Tuberculosis in prisons: increasingly difficult to treat
One speaks of multiresistant or multi-drug-resistant tuberculosis (MDR TB) whenever the disease no longer responds to two or more of the drugs used in the combination commonly used to treat it. This disease is spreading at an alarming pace, particularly in prisons. To mark World TB Day, the ICRC is presenting a documentary filmed in Azerbaijan that illustrates the treatment of multiresistant tuberculosis in detention facilities.
Interview with Dr Raed Aburabi, ICRC coordinator for health care in detention
Can you tell us about the film the ICRC has made about efforts to combat multi-drug-resistant tuberculosis in prisons?
The ICRC has just completed a multi-year programme in Azerbaijan in cooperation with the prison health authorities for treating patients suffering from the multiresistant form of tuberculosis. We have made this film, which is both educational and explanatory, in order to share our experience with other prison health professionals and with the public at large.
It is the first time to my knowledge that an audio-visual medium shows the full itinerary of detainees who have contracted TB – from their imprisonment to the medical examinations and the various stages of the individualized treatment they receive.
Can you tell us more about multi-drug-resistant tuberculosis?
The underlying problem is the high prevalence of TB in prison settings due to a combination of factors including overcrowding, lack of ventilation, and restricted access to proper medical care. Inadequate treatment of "simple" TB – a very common occurrence in prisons – instead of destroying the bacillus, favours the emergence of resistant strains and creates new cases of MDR TB that are increasingly difficult to treat. What is more, detainees can make their condition worse by refusing to follow the treatment or engaging in risky conduct – the combination of MDR TB and other infections such as HIV/AIDS or hepatitis C is an explosive cocktail.
What are the solutions, and how can detainee patients be treated?
The ICRC has run a programme in Azerbaijan closely monitoring detainees suffering from multi-drug-resistant tuberculosis, as we have already done in collaboration with the prison authorities in Georgia and Armenia. The only guarantee of effective treatment is to monitor the detainee patients individually – from diagnosis to cure – a process that can take up to two years. This is what is shown in the film, stage by stage. The key to the success of the programme also lies in the ICRC's exceptional collaboration with an Azerbaijani NGO that provides appropriate medical supervision for detainee patients who are released before the end of their treatment.
Obviously, the prison and health authorities must also commit themselves to supporting the programme if it is to be a success. We are now running similar programmes in Kyrgyzstan and the Philippines.