For broadcast tapes and information on footage: Jan Powell, International Committee of the Red Cross, Geneva,
ICRC is working with civil and prison authorities in Kyrgyzstan, as well as international organisations such as MSF (Doctors without Borders), to fight the disease. ICRC provides technical assistance for the diagnosis and management of this complex illness.
As a result, since October 2007, a programme has been set up to treat detainees with MDR TB in Kyrgyzstan. It is the first such programme in Central Asia, where before, sufferers had little or no hope of recovery. There is, however, a waiting list for treatment. Four detainees have died since the programme started, because there are simply not enough drugs to go round.
But it is not only a question of drugs and financial resources. Skilled health workers are leaving the profession, demoralised and undervalued. In Kyrgyzstan for example, average wages for a prison nurse are 1,200 Som or 33$ a month. Ways must be found to train and retain skilled doctors and nurses to treat MDR sufferers.
TB does not stay behind bars. If MDR TB is not controlled in prisons, it cannot be controlled in the civilian population. With increased migration and travel, the likelihood of MDR TB spreading to other parts of the world is considerable.
Video Story
In a prison in the Kyrgyz capital Bishkek, detainees wait in line for a chest X ray to screen them for tuberculosis. Most of these prisoners do not believe that they have TB . But in a survey carried out in one prison in Bishkek by the ICRC and prison authorities, 40% of prisoners were TB suspects; many of those diagnosed with TB had the extremely dangerous multi-drug resistant variety.
Detainees are often kept in overcrowded, badly ventilated conditions, with poor nutrition and sanitation. In one block in Prison Colony 19, around 30 men live crowded together in bunk beds, ideal conditions to spread TB. Before ICRC started work to renew the water supply at this prison, there was only a single shower for up to 700 prisoners.
Dr Maxim Berdnikov who heads the ICRC 's programme to help the authorities control MDR TB in Kyrgyz prisons, is extremely concerned about the spread of the disease, describing the situation as 'alarming'.
The ICRC has worked with the authorities to establish a comprehensive programme for MDR sufferers in prisons. Once identified, they are transferred to a special prison hospital which has been renovated and equipped with a laboratory and consulting rooms. Patients receive the WHO recommended treatment known as Dots-Plus. This involves up to 20 tablets a day, which may have serious and unpleasant side effects. The course lasts 2 to 3 years and costs 6-8,000$.
Turusbek discovered he had TB in 2001 while he was in prison. What he thought was a simple fever got gradually worse: “I was constantly coughing day and night so I couldn’t sleep, and I had a high temperature. I felt as though my life was draining away.” Turuskbek was given antibiotics and later released. As often happens, once he was out of detention, with better food and living conditions, he felt better and had no further treatment. But when he was given another prison sentence, the symptoms returned. He was eventually diagnosed with MDR TB and moved to the prison hospital in Colony 27, to start Dots-Plus.
Helping people like Turusbek is essential if MDR TB is to be controlled, not just in Central Asia, but in the wider world. According to Dr Berdnikov: “We live in a much different world, when travel is very common…and I believe that the European Union is not that far from Kyrgyzstan. You know with all these workers who go to Russia, they might end up in one of the European countries, and who knows if one of them might bring the MDR TB strain with him or her?"
SHOTLIST
00 00 Bishkek prisons, exteriors, barbed wire, watch towers etc
00 13 prison guards
00 17 guard
00 24 ICRC vehicle and personnel arrive at prison
00 35 watch towers
00 41 ICRC personnel go into prison
00 49 personnel put on protective face masks
01 00 prison courtyard - detainees line up for x- ray in truck, brought from civilian sector. These detainees are being screened for TB - various shots
01 15 vox pop detainee, Maxat, Russian "I was tested while I was in school "
01 22 vox pop detainee, Evgene "I am not worried because I know that I don’t have TB"
01 29 Maxat "No I am not worried, this is all for our health."
01 33 prisoners go into truck
01 42 Maxat has X ray –various - comes out of truck
02 23 Dr Maxim Berdnikov, Head of ICRC TB programme , Kyrgyzstan, examines prisoner
02 38 ITW Dr Maxim Berdnikov (English)
"The level of TB in prisons in Kyrgyzstan is very high, it is really dangerous for detainees who are arriving to this prison environment , to newly arrived detainees. They have a very high chance to catch this illness, even if they came to this environment healthy."
0259 Maxim continues
"The situation is alarming especially as regards multi drug resistant TB because MDRTB requires much more clinical skills, skilled workers, doctors, nurses and it is much longer than the treatment of susceptible TB".
03 18 prisoners in courtyard
03 22 series of shots showing poor living conditions, rubbish, dilapidated interiors,
03 48 In prison bunkhouse, showing bunkbeds, crowded conditions, broken windows, dirt
04 43 ITW Dr Maxim (English)
"I believe we should worry, because we live in a much different world, when travel is very common, people are moving, migration, and I believe that the European Union is not that far from Kyrgyzstan. You know with all these workers who go to Russia, then they might end up in one of the European countries, who knows if one of them will bring the MDR TB strain with him or with her?"
0517 Dr Maxim (Russian - English translation:)
"That’s why without good control of TB in prisons we cannot protect the civil population. It is also the same in the modern world, when people migrate from Asia to Russia or say Kazakhstan, they could well bring with them infectious diseases, including the MDR variety of TB."
05 49 Hospital prison Colony 27, Bishkek, for prisoners with MDR TB. Corridors, guards, sick prisoner walking in corridor
06 24 Renovated consulting rooms, preparing Dots-Plus medication
06 36 Nurse gives medication to prisoner, Turusbek
07 15 ITW Turusbek (Kyrgyz) Turusbek has been in and out of prison several times, he has a large family , a wife and five children who live and farm in the south of Kyrgyzstan. Poor management of his TB in the early stages is likely to have contributed to the development of MDR TB
"I was constantly coughing day and night so I couldn’t sleep, and I had a high temperature. I felt as though my life was draining away"
07 36 "I don’t want to infect my family with TB and that’s why I want to finish my treatment properly before I go back to them."
08 02 Guards in prison courtyard
08 06 Prisoner with ICRC doctor, gives sputum sample, and walks with doctor
08 34 Microscopy room - various showing health workers examining sputum under microscope
08 50 Close-up through microscope showing the red threads which are the signs of TB
08 57 Bishkek town , bus station, local colour people and close-ups, travelling and getting onto buses and taxis - detainees who come out of prison untreated spread TB far and wide.
09 31 Changing the guard outside Bishkek presidential Palace, goose-stepping guards.
10 00 ENDS
For more information, please contact:
Marçal Izard, ICRC Geneva, tel: +41 22 730 2458 or +41 79 217 32 24
Maxim Berdnikov, ICRC Bishkek, tel: +996 772 504916
