Prague, 24 March 1999 (RFE/RL) -- The World Health Organization (WHO) said yesterday that governments everywhere must increase their efforts to fight tuberculosis. But in its annual report on TB surveillance, it reserved special criticism for countries in Eastern Europe and Central Asia.
Since the collapse of East bloc communist regimes a decade ago, the number of cases of tuberculosis in countries such as Russia, Kyrgyzstan, Romania and Ukraine has increased by 10 percent a year. In Russia alone, it's estimated there are nearly 160,000 TB patients. The WHO says most patients aren't getting proper treatment. And that has led to a dramatic increase in the number of cases that can no longer be treated with drugs.
But there are a few regions that are having progress in the fight against tuberculosis. One of them is the Tomsk oblast in Siberia.
Like most other parts of the former communist bloc, Tomsk had seen its TB cases decline through the 1980s. But when the Soviet Union fell apart, its tuberculosis treatment program did as well. And the number of new cases started to rise.
Olga Charoburova is the deputy director of the Tomsk Tuberculosis Service. She says the city was not prepared for the economic hardship that followed the breakup of the Soviet Union.
"The situation in the region was such that -- as in some other Russian regions -- there was no medicine, nothing to treat sick people with."
Five years ago, Tomsk city officials asked for help from the international community. The British medical relief agency Merlin sent a team of doctors and nurses. They found that even though the oblast was short of money, medics were still using traditional methods. Most patients were admitted to hospital for drug treatment for at least 12 months. Up to 10 percent had surgery to remove part of their lungs. And everyone in the region was asked to go for an annual X-ray test to see if they had TB.
Max Kammerling is the medical director of Merlin's TB project in Tomsk. He says the traditional methods do work. But they are extremely expensive. And because so much money was going to hospitals and screening programs, there wasn't enough money to pay for drugs.
"The drugs that are so necessary for the treatment of TB ceased to be available. They were getting an inadequate course of drugs for an inadequate length of time. What happens if you treat people with an inadequate number of drugs or for an inadequate period of time is that although they may begin to feel better, there is a very high chance the disease will return. And because they have been treated inadequately, the germs that cause tuberculosis will become resistant to the more commonly used drugs."
In the last five years, tuberculosis treatment in Tomsk has changed dramatically. The oblast has adopted a method called Directly Observed Treatment Short Course, or DOTS, which is recommended by the World Health Organization.
The therapy involves giving every TB patient a standard drug treatment that lasts for just six months. In Tomsk, less than half of patients are admitted to hospital, and those who are stay for only a short time. The rest either get their drugs from a dispensary, or take them at home under the supervision of a nurse or community health worker. And there is no more mass X-ray screening. Only people in high-risk groups -- such as the elderly or the poor -- are screened regularly.
Kammerling says the results have been dramatic. Eighty-six per cent of patients in Tomsk are now cured, compared to an average of 50 percent in the rest of Russia. And for the first time last year, the number of new cases actually dropped slightly.
Charoburova admits that doctors in the region at first questioned whether the new methods could work.
"Of course, in the beginning there were psychological difficulties. It was hard for doctors who their whole life had been trained to use one method to get used to and to switch to a new one."
But she says they were convinced by a study that showed the new treatment is cheaper and just as effective as the old cure.
"We realized that the results of the new method were not worse, were even better, and also less costly and more expedient. We did a lot of training of medical staff, and now everybody is convinced of the efficiency of the new methods and no longer talks of any other."
With money from international aid agencies, Tomsk oblast hopes to expand its TB treatment program. It recently set up a new center to train doctors in surrounding regions in how to implement a DOTS program. There are also plans to expand the program to prisons and to set up a special program targeted at people who have drug-resistant TB.
(Second of two features on WHO efforts to fight tuberculosis.)