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Azerbaijan, Georgia 'Show The Way' To Fight TB In Prisons

Nurses at a TB dispensary in the city of Sumgait in Azerbaijan take a blood sample from a former prisoner, who caught the disease in jail and has been continuing his treatment since being released (photo: ICRC/Zalmaï Ahad).
The International Committee of the Red Cross (ICRC) says efforts to stop tuberculosis (TB) from breeding inside Azerbaijani and Georgian prisons have been successful -- and show the way for other TB-affected countries to follow.

The message comes ahead of World Tuberculosis Day on March 24, an annual event aimed at raising awareness about the global TB epidemic and efforts to eliminate the disease.

The ICRC says TB was killing around 300 inmates every year in Azerbaijan's prisons 15 years ago. By last year, the number of deaths at the country's centralized TB prison hospital fell to 20, thanks to prevention measures, improved screening and diagnosis, and medically supervised treatment and follow-up.

"I visited the main prison hospital in Baku, and I was just very impressed by the extreme efficiency of how they've managed to separate prisoners for example who are extremely contagious from those who are responding better to treatment," says ICRC spokeswoman Anna Nelson.

"They have a very effective system in place for screening new arrivals for people who might potentially have TB to make sure they don't spread it if they do [have the disease,] and a very effective system of treatment."

Convicts at the prison hospital near Baku are regularly screened via X-ray and sputum samples to determine whether their TB treatment is working (photo: ICRC/Zalmaï Ahad).
ICRC spokeswoman in Baku Gulnaz Guliyeva tells RFE/RL's Azerbaijani Service this success was made possible through cooperation.

"The Ministry of Justice and the ICRC have cooperated in order to tackle the problem of TB," Guliyeva says. "In 1995 a special hospital was opened in Prison No. 3 to provide specialized treatment of the disease. All the patients who suffered from TB were enrolled there. The separate treatment center serves as a preventive measure to stop the spread of the disease."

Georgian Success

Sylvia Wust, regional adviser for TB in prison programs for the ICRC, describes Georgia as a similar success story. She says more than 200,000 prisoners have been screened over the past 15 years, 7,000 diagnosed, and 5,000 successfully cured. This has resulted in a sharp decrease in the number of deaths from the disease – from about 100 people every year to only a few.

To be sure, Marine Janjghava, head of the management, coordination, and control service at Georgia's National Tuberculosis Program, tells RFE/RL's Georgian Service that there are still problems.

"About a year ago, the Red Cross left Georgia and subsequently our program fully took control of the situation in the penitentiary system. But because of growth of the number of inmates it became difficult to carry out all activities that had been undertaken under the auspices of the Red Cross," Janjghava says.

"The situation has not worsened but there are some problems. Mainly that's late identification [of the disease]," she adds. "But once the prisoner is diagnosed with the disease, medical treatment is available."

Prisons As 'Breeding Ground'

TB kills on average one person every 20 seconds worldwide. The World Health Organization (WHO) says there were 9.8 million TB cases in 2008, with 1.8 million resulting in death.

"Prisons are a breeding ground for tuberculosis," Anna Nelson says.
TB has adapted to existing treatments, resulting in a major increase in multi- and extremely drug-resistant strains, with the former Soviet Union among the regions hardest hit. Nelson says that adds a sense of urgency to the fight against the disease.

"It is smarter, more resilient, and essentially outpacing everyone at every turn," the ICRC spokeswoman says. "And we're in third gear right now and we really need to step on the gas to tackle this problem."

Prisons allow the airborne illness to thrive and spread due to overcrowding, poor nutrition, and inadequate health services. The incidence of TB inside prisons can be up to 40 times higher than outside and Nelson says the disease can be easily transmitted to guards, staff, visitors, and the families of infected, released detainees.

Nelson says that because tuberculosis is "so contagious, it can't be kept behind bars; it finds ways to escape; it's a very smart disease. So we'd like to see more effort, more commitment, more resources put towards stopping the spread of this disease inside prisons in order to also be able to stop it outside. It's really a key component."

The ICRC is urging other TB-affected countries to follow the example of Georgia and Azerbaijan, to find the political courage to tackle the problem head-on and persevere in the long-run in order to save lives.

Nelson says that efforts to stem the spread of this "very aggressive," deadly disease across the globe could otherwise fall well short of what's needed. "It's by no means perfect anywhere, but what we can say is that this level of commitment, this level of recognition and willingness to tackle it really has made a difference [in Azerbaijan and Georgia]," she says. "But it's 15 years in the making. It requires patience and persistence as well."

The ICRC says ample doses of fresh air, a diet of healthful foods, a heightened awareness of how TB spreads, and a better understanding by patients of the severe side effects that drugs cause can make a big difference.

The organization also calls on authorities to implement the WHO's TB control strategy, known as DOTS, which requires regular supplies of medication and observed treatment.

RFE/RL's Azerbaijani and Georgian services contributed to this report