet, vitamins and medicines." Teshebai does not seem to be concerned that he is infecting others. He is more concerned about providing for his family and raising his four children, aged eight to 14. It was bad news for him when the children seemed to have caught the infection too as they recently tested positive for TB at school. They now have to undergo lengthy treatment - an extra strain on Teshebai's meagre income. Notwithstanding all this, Teshebai is unwilling to go to hospital since it takes months to treat chronic lung diseases. He does not want to move from the frying pan into the fire. "I have served my sentence, I cannot go into hospital," he said firmly. According to Luch Solomona (Rays of Solomon), a local NGO in Osh, there are hundreds if not thousands of people like Teshebai whose health was undermined in state penal institutions and who are now are on the streets in search of their daily bread. Some of them get by through pushing heavy carts at bazaars, almost suffocating under the heavy load, while others survive by digging in rubbish. Some of them wash cars or polish shoes. It is easy to recognise them by their pale faces, coughing and gloomy looks. Based on their researches, analysts from local human rights NGOs such as Spravedlivost (Justice) based in the southern city of Jalal-Abad and Luch Solomona based in Osh city state that prisons are becoming sources of propagation for TB, HIV and other serious infections. The Kyrgyz Justice Ministry estimates that approximately 2,000 out of 17,000 prisoners serving their terms are infected with an "open" (easily contractible) form of TB. As doctors say, each sick person with this form of the disease can infect up to 100 people after being released from prison. However, the situation is more problematic in the northern Chui province, namely in the capital Bishkek and the cities of Tokmak and Kara-Balta. "The majority of the facilities of the penal system (Central Corrections Department, CCD) are located in Chui province and all specialised TB hospitals of the penitentiary system are in Chui province too," Avtandil Alisherov, head of the national TB Research Institute told IRIN in Bishkek. Coupled with that, the epidemiological situation in the country is aggravated by numerous amnesties (there have been 14 of them in the 13 years since the ex-Soviet republic gained its independence in 1991). "When there is an amnesty or when convicts have served their terms they are released and they don't go home, they settle in Chui province, namely Bishkek city," Alisherov maintained. The population of Kyrgyzstan is some five million with around one million living in the capital. The TB Institute reckons that every year some 1,500 inmates infected with TB are released based on amnesties. "In 2001 year alone around 1,600 TB-infected convicts were freed, out of which only some 600 registered with the medical institutions, while we lost track of the remaining 1,000. It means that these people are [working] in the markets, infecting other people," the health official explained. According to the TB Institute, the TB prevalence rate in 2003 was more than 100 cases per 100,000 population in Chui province, while in the neighbouring north-eastern province of Issyk-Kul that figure stood at some 80 cases per 100,000 population. The other problem is the issue of drug-resistance. A recent report launched by the Global Project on Anti-TB Drug Resistance Surveillance, a joint project of the World Health Organisation (WHO) and the International Union against Tuberculosis and Lung Disease, said that the prevalence of TB strains resistant to two or more drugs was exceptionally high in almost all former Soviet Union countries surveyed. "TB drug resistance is an urgent public health issue for countries from the former Soviet Union," Dr. Mario Raviglione, director of WHO's Stop TB Department, said. A sub-survey of 8,400 previously treated patients found that 30 percent of those in the former Soviet Union had strains of TB which were resistant to four drugs, compared with 1.3 percent elsewhere. Given the magnitude of the problem, some health bodies dealing with TB have appealed to the country's parliament to ban amnesties for TB patients in prisons in order to prevent possible infections. "They [the penal system] have specialised TB facilities and they can treat and cure infected inmates, keeping them there till the end of their terms under the control," Alisherov stressed. The serious disease is said to be generated by poor conditions in prisons, overcrowded cells, malnutrition, dampness and lack of adequate health care. Officials themselves concede that funds allocated by the government to feed prisoners are not enough. Sick people in penal institutions have the same conditions as other prisoners since there are no means to keep them separately. "Recently I went to Jalal-Abad prison to visit my son," Zumrat Abidinova, a teacher from the southern Naukat district told IRIN. "Everybody was coughing in the visitors' room. Nearly everybody was asked to bring more lard, considering it to be the best remedy against the disease." "When my son is released, it will take more than a year to cure him," she said with a heavy heart. "I am ready to sell my last belonging to heal him...Who will take care of a former prisoner when law-abiding citizens are neglected? In the long run, it is the government which must bear responsibility for this misfortune. Our sons caught TB because of intolerable conditions in state [penal] colonies." In an effort to deal with the issue, Abidinova, along with a group of prisoners' mothers, sent an appeal to the government requesting an improvement in prison conditions. If significant changes are not possible, they demand that terms of imprisonment be reduced for minor criminal offences. Society is debating whether the list of articles of the criminal code sentencing people to imprisonment will be reduced or not. But state officials admit that the issue urgently needs to be dealt with. Borubai Juraev, a member of the legislative house of the Kyrgyz Parliament, said that it was crucial to provide conditions for effectively treating infected people in penal institutions. Special care should be given to single and aged people; it was important to persuade them that they need long hospital treatment, he maintained. Kamil Atakhanov, a well-known specialist at the Osh TB hospital, does not remember a single case in which a former prisoner asked for medical aid. He said it was due to a lack of discipline and egoism of some sick people, while forced treatment of TB patients was not practiced. The doctor noted that an opening of a hospital for such forced treatment had been discussed recently in the northern Chui province, but no facility had been constructed so far. "Even if a court verdict orders a sick person to undergo treatment, there is no place to send him to," he highlighted. Many of his colleagues say that it is essential to open a specialised medical facility. He also called for stricter control over former prisoners infected by TB. It must be a rule that the law enforcement agencies, while issuing IDs (by law, imprisoned people are deprived of their documents) and registering former prisoners locally, force them to register with a local TB hospital (if a person is infected), the experienced health official said. He also noted that it was time to establish specialised sections in penal institutions for the treatment of TB patients. "As for funds, they can be raised with a help of international organisations," he said. Representatives of the CCD of the Justice Ministry state that the solution of the issue lies with improving the financing of penal institutions (according to CCD, their needs are now met only by 30 percent) and constructing additional facilities. "We do not need huge colonies which can keep up to 2,000 prisoners," Vladimir Nosov, the head of CCD said. According to the CCD, in order to have normal conditions in prisons, the number of inmates at each of them should be no more than 250. In such small correctional colonies it would be possible to create conditions for individual approach to prisoners. Meanwhile, former prisoners maintain they are being neglected both by the government and society. As for the police, they always keep them under constant pressure. Instead of providing help, the police extort money from them. "We need a special programme for the social rehabilitation of former prisoners, which would include issues of medical care, employment and integration into the society," Ravshanbek Gapirov, the head of Pravosudie - istina (Justice is the truth), a human rights protection centre based in Osh, said. In an effort to help the former convicts, he has managed to find jobs at constructions sites for a few healthy guys. But the majority of employers brush them away: "Why should we take walking shadows, which work one week and are sick the next." Employers are not willing to bear the possible costs of treating such workers or providing assistance to their families if needed. There are no chances to get jobs in cafes, restaurants or other sectors of public catering at all since, first of all, health certificates are required to get a job in the sector. "We recommend that the local authorities draw special attention to such people, to provide help within their resources," some officials at the Osh and Jalal-Abad governorships told IRIN. But resources remain scarce and the authorities can provide only one-time in-kind aid. The rest is the responsibility of a person himself and his relatives. As specialists point out, Kyrgyzstan is getting help from the international community for fighting TB. The Global Fund to Fight AIDS, TB and Malaria provides a substantial amount of aid to the country as well as other international organisations. And while some officials note that the country has developed a rather strong legal base to prevent socially dangerous diseases, Abdumalik Sharipov, a local rights activist, maintains that there are gaps in the system, namely the situation in the penal system and the plight of former convicts. Although there had been a lot of talk regarding former inmates - walking sources of TB - no concrete measures regarding them had been taken, he said.