Kyrgyzstan: fighting drug-resistant TB in the prisons

20-03-2008 Feature

Prisons in Kyrgyzstan have long been a breeding ground for tuberculosis, including drug-resistant strains that are extremely difficult to treat. The ICRC is helping the authorities to tackle this deadly infectious illness in prisons. Jan Powell reports from the Kyrgyzstan capital, Bishkek.

  ©ICRC/J. Powell    
  A prison near Bishkek    
  ©ICRC/J. Powell    
  Crowded living conditions help spread tuberculosis.    
  ©ICRC/J. Powell    
  An ICRC doctor talks to a TB suspect before taking a sputum sample.    
  ©ICRC/J. Powell    
  Turusbek found out he had TB when he was in prison in 2001.    
  ©ICRC/J. Powell    
  Preparing the daily medication for MDR sufferers.    

A group of 30 men form two lines in the prison yard of Colony 19, one of Kyrgyzstan’s old Soviet-era prisons, close to the capital, Bishkek. The men all wear the same black clothing, and wait patiently in front of the aged truck parked in the prison yard.

“…when people come out [of prisons] they bring all their infectious diseases with them…”
Dr. Maxim Berdnikov 
As the guard calls their names, they step forward one by one, and climb into the battered truck for a chest X-ray. It’s part of a programme to screen prisoners for the deadly infectious disease - tuberculosis.

“I’m not worried,” says Eugene, who is behind bars for the sixth time. “I don’t think I’m sick.” Many of the detainees are unaware of the seriousness of TB. In one prison where the ICRC carried out screening, 40% of the detainees were found to be suspect, and many of them were later diagnosed with MDR TB – a deadly form of Mycobacterium tuberculosis that does not respond to the usual first-line anti-biotic treatment.

Levels of TB in the ex-Soviet republics of Central Asia are among the highest in the world. In Kyrgyzstan, prisoners are most vulnerable. The disease thrives and spreads in the kind of overcrowded, unhygienic conditions often found in prisons. To make matters worse, when detainees who are sick with TB are moved from one place to another they take the illness with them, spreading it to others.

 “I felt my life was draining away”  

Dr Maxim Berdnikov heads the ICRC’s programme supporting the Kyrgyz authorities'anti-TB strategy in the prisons. He is particularly concerned about the drug-resistant varieties: “It’s a very serious problem. MDR is much more difficult to fight, and requires more significant financial resources and, of course, well trained medical staff.”

TB is not a simple disease to diagnose and treat. Turusbek, for example, discovered he had it when he was in prison in 2001. What he thought was a simple fever got gradually worse: “I was constantly coughing day and night so I couldn’t sleep, and I had a high temperature. I felt as though my life was draining away.”

Turusbek was given antibiotics and later released. As often happens, once he was out of detention, with better food and living conditions, he felt better and had no further treatment. But when he was given another prison sentence, the symptoms returned. He was eventually diagnosed with MDR TB.

In October 2007, he finally started treatment on a new programme which the ICRC has helped the authorities to set up. The programme is the only one of its kind in Central Asian prisons, and there is a waiting list to get on it. Since October 2007, four patients have died from MDR TB because there are simply not enough of the expensive drugs to go round.

 20 pills a day, plus the side effects  

Turusbek is now being treated with a medication regime in line with the WHO (World Health Organisation) strategy called ‘Dots-Plus’, specific for resistant forms of tuberculosis. He has to take up to 20 pills a day, some with serious side effects and he now understands how critical his condition is. He’s anxious that when he is released from prison, he will be able to continue treatment, which could last up to three years.

“I don’t know what medicines I would have to take, and I couldn’t afford to buy them myself,” Turusbek says. “But I have heard that ICRC helps MDR patients on release to get to public hospitals to go on with their treatment. I hope they'll help me too.”

Aiding people like Turusbek is essential if MDR TB is to be controlled, not just in Central Asia but in the wider world. As Dr Berdnikov points out, “Prisons are not separate from the outside world, and when people come out they bring all their infectious diseases with them. As people migrate from Asia to Russia or Europe, they could bring the MDR variety of TB with them too.”

Turusbek’s thoughts are more immediate. In the room he shares with eight other MDR sufferers he thinks about his family, his parents, his wife and five children who work a farm 500 kilometres away in the south of Kyrgyzstan: “I don’t want to infect my family with TB and that’s why I want to finish my treatment properly before I go back to them.”

 ICRC video news producer Jan Powell has just returned from Kyrgyzstan where she was producing a TV report for the ICRC on the deadly threat of MDR TB in prisons. Accompanying her was the   BBC's Imogen Foulkesher impressions  , who wrote   for the ICRC website.  See also: Footage on the TB programme in Kyrgyzstan