"They treat them like living corpses"

OK: Which hospital or clinic made the worst impression on you?

MF: The Botkin Hospital for Infectious Diseases in St. Petersburg. It was even worse than the tuberculosis clinic in Togliatti. In St. Petersburg, I was given access to the HIV-TB ward. This is where they treat patients that will not be admitted to the tuberculosis unit. All of them are connected with HIV and TB. Many are former drug addicts. They are difficult patients who constantly disrupt their own treatment. Nobody wants to deal with them.

 

© Misha Friedman

 

At Botkin Hospital, there were 53 patients in the unit, although the official maximum capacity is 40. What really set them them apart from TB patients in the Caucasus, Ukraine, Uzbekistan and even Togliatti was their age. They were all between 25 and 30. It was frightening. There is a stereotype in Russia that a TB patient is an elderly ex-convict, but I saw firsthand that this isn’t true. Moreover, almost one-third of all TB patients are women.

OK: Did you talk to them?

MF: Yes.

GO: What do they say? What do they think about their lives?

MF: They were very aware of what was happening to them: they were dying. They understood that the hospital was their last hope. Once they got into this unit, it was likely to be the end for them. Very few of them had visitors. The general attitude of the medical staff was not encouraging. Across the board, the lack of psychosocial support for TB patients is a common problem in the CIS countries.

GO: What kind of psychological support would the patients benefit from?

MF: It is extremely hard to take medicine every day, especially toxic medicine. If, for example, a person is released from prison, he or she is most likely to have tuberculosis, along with many other diseases, and is simply unable to comply with treatment. Therefore, it is crucial that these patients have a professional they can talk to, and receive the psychological support that they need. Tuberculosis is curable, it can be dealt with, but many TB patients die from it simply because they give up. They end up in hospitals that have not been renovated for decades where they are treated like living corpses because no one cares about them. Many of them also need help restoring the documents necessary for applying for  additional benefits or certain kinds of medications. It is essential to establish a relationship between the penal and medical systems so that sick people released from prison are directed toward the proper medical care. Today, this doesn’t happen because there are no established networks facilitating communication between institutions. Social workers are the missing link. When treating TB, the psychologist is just as important as the doctor, nurse, and lab technician. No such positions are provided for by the Russian Ministry of Health, despite the fact according to experience across the international community,  TB treatment is not effective without psychosocial support.

OK: Why do you think the Russian Ministry of Health ignores these international practices?

MF: It is their position; no matter what is going on in the world, they want to do it their own way — they think they're special. Even in Ukraine, the government has a more progressive approach in terms of their legislation, including their drug policy. They listen to the recommendations of the WHO and the UN. In Russia, the government sees these recommendations as the machinations of the enemy.

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