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Deadly TB strain sweeps Kyrgyz prisons

A drug-resistant and virtually untreatable form of tuberculosis is spreading from prisons in Kyrgyzstan to the general population. The BBC's Geneva correspondent Imogen Foulkes travelled to Kyrgyzstan with the International Committee of the Red Cross (ICRC) to see why.

Crowded conditions at Kyrgyz prison Colony 19
Overcrowding in Kyrgyz prisons helps spread tuberculosis
Colony 19 is a rundown, Soviet-era prison just outside Kyrgyzstan's capital Bishkek.

Four hundred prisoners live inside its crumbling walls. Conditions are cramped and dirty, there is little water or electricity.

But the worst threat here is invisible.

Dr Maxim Berdnikov is an infectious diseases doctor with the ICRC. His regular visits to Kyrgyz prisons have led to an alarming discovery.

"Levels of tuberculosis in Kyrgyzstan's prisons are the highest I have seen in my entire career," he says.

"I've worked in the Caucasus, where TB is very prevalent too, but here it is higher. It is very worrying."

Today Dr Berdnikov is screening new arrivals for TB, but his equipment is poor - a 40-year-old truck, with X-ray equipment that is even older.

The young men lined up outside will have to wait several days at least before they know the results.

"I'm not worried," says Maxat. "I used to get screened at school, I'm sure my health is fine."

"Of course I'm not worried," adds Yevgeny, "I know I don't have TB."

Prison killer

That optimism is misplaced. Even if they do not have TB now, they stand a good chance of catching it in prison.

"It's really very dangerous for inmates arriving in this prison environment," says Dr Berdnikov.

Kyrgyzstan is not that far from the European Union, many people go to Russia and then onwards - who knows if one of them might bring the multi-drug resistant TB strain with him?
Dr Maxim Berdnikov, ICRC

"They've got a high chance of catching the disease even if they arrived here healthy."

The ICRC says Kyrgyz prisons have become breeding grounds for tuberculosis. Around 40% of screened prisoners are found to have TB, and over a third of those have the new, and highly dangerous, multi-drug resistant (MDR) variety.

TB is the leading cause of death in Kyrgyz prisons, and the rates of MDR TB are among the highest in the world.

There are many reasons for this - overcrowded, poorly ventilated prisons, malnourished prisoners, and, especially in the case of MDR TB, inefficient treatment.

"I got TB when I was in prison," recalls Damir.

"And I did get medicine for it. When I was released they said I was getting better and I would probably improve on my own, so I didn't need to take the pills anymore.

Frightening place

Instead of getting better, the interrupted treatment meant that Damir developed MDR TB.

Just a few months ago he was close to death, but now, thanks to a new project, he is one of a handful of prisoners who are being treated.

Guard and medical staff at Kyrgyz prison Colony 27's MDR TB unit
Everyone at the Colony 27 TB unit must wear protective masks

Most are sent to another prison, Colony 27, which is now reserved for TB patients.

It is a frightening place. Everyone, including guards, nurses, doctors, and visitors must wear protective masks.

A special treatment facility for prisoners with MDR TB opened just five months ago, with the support of the ICRC.

Now 49 MDR patients are being treated, but there is a long waiting list

"Treating MDR TB is highly complicated," Dr Berdnikov explains.

"It takes much longer, for at least two years patients have to take 20 pills a day. They are much more expensive than the drugs for normal TB, and they are toxic - patients often suffer severe side effects."

But there is not really an alternative.

"Patients with MDR TB need to be treated," continues Dr Berdnikov. "It's a death sentence, most of them will die without the drugs."

Money worries

Kyrgyzstan, however, has little money to treat anyone with TB, let alone prison inmates with the multi-drug resistant strain.

Its health service is only now trying to reform itself, following years of economic crisis after the collapse of the Soviet Union, and the abrupt end of financial support from Moscow.

TB rates among Kyrgyzstan's general population are already 10 times higher than in western Europe, and rates of MDR TB are increasing rapidly.

"The latest figures show that in Bishkek around 25% of all new TB cases are MDR," says Maxim Berdnikov.

"That's more than in Azerbaijan's capital, Baku, which the World Health Organisation recently highlighted as having the highest rates in the world."

'People migrate'

Dr Berdnikov's biggest headache is trying to keep track of his MDR TB patients once they are released from prison, and to make sure they still have access to medicine.

Of nine recently released, one has disappeared - no-one knows where he is, or whether he is continuing his treatment.

Outside of prison in Kyrgyzstan
Kyrgystan's Soviet-era prisons are crumbling for lack of funds
"You know sometimes I feel it would be easier to keep them in prison," Dr Berdnikov says.

"But of course we can't do that, they are released when the sentence ends.

"But the problem is their priority then is looking for work to support their families. They travel in crowded buses, they go to crowded markets, and all the time they are spreading infection."

So while inside prison there is a waiting list for treatment for MDR TB, outside there is no guarantee that former inmates with MDR TB will get any treatment at all.

One problem is that many donor countries will not make money available for those who have committed crimes.

Maxim Berdnikov knows this. He has already tried pointing out that a teenager arriving in prison for stealing a chicken may receive a death sentence in the form of MDR TB.

Now he is appealing instead to fear. "People travel, they migrate. And you know Kyrgyzstan is not that far from the European Union. Many people from Kyrgyzstan go to Russia and then onwards.

"Who knows if one of them might bring the MDR TB strain with him?"


video and audio news
Prisoners in Kyrgyzstan reflect on the deadly disease



SEE ALSO
High hopes for TB vaccine
27 Feb 08 |  Health
Drug resistant TB 'at new high'
26 Feb 08 |  Health
Drive to curb drug-resistant TB
22 Jun 07 |  Health
Tuberculosis
08 Feb 03 |  Medical notes

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