TB in prisons threatening national health

Although rising poverty and the breakdown of health services play a role, medical experts maintain that the deteriorating conditions in the overcrowded prison system constitute the leading contributory factor in a rising tuberculosis (TB) epidemic in Kyrgyzstan. With an estimated one quarter of inmates infected with TB, prisoners released back into the community are dramatically contributing to the spread of the disease. The director of the Kyrgyz TB research institute, Avtandil Alisherov, told IRIN on Tuesday that the prisons were the main source of the infection: more than 50 percent of the 1,160 people who died from TB in Kyrgyzstan last year were infected in jail. Meanwhile, the authorities are seriously under-resourced to deal with the outbreak of TB in prisons. With only five US cents budgeted for food per convict, prison administrators were unable to feed them properly, Alisherov explained. “When we give them anti-TB drugs, inmates simply collapse, because their bodies are too weak to take the drug, and it has no effect. It becomes a waste of money.” TB then spreads into the community because Kyrgyz society is unequipped to deal with infected convicts after their release. “When someone is TB infected, all family members stay in the house and take care of the patient, not realising the disease is infectious,” Alisherov said. While he contends that there is not enough awareness of the dangers of TB, he has noticed some gradual and positive changes in attitude among the Kyrgyz public. “Now we see people coming to our hospital asking for TB testing after they have found out that their neighbour is infected,” he said. However, a lack of preparedness has contributed to some of the highest recorded incidences of TB in Central Asia. According to Alisherov, the official incidence for TB last year was 121 per 100,000 - three times the incidence officially recorded in neighbouring Tajikistan. “The real figure is probably 200 per 100,000 people”, he added. With TB now a global epidemic which kills 2 million people each year, the World Health Organisation (WHO) has warned that nearly one billion people could be newly infected by the disease in the next 20 years if control is not further strengthened. TB is contagious and is spread through the air, much like the common cold. Not all people who contract TB are infectious, but WHO studies indicate that, left untreated, each person carrying active TB will infect on average between 10 and 15 people a year. The Kyrgyz government is taking the TB threat very seriously. It has adopted a national TB programme to channel foreign aid and grants, and brought in a law defining the rights and obligations of health workers, patients and state structures with regard to TB. “This has been very successful,” Alisherov said. “Having recently received over US $2 million for medical drugs and equipment, our 7,000 new patients are being treated completely for free,” he added. All recently diagnosed patients receive a directly observed treatment - short-course, also known as DOTS, and used worldwide. For Kyrgyzstan, a country struggling with poverty, unemployment and a lack of infrastructure, the cost of TB is simply too high. A patient whose infection has been identified at an early stage needs 2.5 months of intensive care and seven months of ongoing treatment. According to WHO, a six-month supply of drugs costs US $11 per patient. However, with treatment for multi-resistant strains tailored to individual patients, prices can soar. An 18-month intensive treatment for patients with multi-resistant TB strains, which occasion most of the cases in prisons, can cost between US $3,000 to US $7,000 per patient. But lack of funds is only part of the problem. “Money can only solve the most urgent issues in the short term, but not for the long term,” Zulfia Marat, the project coordinator at the Bureau on Human Rights and Rule of Law in the Kyrgyz capital, told IRIN on Wednesday. “We need to review the government’s policy on prisons and TB-infected inmates,” she maintained. The bureau is a Kyrgyz NGO established in 1992 to promote civil society in Kyrgyzstan. The organisation conducted monitoring in seven prisons and interviewed inmates, doctors and staff to draw up an objective picture of the situation. “Out of the 33 prisons of Kyrgyzstan, we know that four include TB hospitals. After talking to doctors, we estimate that around 3,000 prisoners out of the 20,000 jail population are TB infected,” Marat said. “Doctors acknowledge TB- infection rates are reaching record figures. In larger prisons, one to two inmates die of TB every day,” she added. Prison inmates are not the only ones who suffer. “Not only are inmates dying, but every year, two to three staff members of prisons die of TB - even doctors get infected,” she said. “If the government has no funds to finance TB infrastructures in prisons, it should consider alternative measures of punishment,” she added. Marat believes offenders who have committed petty crimes should not be jailed but do community service. “Because of our legal system, a young man who stole food once and is caught again is put in jail along with killers and drug dealers. People should be punished for their crimes or deprived of freedom - but not of their health, she argued. Despite promises from the government, there is not a single psychologist working with convicts and staff in Kyrgyz prisons. As a result, Marat says, both inmates and staff feel they are totally forgotten by society, and the rate of suicide among inmates is growing. “The most alarming aspect is that TB is expanding every day, and is spreading throughout our society,” she stressed.