Oracle
Well-known member
BBC News Service, Monday March 22nd, 2008
http://news.bbc.co.uk/2/hi/asia-pacific/7307398.stm
Colony 19 is a rundown, Soviet-era prison just outside Kyrgyzstan's capital Bishkek. Four hundred prisoners live inside its crumbling walls. Conditions are cramped and dirty, there is little water or electricity.
But the worst threat here is invisible.
Dr Maxim Berdnikov is an infectious diseases doctor with the ICRC. His regular visits to Kyrgyz prisons have led to an alarming discovery. "Levels of tuberculosis in Kyrgyzstan's prisons are the highest I have seen in my entire career," he says. "It's really very dangerous for inmates arriving in this prison environment. They've got a high chance of catching the disease even if they arrived here healthy."
The ICRC says Kyrgyz prisons have become breeding grounds for tuberculosis. Around 40% of screened prisoners are found to have TB, and over a third of those have the new, and highly dangerous, multi-drug resistant (MDR) variety.
TB is the leading cause of death in Kyrgyz prisons, and the rates of MDR TB are among the highest in the world.
There are many reasons for this - overcrowded, poorly ventilated prisons, malnourished prisoners, and, especially in the case of MDR TB, inefficient treatment.
Kyrgyzstan has little money to treat anyone with TB, let alone prison inmates with the multi-drug resistant strain. Its health service is only now trying to reform itself, following years of economic crisis after the collapse of the Soviet Union, and the abrupt end of financial support from Moscow.
TB rates among Kyrgyzstan's general population are already 10 times higher than in western Europe, and rates of MDR TB are increasing rapidly.
"The latest figures show that in Bishkek around 25% of all new TB cases are MDR," says Maxim Berdnikov. "That's more than in Azerbaijan's capital, Baku, which the World Health Organisation recently highlighted as having the highest rates in the world."
2-03-2007 Interview
The tuberculosis epidemic breaks through prison walls
Tuberculosis is a disease associated with poverty. Prisons, where the number of people suffering from tuberculosis is particularly high, have very limited means available to fight the disease. Interview with Dr. Francisco Duda, coordinator of the ICRC?s work on disease control in prisons.
What is particularly characteristic of the problem of tuberculosis in prisons?
It is the extremely high number of cases of tuberculosis in places of detention. The number of detainees with tuberculosis can be up to 100 times higher than the number of cases in the rest of society! In some countries, 25% of those with the disease are in prisons.
Why are there so many cases of tuberculosis in places of detention?
In many countries, the prison budget is not sufficient to ensure that detention conditions are acceptable. Overcrowding and poor ventilation favour the transmission of the disease. The shortage of food makes the detainees weak and more likely to contract the disease. The prison health services, which are generally in a state of neglect and less efficient than those in society, are unable to provide early diagnosis or effective treatment.
The high incidence of tuberculosis in prisons is also due to the specific nature of the prison population. AIDS and tuberculosis are closely related (see the interview with E. Burnier). There also happens to be a very large number of people with the HIV/AIDS virus in prisons and many detainees are users of intravenous drugs, one of the main groups of people at risk of contracting HIV/AIDS; in some countries they constitute the majority of the detainees. Sexual relations between men is another HIV/AIDS risk factor, is also more prevalent in prison than in the rest of society. Finally, it should be stressed that AIDS increases not only the risk of contracting tuberculosis but also that of dying from it.
What effects do these high tuberculosis rates in prison have on the rest of the community?
To succeed in controlling tuberculosis in society, it is vital for the fight against tuberculosis in prison to be included in the programme. In fact, there are a great many possible transmission vectors between prison and the community. It is estimated that worldwide there is an average of between eight and ten million prisoners on any one day. Because of the frequent movement in and out of places of detention, four to six times more people pass through there in the course of a year. Moreover, non-detainees ? particularly those who work there and the detainees? families ? have regular contact with the prison.
These exchanges between prison and the rest of society help to pass on the tuberculosis bacillus, and it is pointless to try to combat the disease without taking account of places of detention.
What can you tell us about resistance to tuberculosis treatment?
Tuberculosis is generally treated with four medicines over a period of between six to nine months. In some cases, resistance to a particular medicine develops, either because treatment has been broken off or is inadequate, or because of direct transmission by someone who has built up a resistance to the disease. The usual treatment is then no longer effective.
Two of the medicines are considered as forming the ?backbone? of the treatment because they kill the bacteria. When resistance to these two medicines occurs, we talk about multi-drug resistant (MDR) tuberculosis. MDR tuberculosis can be treated but treatment is lengthy, complex and costly.
However, what is more disturbing is that since March 2006, the World Health Organization (WHO) has been reporting the first cases of extreme drug resistant (XDR) tuberculosis, which is characterized by resistance to the three main categories of medicines used to treat MDR tuberculosis and is associated with a very high mortality rate.
Read more at:
http://www.icrc.org/web/eng/siteeng0.nsf/htmlall/tuberculosis-interview-240307
An in-depth article: The Crisis of Tuberculosis in Prisons. Sanjay Basu
and C. Brandon Ogbunugafor, Robert James, September 2006. Prison Health Initiative, Yale University School of Medicine.
http://www.zmag.org/content/showarticle.cfm?ItemID=10883
You should read this article; it's quite an eye-opener.
Commentary: More than fifty percent of the population of Kyrgyzstan lives below the poverty line; the public health system and municipal services are in very poor shape. Much like it's ex-Soviet neighbors, the economy has been in a struggling since the 1980s, when much of the Russian-driven industrial boom faded away as money was funneled into the war effort in Afghanistan. One year ago, when the International Red Cross/Red Crescent posted the material quoted above on MDR-TB movement into rural areas and communities near prisons, it was an emerging problem. It's much worse now, and its symptomatic of similar problems in prisons in many other countries, including Russia and the US.
If you look at the demographics of this county,
http://en.wikipedia.org/wiki/Image:Pyramide_Kirghizistan.PNG
...you quickly understand just how vulnerable it is to infectious disease (predominantly TB, hepatitis and GI infections, much of it arising from badly contaminated public and private water supply). The government has no money for vaccines, for medicines, for anything but crude medical treatment, for most of it's citizens.
When pandemic infection comes knocking on the door of Kyrgyzstan, fully one third of the population may perish. We have many other nations on the planet in nearly as dire condition, laid out like a global domino game spanning continents, each block with a population primed for not one, but waves of infectious disease. Places where the TB rate reaches as high as one fifth of the population. Places where coinfection between HIV, MDR-TB, and herpesvirus have drawn life expectancy below that of even the poorest nations, 100 years ago.
One third of the the human population carries either latent or infectious TB bacillus. This is NOT a normal organismal condition for humans. It is a ticking time bomb. You won't understand why, until we open Pandora's Box
http://news.bbc.co.uk/2/hi/asia-pacific/7307398.stm
Colony 19 is a rundown, Soviet-era prison just outside Kyrgyzstan's capital Bishkek. Four hundred prisoners live inside its crumbling walls. Conditions are cramped and dirty, there is little water or electricity.
But the worst threat here is invisible.
Dr Maxim Berdnikov is an infectious diseases doctor with the ICRC. His regular visits to Kyrgyz prisons have led to an alarming discovery. "Levels of tuberculosis in Kyrgyzstan's prisons are the highest I have seen in my entire career," he says. "It's really very dangerous for inmates arriving in this prison environment. They've got a high chance of catching the disease even if they arrived here healthy."
The ICRC says Kyrgyz prisons have become breeding grounds for tuberculosis. Around 40% of screened prisoners are found to have TB, and over a third of those have the new, and highly dangerous, multi-drug resistant (MDR) variety.
TB is the leading cause of death in Kyrgyz prisons, and the rates of MDR TB are among the highest in the world.
There are many reasons for this - overcrowded, poorly ventilated prisons, malnourished prisoners, and, especially in the case of MDR TB, inefficient treatment.
Kyrgyzstan has little money to treat anyone with TB, let alone prison inmates with the multi-drug resistant strain. Its health service is only now trying to reform itself, following years of economic crisis after the collapse of the Soviet Union, and the abrupt end of financial support from Moscow.
TB rates among Kyrgyzstan's general population are already 10 times higher than in western Europe, and rates of MDR TB are increasing rapidly.
"The latest figures show that in Bishkek around 25% of all new TB cases are MDR," says Maxim Berdnikov. "That's more than in Azerbaijan's capital, Baku, which the World Health Organisation recently highlighted as having the highest rates in the world."
2-03-2007 Interview
The tuberculosis epidemic breaks through prison walls
Tuberculosis is a disease associated with poverty. Prisons, where the number of people suffering from tuberculosis is particularly high, have very limited means available to fight the disease. Interview with Dr. Francisco Duda, coordinator of the ICRC?s work on disease control in prisons.
What is particularly characteristic of the problem of tuberculosis in prisons?
It is the extremely high number of cases of tuberculosis in places of detention. The number of detainees with tuberculosis can be up to 100 times higher than the number of cases in the rest of society! In some countries, 25% of those with the disease are in prisons.
Why are there so many cases of tuberculosis in places of detention?
In many countries, the prison budget is not sufficient to ensure that detention conditions are acceptable. Overcrowding and poor ventilation favour the transmission of the disease. The shortage of food makes the detainees weak and more likely to contract the disease. The prison health services, which are generally in a state of neglect and less efficient than those in society, are unable to provide early diagnosis or effective treatment.
The high incidence of tuberculosis in prisons is also due to the specific nature of the prison population. AIDS and tuberculosis are closely related (see the interview with E. Burnier). There also happens to be a very large number of people with the HIV/AIDS virus in prisons and many detainees are users of intravenous drugs, one of the main groups of people at risk of contracting HIV/AIDS; in some countries they constitute the majority of the detainees. Sexual relations between men is another HIV/AIDS risk factor, is also more prevalent in prison than in the rest of society. Finally, it should be stressed that AIDS increases not only the risk of contracting tuberculosis but also that of dying from it.
What effects do these high tuberculosis rates in prison have on the rest of the community?
To succeed in controlling tuberculosis in society, it is vital for the fight against tuberculosis in prison to be included in the programme. In fact, there are a great many possible transmission vectors between prison and the community. It is estimated that worldwide there is an average of between eight and ten million prisoners on any one day. Because of the frequent movement in and out of places of detention, four to six times more people pass through there in the course of a year. Moreover, non-detainees ? particularly those who work there and the detainees? families ? have regular contact with the prison.
These exchanges between prison and the rest of society help to pass on the tuberculosis bacillus, and it is pointless to try to combat the disease without taking account of places of detention.
What can you tell us about resistance to tuberculosis treatment?
Tuberculosis is generally treated with four medicines over a period of between six to nine months. In some cases, resistance to a particular medicine develops, either because treatment has been broken off or is inadequate, or because of direct transmission by someone who has built up a resistance to the disease. The usual treatment is then no longer effective.
Two of the medicines are considered as forming the ?backbone? of the treatment because they kill the bacteria. When resistance to these two medicines occurs, we talk about multi-drug resistant (MDR) tuberculosis. MDR tuberculosis can be treated but treatment is lengthy, complex and costly.
However, what is more disturbing is that since March 2006, the World Health Organization (WHO) has been reporting the first cases of extreme drug resistant (XDR) tuberculosis, which is characterized by resistance to the three main categories of medicines used to treat MDR tuberculosis and is associated with a very high mortality rate.
Read more at:
http://www.icrc.org/web/eng/siteeng0.nsf/htmlall/tuberculosis-interview-240307
An in-depth article: The Crisis of Tuberculosis in Prisons. Sanjay Basu
and C. Brandon Ogbunugafor, Robert James, September 2006. Prison Health Initiative, Yale University School of Medicine.
http://www.zmag.org/content/showarticle.cfm?ItemID=10883
You should read this article; it's quite an eye-opener.
Commentary: More than fifty percent of the population of Kyrgyzstan lives below the poverty line; the public health system and municipal services are in very poor shape. Much like it's ex-Soviet neighbors, the economy has been in a struggling since the 1980s, when much of the Russian-driven industrial boom faded away as money was funneled into the war effort in Afghanistan. One year ago, when the International Red Cross/Red Crescent posted the material quoted above on MDR-TB movement into rural areas and communities near prisons, it was an emerging problem. It's much worse now, and its symptomatic of similar problems in prisons in many other countries, including Russia and the US.
If you look at the demographics of this county,
http://en.wikipedia.org/wiki/Image:Pyramide_Kirghizistan.PNG
...you quickly understand just how vulnerable it is to infectious disease (predominantly TB, hepatitis and GI infections, much of it arising from badly contaminated public and private water supply). The government has no money for vaccines, for medicines, for anything but crude medical treatment, for most of it's citizens.
When pandemic infection comes knocking on the door of Kyrgyzstan, fully one third of the population may perish. We have many other nations on the planet in nearly as dire condition, laid out like a global domino game spanning continents, each block with a population primed for not one, but waves of infectious disease. Places where the TB rate reaches as high as one fifth of the population. Places where coinfection between HIV, MDR-TB, and herpesvirus have drawn life expectancy below that of even the poorest nations, 100 years ago.
One third of the the human population carries either latent or infectious TB bacillus. This is NOT a normal organismal condition for humans. It is a ticking time bomb. You won't understand why, until we open Pandora's Box