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Russia: Tuberculosis Making Strong Comeback

St. Petersburg, 11 March 1999 (RFE/RL) -- Doctors in Russia say they are fighting an increase in the number of cases of tuberculosis (TB), a disease largely eradicated in the West but making a strong comeback, especially in Siberia.

TB is curable in 95 percent of cases, but according to Goskomstat -- the state statistics agency -- some 25,000 people die annually from it in Russia, primarily due to the failure to treat it properly.

The Russian Health Ministry says 100,000 new cases of TB were diagnosed in the first ten months of 1998. It says the Russian mortality rate for TB is almost 17 per 100,000 cases, far greater than the U.S. rate of 0.5. Worldwide, TB kills about 3 million people each year, mostly in Asia and Africa.

While 80 percent of TB cases affect the lungs, the infectious disease can attack almost any part of the body. It is spread from person to person through the air, but it is not easy to become infected. Most infections occur because of exposure to the bacteria over long periods of time.

Doctor Svetlana Sanayev -- head of the eye department at Saint Petersburg's City Tuberculosis Center -- says many people do not realize that TB can infect almost all organs. She said Russian doctors can diagnose all these forms of TB because their knowledge of the problem is more advanced than in the West. She said: "We have been studying the problem longer, and it is more severe here."

TB is now recognized as a social disease. As an airborne disease, it flourishes in areas of social and economic crisis, where there is poverty, overcrowding, alcoholism, drug abuse and homelessness.

Yet TB is not as infectious as many people believe. According to Vladimir Zhemkov -- chief physician at the City Tuberculosis Center -- if a person infected with TB comes into contact with 100 people, only 12 to 16 of them will develop the disease over the course of a year. He said many people already have immunity to TB or are strong enough that even if the bacteria enter their system, it will do no harm as long as the person remains healthy.

Nevertheless, doctors say the problem is getting worse in Russia. There has been a 10 percent increase each year in the number of TB cases in Russia since 1991.

The most disturbing news is the rapid spread of a dangerous form of tuberculosis known as multi-drug resistant tuberculosis, or MDR TB. Today, more than 20,000 Russians are believed to be infected with MDR TB, most of them prisoners.

According to the American Lung Association, some TB germs become resistant to the effects of some TB drugs. This happens when the disease is not properly treated. These resistant germs can then cause TB disease. The TB disease they cause is much harder to treat because the drugs do not kill the germs.

Tine Demeulaere is the head of Russia's chapter of Medecins Sans Frontiere (MSF), the private international health organization. She is in charge of an MSF program that treats about 1,000 TB patients in a prison hospital in the Siberian region of Kemerovo. She spends one week of every month at the hospital.

Demeulaere says that -- at a minimum -- a TB patient should be treated with four types of medicines. Many Russian hospitals do not have enough money to administer the full treatment, however. Demeulare says most Russian doctors cannot stand by and watch TB patients die, so they administer at least some medicine, which she says results in more virulent strains of MDR.

She says Russian doctors should "either treat patients properly or don't do it at all." She predicts that MDR TB will start to appear in western countries with greater frequency. She said the potential is enormous for an outbreak in the West and that "people are not waking up to the threat."

Demeulaere said that while MDR TB is curable, the cost of doing so -- from $2,000 to $8,000 per patient -- is prohibitive in Russia's impoverished health care system.

Cases of tuberculosis are worse in Siberia due to the region's poverty and its large prison population. At least 10 per cent of Russia's 1.2 million prisoners are believed to have TB. Some 18,000 of them are believed to be infected with MDR TB. Other experts put the MDR TB infection rate in Russian prisons as high as 100,000.

Although abysmal prison conditions -- such as poor health care, inadequate sanitation and severe overcrowding -- further the spread of the disease, prison officials in Russia protest when prisons are labeled as the prime incubator of TB.

Mikhail Perin -- chief medical officer for Russia's prison system -- says Russia's prisons are a "sponge that society uses to wipe its face clean of social dirt." He said those who end up in prison are often the dregs of society -- alcoholics, drug addicts and other people who have lost their familial and societal ties. Perin says it is precisely these people who are already infected with TB. Perin estimates that 60,000 convicts infected with TB have entered the prison system in the past two years alone.

The MSF's Demeulaere says the situation in Russian prisons is indeed grim. She said they have infection rates of 32 to 100 times higher than in civil society, primarily because less treatment is available. Other factors include overcrowding, poor food and the high stress of prison life.

But the problem isn't getting worse in all parts of the country. Russia's second city, Saint Petersburg, seems to have its TB problem under control. According to the city's Health Care Committee, the number of new cases declined from 40 per 100,000 people in 1994 to 38 per 100,000 people in 1997. The total number of cases in Saint Petersburg is just under 2,000.

Unlike many other parts of Russia, Saint Petersburg has the funds and equipment to fight the disease. Now, the non-profit sector is also tackling the problem.

In early September, Russia's only soup kitchen designed to specifically feed homeless people infected with TB opened in the city. Run by the Catholic Charities, Caritas and the Maltese Knights Social Services, the kitchen feeds 150 people each day.

The director of the project -- Father Hartmut Kania -- said the charities noticed that many of the homeless people coming to another soup kitchen were infected with TB. He said that when the local government wanted to close the soup kitchen down as a result, the charities reached an agreement to create a special soup kitchen for those infected with TB.

One of the ideas behind the soup kitchen is that those infected with TB will eat there regularly and that state health care workers will be able to monitor and administer the full nine-month course of treatment.

(John Varoli is a St. Petersburg-based correspondent for RFE/RL.)