20 years under Putin: a timeline

"The real TB numbers are practically a state secret"

OK: After Uzbekistan, you went to Ukraine and Russia. What differences did you observe between these countries?

MF: The biggest difference is that in Russia and Ukraine, TB is most often related to HIV. This is a huge problem. HIV weakens the immune system and causes patients to be more susceptible to TB, which often ends up fatal. In hospitals, it is common for staff to report the cause of death as HIV when in reality it's tuberculosis.


© Misha Friedman


OK: Why do they do that?

MF: To lower the tuberculosis statistics.

OK: What are they trying to accomplish?

MF: The real TB numbers are practically a state secret. Both in Ukraine and in Russia. This is because the governments are attempting to conceal the fact it’s basically an epidemic.

OK: What are there real numbers?

MF: We have the WHO data. For example, last year in Russia, there were 190,000 new cases of tuberculosis and 26,000 fatalities from the disease. The number of new HIV cases was about 50,000, and over 76,000 people died from the disease. We must keep in mind that these are just the reported cases. As any epidemiologist will tell you, the real numbers, at least for HIV, are probably 3-4 times higher than that.

OK: Why are the numbers so high?

MF: As far as I understand, the biggest problem today is drug-resistant tuberculosis (DRT), when patients develop resistances to the drugs used to treat them. About 15-20% of all new cases of tuberculosis are DRT. According to a number of specialists within the CIS, doctors have started treating DRT over the past several years, but they do it so poorly, they end up harming their patients. Especially in prisons and outside of the major cities.

OK: What are these doctors doing wrong?

MF: The laboratory plays an important role in DRT treatment. It’s the lab tests that reveal the specific resistance that a patient has. In Russia, there are hardly any high-quality certified laboratories. In addition to this, treatment is effective only if all necessary drugs are available at the hospital. This is rarely the case. A patient might need four different drugs, but only three of them will be in the pharmacy. The doctor should not start the treatment until all of them are available. But they do it anyway. As a result, not only are these three drugs not working, but the patient develops additional resistances. Recently, I talked to a doctor in Togliatti. She confirmed that this was a common practice, but one she engaged in when she knew that she would never get the missing drug.

OK: What should a doctor do when this happens? Not treat the TB at all?

MF: I’m not here to argue with the doctors, but this approach is alarming. There is a high risk that the patient will not only not get better, but also develop additional resistances and, as a result, die.

OK: And what is the solution, then?

MF: This problem requires a holistic approach. Tuberculosis treatment is the most underpaid area of medicine. When doctors specialize in oncology or emergency surgery, they get patients from a range of economic backgrounds. In Russia, oncologists or surgeons can survive off of their wealthy patients. Tuberculosis on the other hand is a disease of the impoverished, and thus, the doctors are underpaid. Even HIV departments are better off due to the active support of the gay community. Tuberculosis, on the other hand, mainly afflicts the poor, and thus, the doctors are underpaid.

OK: Aren’t there organizations that support them?

MF: There are, but only a small handful. And none of them specialize in tuberculosis. Tuberculosis can’t be eradicated with activism alone.