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Kyrgyzstan: managing tuberculosis

23-03-2009 Interview

Tuberculosis is a major killer in Kyrgyzstan, particularly in prisons, where rates of infection are around 40 times higher than in the general population. Gulmira Kalmambetova of the ICRC explains how the organization is helping curb the spread of the disease.

   

  ©ICRC    
 
  Gulmira Kalmambetova (standing), head of the ICRC TB programme in Bishkek with Elzat Turalieva, head of laboratory in Colony 27 prison.    
     

 A lot people may not know exactly what tuberculosis (TB) is and how it is transmitted. Could you give us a brief description of the disease?   

   
 
 
 
     
 

Tuberculosis is an infection that most often affects the lungs. Its symptoms include persistent coughing, coughing up blood, weight loss, night sweats and fever. The bacteria that cause the disease are transmitted from one person to another in tiny droplets when an infected person sneezes or coughs. A healthy person can only get infected through very close contact with a sufferer – for instance by living in the same room with them over an extended period of time.

 

 Most people see tuberculosis as a death sentence. Is the disease really incurable?  

There are antibiotics which, if properly administered, are effective in treating and curing the disease. Tuberculosis normally progresses slowly, and can take weeks, months, or even years to develop. If it remains untreated, in the vast majority of cases it becomes fatal.

Tuberculosis is generally treated with four medicines for six to nine months. In some cases, resistance to a particular medicine develops, either because treatment has been interrupted or is inadequate, or because of direct transmission by someone who has developed a resistance to the disease. At this stage the usual treatment becomes ineffective.

Two of the medicines are considered as forming the “backbone” of the treatment because they kill the bacteria. When resistance to these two medicines occurs, we talk about multi-drug resistant (MDR) tuberculosis. While MDR tuberculosis can be treated, its treatment is lengthy, complex and expensive.

 What is the current TB situation in Kyrgyzstan?  

    

Kyrgyzstan is among the countries with the highest incidence of TB. The situation is particularly alarming in places of detention, with tuberculosis being up to 40 times more prevalent inside than outside prison walls. This is often due to overcrowding, inadequate ventilation, lack of awareness of preventive measures and failure to ensure adherence to treatment. The shortage of food weakens detainees, makin g them more vulnerable to the disease.

 How is the problem of tuberculosis tackled, and what role does the ICRC play?  

    

A number of organizations are involved in efforts to combat tuberculosis in Kyrgyzstan. The country is included in the World Health Organization (WHO) global " Stop Tuberculosis Programme " . In addition, the Global Fund to Fight Aids, Malaria and Tuberculosis supports Kyrgyzstan’s national TB programme in providing treatment for everyone suffering from tuberculosis.

One of the ICRC’s main achievements is its programme for the treatment of multi-drug resistant tuberculosis at the hospital in Colony 27 prison – a prison filled with inmates suffering from tuberculosis. As part of the programme, implemented in close cooperation with the health and justice ministries, prisoners found to be suffering from the MDR form of the disease are transferred to the hospital, where they receive the WHO recommended treatment known as Dots-Plus. Additionally the ICRC cooperates closely with Médecins Sans Frontières, which is also active in the treatment of tuberculosis.

In collaboration with WHO, the ICRC provides continuous training for medical staff working in TB facilities in and outside prisons. The ICRC, the Kyrgyzstan Red Crescent Society and other organizations, such as Project Hope, work together especially in providing social care for released prisoners.

   
  ©ICRC    
 
  A patient taking his medicine in the presence of Ryskul Cholusheva, ICRC Bishkek medical field officer.    
     

 What does the ICRC do in Colony 27, and why this prison in particular?  

    

In 2004, the ICRC began upgrading sanitary and medical facilities in Colony 27 as part of its contribution to the national anti-TB strategy.

In November 2008, the organization started installing a new heating system in the colony. By December, the hospital facilities within the colony were equipped with the heating system, and by January 2009 the system had been extended to the outpatient medical department and two living areas. The new system, comprising over 200 radiators and around 1,500 metres of pipes, runs on either coal or electricity. The organization has also installed a hospice for the care of prisoners who are terminally ill or refusing treatment.

Over the years the ICRC has donated a substantial amount of new medical equipment and medicines to the prison.

One of the reasons why the ICRC concentrat es on Colony 27 is that all the 100 or so inmates have contracted the multi-drug-resistant form of tuberculosis. Unless treated effectively, they can be a threat to public health in the wider community as people spread the TB bacillus by repeatedly entering and leaving the prison grounds.

 What is the ICRC's long-term goal within the programme?  

    

The ICRC is helping ensure that the prison system has the health facilities, drugs, equipment and expertise to diagnose and treat all inmates suffering from tuberculosis adequately and in a sustainable manner. This is going hand-in-hand with support in improving the prisoners’ living conditions.

To help control the rising incidence of multi-drug resistant TB, it is crucial that people suffering from tuberculosis complete their treatment. For this reason, the ICRC puts particular emphasis on improving social care for released prisoners to ensure that they continue and complete their TB treatment in facilities outside the prison system.