20 years under Putin: a timeline

"Everything depends on political will"

OK: What needs to change in order to improve the tuberculosis situation?

MF: Everything depends on the political will of the country. Russia needs to start listening closely to what the international community says, because at this point, they are trying to reinvent the wheel. All that I see in Russia today are political games with the drug policy and substitution therapy. In hospitals, the sicker a patient is, the worse the conditions of his ward and the quality of his treatment, and the more he is ignored. This is especially true in tuberculosis units, which have a set budget. In theory, the opposite should be the case.


© Misha Friedman


The government must establish a systematic approach to treating tuberculosis. And it’s not just about drugs: there has to be infection control, and properly administrated laboratory and psychosocial services. Personnel is another serious issue. Today it is impossible to motivate young doctors and nurses to work at tuberculosis clinics, where they will find low wages, receive no benefits, and be obligated to work with very difficult patients. Where’s the incentive to do that? There is none.

The average age of a TB clinic employee is about 50. It’s nearly impossible to interest somebody approaching retirement age in new developments in treatment. The government needs to motivate medical students to pursue specialization in this field by offering higher salaries. It is a common practice in the rest of the world.

OK: Last year the Global Fund for AIDS, Tuberculosis and Malaria withdrew from Russia. In your opinion, why did this happen at a time when the TB situation in the country has clearly deteriorated?

MF: As far as I understand, it was politically motivated. The Fund officials said that since Russia is a G-20 member, which means that it is not a poor country, it should be able to tackle the problems of TB and HIV on its own. The Russian government then made a large contribution to the Fund, and according to Fund regulations, a donor country can’t also receive financial support. The Fund accepted this money and shut down the grant program for Russia. As a result, hundreds of small NGOs lost their source of financing. Of course, some of these programs will receive money from the Russian government, but they will all be the ‘safe’ ones that do not provoke public debate and are generally in line with the Ministry of Health’s political agenda. For example, organizations advocating for anonymous HIV testing in hospitals. This is something the Ministry is capable of supporting, whereas they would never help fund social work. And if there is no dialogue, if there is no intermediary between TB patients and hospitals, treatment simply won’t happen.

OK: It looks like the Global Fund is not returning to Russia any time soon. Are there other ways to support these programs and to keep psychological care alive?

MF: I believe that NGOs should have an easier time soliciting charitable donations from the Russian business community. Or, for example, that other international organizations should be allowed to run projects similar to what the Global Fund financed. Finally, international and Russian charities should start working directly with local NGOs, which was the case before 2004 when the Global Fund took over.

OK: Do you think that your work as a photographer could make a difference?

MF: A picture does not change anything. It needs to have an agenda. In fact, it’s easier to take pictures with an agenda. Tuberculosis is a very important problem. I would want the people who influence public policy to see my work. That is the driving force behind this project.