Peru: overcrowding fuels tuberculosis infection in prisons

06-04-2009 Feature

Tuberculosis is a disease which is transmitted from person to person. For this reason, it spreads easily in prisons marked by overcrowded conditions. In Peru, the International Committee of the Red Cross (ICRC) took part in training health promoters to detect possible cases of infection in order to obtain immediate treatment for them.


  ©ICRC / M.Mejía / pe-e-00374    
  Prisoners wait to receive medicines.    
    Christmas was approaching and Juan Carlos, a Lurigancho Prison inmate, suspected that he had tuberculosis. One morning in December, he began to cough and spit up blood. He did not want his mother to find out that he might have tuberculosis because, in that case, his relatives would not come to visit him during the holidays. He said nothing to her, but neither did he want to confirm his suspicions; he was afraid. The coughing became more severe; he could no lo nger eat or breathe well, and he was overwhelmed with fatigue. When he could no longer hide his illness, he agreed to be tested. The test was positive. Juan Carlos has TB, and now his mother also suffers from the disease.    
  Resistance to treatment
  Tuberculosis is customarily treated with four medicines for a period of six to nine months. Sometimes resistance develops to a particular drug, either because treatment has been interrupted or is inadequate, or because of direct transmission of some other infection which exhibits such resistance. At this stage, the usual treatment becomes ineffective. Two of the medicines are considered basic, because they kill bacteria. When the patient shows resistance to these two medicines, he or she is said to have multidrug-resistant (MDR) tuberculosis. While the MDR variety can be cured, the treatment is long, complicated and costly. In certain cases, prison inmates abandon the cure because of its undesirable side effects and the perseverance needed to see it through.    

“The problem with tuberculosis in Lurigancho Prison is that overcrowding breeds reservoirs of TB which are then disseminated. They go through the walls, turning this disease into a public health problem. Lurigancho was designed to hold 2,000 people, but there are more than 11,000 inmates at present, " Dr. Miguel Angel Melgarejo, medical coordinator of the prison, explains. In 2008 there were approximately 900,000 visits to the prison, which gives an idea of the magnitude of the infection risk.

The number of new cases detected has grown at a dizzying pace in recent years. “It has tripled in four years,” Dr. Melgarejo notes. In 2008 alone, 730 new cases were reco rded, and it is estimated that more than 103 new infections have occurred in the first two months of 2009.

In 2007, the tuberculosis prevalence or morbidity rate in Lurigancho Prison was nearly 49 times higher than at the national level.

A number of alternatives and programmes have been initiated in an effort to eradicate the disease. With the support of the ICRC and other organizations, health promoters have been trained. These inmates keep an eye out for others who are showing respiratory symptoms and may be carriers of the bacillus, so that they can be taken immediately to the prison infirmary.

The presence of 30 full-time health promoters at Lurigancho Prison — along with an expansion in medical personnel, thanks to support from the Global Fund to Fight AIDS, Tuberculosis and Malaria — helped to increase detection of TB cases, which corroborated the statistics.

" The more you look, the more you find, " Dr. Melgarejo explains. Nevertheless, he remains worried that the growth curve of this disease has not stabilized up to now.

" What is worrying about TB at Lurigancho Prison is that the increase in cases is alarming and we have not managed to stabilize the numbers, and this is due to many factors. Besides the overcrowded conditions, the living habits of some inmates also play a role. They are more prone to contract the disease or to have a relapse, and this creates treatment-resistant cases, " Dr. Melgarejo explains.

  ©ICRC / M.Mejía /pe-e-00373    
  A health promoter with an asymptomatic patient.    
    The health workers also give talks to the inmates and their families. They carry out monitoring campaigns in the cell blocks with the highest incidence of TB and collect samples to help identify those who have contracted the disease. Lurigancho Prison received support from the Global Fund, which financed, among other things, a specialized laboratory for analysing samples and an autoclave, a form of technology used to destroy any micro-organisms that these samples may contain.

The prison's health unit remains on the alert and, together with the health promoters, its representatives pay two visits a month to the places where people at risk are found, in the cell blocks that are the most overcrowded.

" We have to go at 7 a.m., before the inmates begin their day, since the people who are most affected are precisely the ones who move frequently between the cell blocks. When we do not carry out campaigns — at the beginning of the year, for instance, because of lack of staff — the number of people with TB increases, " Dr. Melgarejo notes.

The prison has an internment area for TB patients that is too small. Currently, 140 TB patients are hospitalized and the rest are receiving outpatient treatment.