- MOSCOW (Reuters) - Tuberculosis,
long ago subdued by Western doctors, is not only rampant in Russia but
increasingly mutating into terrifying new forms that even the most powerful
new medicines cannot kill.
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- It is spreading among the country's most vulnerable groups:
around one in 10 prisoners in Russia's jails have it, and among homeless
people the rate is broadly similar.
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- And post-Soviet medical mismanagement, many doctors say,
has already allowed the contagious, air-borne disease to mutate into strains
that cannot be killed by even the most modern medicines.
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- "The reservoirs of super-resistance will be huge,
it will be impossible to treat," said Andrei Slavutsky of the medical
charity Medecins Sans Frontieres (MSF). MSF was so disgusted by official
refusal to adopt treatment techniques backed by the World Health Organization
(WHO) that it ended its tuberculosis program in Siberian prisons.
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- The Soviet Union developed an effective if cumbersome
anti-TB program using mass tests to catch the disease early. The totalitarian
system ensured that the population did what health authorities wanted.
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- But the fall of communism starved the system of cash
and robbed it of its ability to control patients, and an explosive epidemic
followed its failure to adapt.
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- The WHO estimates that TB in Russia has risen threefold
since 1991, and predicts an epidemic among HIV-positive Russians whose
immune system is hit by the virus that causes AIDS.
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- WHO figures put TB prevalence in Russia at 134 cases
per 100,000 people compared with six per 100,000 in Norway, 12 in Britain
and five in the United States.
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- "People need good living conditions, to be well
fed and to work. The problem is 85 percent social and only 15 percent medical,"
said Mikhail Perelman, Russia's top TB expert.
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- NOT ENOUGH
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- Some doctors think medical authorities have not only
been slow in fighting the epidemic, but that action has been so inappropriate
as to be harmful.
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- Multi-drug-resistant (MDR) TB can be treated only with
expensive modern drugs, and is often caused by not ensuring that patients
finish a course of treatment. MDR-TB drugs need to be used for longer,
are less effective and have more harmful side effects than traditional
treatment.
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- "Lack of resources in the 1990s also led to late
diagnosis and ineffective treatment. Insufficient supervision, poor management
and low treatment effectiveness led to the growth of MDR-TB," said
Wieslaw Jakubowiak, the WHO's TB control program coordinator in Russia.
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- WHO figures show MDR-TB running as high as one in 10
new TB cases among the general population in some regions, and almost as
high as one in five in the prisons. "This situation needs to be immediately
addressed," said Jakubowiak.
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- Many doctors say Russia is now incorrectly using modern
drugs -- the last line of defense against MDR-TB -- allowing the disease
to mutate to survive those as well.
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- Zulfira Kornilova, deputy director of an institute in
a forest outside Moscow which treats Russia's most serious TB cases, said
her experts were picking up terrifying rates of super-resistant strains.
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- "There is now a group of patients who do not respond
to any medicine. It is maybe 15-20 percent of all those who have MDR-TB,"
she said.
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- "But there are no exact figures for super-resistant
forms, because the laboratories do not have the right equipment and are
not clean enough."
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- CONSERVATISM
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- Partly to improve these diagnosis rates, the World Bank
is lending Russia $150 million. Like many foreign initiatives the agreement
was held up for years by Russian reluctance to modify tried and tested
practices.
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- Perelman said that despite the growth of MDR-TB, he resented
interference, adding that the Russian system was best suited to the country.
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- "Imagine what would happen if I came to the United
States or England and started to work whatever way I wanted? They would
put me in prison," he said.
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- The WHO says Russia is now closely approaching internationally
acknowledged standards and has put the disease at the top of its agenda,
but for many doctors the change is coming far too late.
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- "There is already massive supply of second-line
drugs going on, but without clear guidelines explaining how to use them
efficiently this is absolutely criminal," said MSF's Slavutsky.
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- "Use of second-line drugs in this situation will
stimulate the creation and spread of super-resistance."
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