Tuberculosis in Russian Prisons
Introduction
Authored by: Christopher Murphy
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Mycobaterium tuberculosis, better known as tuberculosis, is considered one of the most deadly infectious diseases.
Humans are tuberculosis's only reservoir, meaning that humans are the only compatible organism to host this infectious agent. As a result, humans have suffered heavily from this disease. More specifically, the 17th and 18th centuries experienced the "White Plague" in which about everyone had been infected and 25% of adult deaths could be attributed to tuberculosis. Roughly 33% percent of the world has latent tuberculosis, as long as the immune system is not compromised there will be no issues.
In recent years there has been a reemergence of tuberculosis, one area severely affected by tuberculosis is Russia.
As patients are being treated for tuberculosis the most important things is to make sure the patients takes all of the medicine. What tends to happen is that during the beginning months the majority of the tuberculosis bacteria is killed and the symptoms go away, the treatment lasts much longer (6 to 9 months) than symptoms do. When this happens many patients will stop taking the medications falsely believing that they are cured. Unbeknown to them some tuberculosis survives and makes a waxy coat and buries away in the lung. Among the remaining tuberculosis are extremely resistant bacteria and with the stopping of treatment the more resistant strains take over. Another reason patients may object to continuing therapy is that the DOTS drugs have adverse side effects such as hallucinations, nightmares and vomiting. It is hard to tell who will react adversely to the drugs and to what extent.
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Why Tuberculosis is so prevalent in Russia
Tuberculosis is a opportunistic infection, it exploits compromised immune systems. The compromising of immune systems can occur as the result of any of the following: sizable populations, lack of nutrition, the use of intravenous drugs, alcoholism and HIV/AIDS.
All of these risk factors can be found in Russia, particularly in Russian prisons. These prisons are overcrowded and in sordid conditions, consequences of severe penal codes and lack of funds. As a result, tuberculosis flourishes under these conditions. Moreover, prisoners are 58 times likelier to contract tuberculosis than the average Russian citizen and are 28 times likelier to die from the disease than the average Russian citizen.
As of 1999 the Russian prison population neared 1.1 million prisoners, of those prisoners 1 in 11 have tuberculosis. In addition, treatment is sporadic at best and consequently MDR strains have arisen affecting 20,000 prisoners.
The prison population surged above over a million and the movement of people being incarcerated and being released also numbered in the millions. The strict penal codes in addition to the dire economic state of Russia only added to this number. As a result prisoners with latent infections could no longer had the immune strength to suppress the TB and other prisoners became infected by being in such close proximity with sick prisoners. The number of TB cases has reached an epidemic level.
There are several contributing factors to prevalence of tuberculosis in Russia. The recent spike in cases is attributed to the combined affect of the fall of the Soviet Union and prisoners who are inadequately treated for TB being released back into society. As a result of the collapse of Russian infrastructure, alcoholism, unemployment, crime rate, incarceration rate and the movement in and out of prison all increased significantly. In addition, health and social services ceased to exist only exacerbating the problem at hand. Diagnostic tests could not be afforded any more as well microscopes for sputum examination. Consequently, much of the treatment was stop-and-go leading to TB rates that topped the charts as the world's highest. The immune system is weakened through drugs, alcohol, continual stress, tight and squalid living areas, co-infections(e.g. HIV/AIDS) and inadequate nutrition. To highlight the consequences of the effects of crime, prisons were deemed "epidemiological pumps" for the rest of Russian society. After being in cramped quarters inside prisons, released prisoners would return home to equally small apartment blocs. During the winters, these unventilated apartments served as breeding grounds for TB. Russia had previously its satellites to produce antibiotics but with the collapse drugs and funding were both in short supply. The newly independent satellite republics no longer continued the barter trade with Russia for antibiotics. Another factor perpetuating was the Health ministry's resistance to adopting the DOTS strategy. They were adamant about keeping the status quo. Surgery, removing a partial lung is the approved method in Russia despite the controversy this procedure warrants from the outside world. Doctors are also skeptical about DOTS and passionate about their own version. Mikhail I. Perelman encapsulates this idea with his quote, "DOTS-this system was developed for the poorest countries of Africa. These places are not like Russia." Roughly 10 to 15% of patients undergo this operation. On the contrary, many of the local doctors were fine with participating in the DOTS strategy, however, many of the pharmacies ran out of supplies-even first-line drugs where in short supply.
Include some current research in each section.
Tuberculosis thrives in impoverished and stressful environments, this is particularly noted in the poorer areas of Russia such as Siberia and Russia's Far East. Prisons, by nature, are ideal environments for tuberculosis, particularly in Russian prisons in the 1990s. As previously mentioned before approximately 33% of the world has latent tuberculosis. Therefore it is very likely that when prison populations increased in the 1990s, many of the inmates were carrying tuberculosis. All of a sudden a large amount of people were crowded together in extremely sordid conditions resulting in uniquely high stress levels. In addition, due to the stigma towards prisoners, little has been done to improve their conditions. The isolation of prisoners is less than ideal, all the infected prisoners are sometimes housed together causing re-infection, though occasionally those making a recovery will be separated. The is also the risk of workers at prisons and hospitals will become infected and transmit the disease to people outside of the prisons and hospitals.
Attempts of Fighting off Tuberculosis
Russia continued to struggle with Tuberculosis until recent outside help. Starting in the late 1990s George Soros has been a principle financial contributor. In addition, the work of Medical Emergency Relief International and Partners in Health in the area,as they experimenting to develop a new TB program, has lead to success. The DOTS program has been implemented and is usaully the strategy of choice. It is an everyday procedure in which 4 antibiotics are taken orally for 6 to 9 months under the care of a health official. In following years, Partners in Health developed a technique called DOTS Plus which all MDR-TB cases are being treated, which has lead to more extensive and intensive treatment. It is considered a bolder and more costly procedure. Local doctors were encouraged first in the prison system and then all throughout the region. This program takes up to two years and requires 6 to 8 drugs. MDR-TB and TB are similar in their capability to be lethal, the main difference is that MDR-TB is much harder to treat than TB. There is more and more agreement that MDR-TB should be the form of TB to be concentrated on because in treating MDR-TB then TB will also be treated.
Russia has heavily relied outside the Eli Lilly and Company Foundation and the Global Fund to Fight AIDS, TB and Malaria. Furthermore, the creation of the Green Light Committee, a drug procurement consortium, has been crucial to the fight against tuberculosis. Green Light Committee is compromised of WHO, U.S. CDC, ngos and pharmaceutical firms. The effectiveness of this program is highlighted by the drop in cost of patient care. Previously, treatment cost $10,000 to $15,000 and currently runs around $3,000 to $4,000. Through this committee countries such as Russia could afford medication, including the more expensive second line drugs to treat MDR-TB. This was the direct consequence of purchase contracts and subsidies. The general condition of hospitals has improved with increased funding from organizations such as Global Fund. Improvements include new lab equipment such as airtight closets to house sputum and technology for culturing. The handling of cases has also changed for the better, those with TB are sent back to the barracks while MDR-TB prisoners are isolated in the hospitals, 6 to 8 prisoners to a room.
The goal of the international organizations is to counsel, help develop an infrastructure and empower Russia to be self-reliant. The technique of choice, DOTS, can be cumbersome and requires a significant amount of work by the health workers. It was first believed that the drug streptomycin was the cure all until it was discovered that tuberculosis mutates and that multiple drugs were necessary. The logic is based on statistics and probability, the drugs attack the tuberculosis in several different places simultaneously. Tuberculosis is slow growing, only reproducing once a day, resulting in a lengthy therapy session.
One new idea of treatment is the pursue the strategy of directing more attention to MDR-TB than susceptible TB. This strategy has been adopted by Russia and many over former satellite republics that collectively form the Commonwealth of Independent States. It is hoped that this method begins to be adopted by other countries around the world as well as helping reach the 2015 goal of cutting the TB's global prevalence and mortality in half.
Sample Section 3
Include some current research in each section.
Conclusion
Overall paper length should be approximately 2,000 to 2,500 words.
Include at least two data figures.
Use professional sources, including at least two research studies.
References
Edited by student of Joan Slonczewski for BIOL 191 Microbiology, 2009, Kenyon College.
