Tuberculosis Strikes Kyrgyz

Last spring, near the city of Osh, residents proved just how desperate food shortages are in southern Kyrgyzstan. They dug up thousands of field mice burrows and ate their winter stores.

Poor nutrition is largely to blame for an alarming increase in tuberculosis, TB, in the region. In Osh, the number of first-time sufferers rose from 220 to 346 in just three years. Over the last six months or so, 203 new cases were reported.

The Soviet healthcare system successfully contained tuberculosis with inoculations and other preventive measures. But when the Communist state crumbled, so did the health service. TB wards were shut down, deliveries of medicine and medical equipment dried up, and the illness began to reassert itself.

In the past, all high-risk groups, like children, adolescents and the elderly, were given BCG vaccinations. But now 75 per cent of southern Kyrgyzstan can’t afford the injections. Mandatory chest X-rays – a powerful weapon against TB – have long been abandoned because of their expense.

Without widespread preventive measures, it’s almost impossible to isolate people who are suffering from tuberculosis. Most sufferers have no idea they have the disease, and – as TB bacteria can be passed through air and water as easily as a flu virus – undetected sufferers are very infectious without knowing it.

Poverty has left many people with weakened immune systems, making them prime candidates for the disease.

Cultural attitudes don’t help. Kyrgyz have been so used to being nannied by the powerful Soviet healthcare system that they now struggle to look after themselves.

“Often people come to us in such a bad condition,” says Kamil Atakhanov, chief of the Osh Oblast Tuberculosis Center, “that you can only shrug your shoulders: Medicine is no longer any help to them. They say they didn’t have the time to come in.”

There are other kinds of irresponsible behaviour, too. “People will go into hospital, nearly dying, stay a couple of months recovering, feel a little better, and then run off. Interrupted treatment is dangerous because it makes overcoming the illness at a later stage much more difficult, and treatment won’t have any effect any more.”

Economic factors mean the illness is hitting new sectors of the population, where once it targeted the very old and young.

“Many TB sufferers are aged 18-44. Why? Unemployment, migration, trade. For example, they’ll go to buy goods in Russia - where it’s much colder than here - catch cold, then quickly pick up something more severe, like TB,”said Atakhanov.

The DOT (direct observation therapy) strategy recommended by the World Health Organisation, is for now the best weapon against TB. Testing in Kyrgyzstan began in 1996 and in the south in October of 1998.

There have been positive results, despite doctors’ initial scepticism. But DOT is only used on people who have fallen ill with TB for the first time. Only they receive two months of therapy and medicines, followed by another 4-6 months of further treatment, all provided free.

People who have fallen ill again, or who are chronic sufferers, must pay for all the medicines themselves.

“I have families on my books that can’t even find the money to bring their child to be examined,” says one district doctor in Osh Oblast.

“They simply don’t have the money to pay 30 som (60 cents) for an X-ray. We visit them at home at our own expense (because free tickets for district doctors and nurses have been abolished) and see how our patients are fed. Sometimes their dinner is tea and a crust of bread. But people with TB need carbohydrates and fats – meat, milk, butter. These people can’t even afford fruit and vegetables.”

Hospitalising them wouldn’t make much difference, either. “People have always been fed badly in our hospitals, and now it’s worse, " continued the doctor.

" Only 12 som (24cents) are allocated per person. You can’t even feed a child on that amount. When I give my patients a list of medicines, each of which costs up to a 100 som ($2) or more at the market, and yet more at the chemists, I begin to despair: I know that they can’t buy everything that they need. Or they’ll take the medicines irregularly, with interruptions, which makes them useless.”

Even though DOT has its problems, it is the only credible anti-TB program, and as such the only one the World Bank agrees to fund. But although the Kyrgyz government is undoubtedly committed to fighting tuberculosis, as long as most of the population lives below the poverty line, it could be a losing battle.

Alla Pyatibratova is an IWPR contributor.