Ministry of Public Health states that 90 become ill and 35 die of tuberculosis in Ukraine daily

Vyacheslav Moiseyev is for the third time at the Kyiv’s Tuberculosis Sanatorium No. 1. He says bitterly that the hospital interior is now more familiar to him than that of his own home. It all began so banally. Tuberculosis was diagnosed in Vyacheslav when he was in prison. He suddenly ran a fever, felt weak, and had fits of coughing... He was excused from work for three days and some time later had his lungs X-rayed. He served the rest of his term in a special TB block, and when he was released this tuberculosis clinic became, so to speak, his first port of call.

Places here never stay vacant. The pulmonary department, normally designed for 80 beds, is now crammed with 87 patients. It has become routine practice for the staff to put additional beds in the wards. Meanwhile, there is a list of those who need help in the chief doctor’s room. Only the maternity ward of the city TB clinic is half-empty. Incidentally, this is Ukraine’s only place that delivers women with tuberculosis or infected with Koch’s bacillus. “This congestion is all right,” says chief medical officer Leonid Stadnyk, “for the TB situation in Kyiv is more or less good. While the average incidence in Ukraine is 67 per 100,000 of the population, it is only 37 in the capital. This was achieved by means of preventive measures — they have helped check the incidence rate in the past few years.” Now, every local outpatient clinic identifies for itself the so-called risk group. For example, this group consists of 100,000 people on Kyiv’s Left Bank alone. Among them are, first of all, workers in health-hazard industrial facilities, those who suffer from chronic bronchitis, asthma, and take hormonal medicines. It is far from always possible to make alcoholics, drug addicts, and ex-prisoners have their lungs X-rayed: even though these people present a danger to others, compulsory testing is banned in Ukraine. Simultaneously, US studies show a TB case can infect up to 50 unsuspecting passengers on a five-hour air flight. The afflicted himself may not always easily learn he is infected. For example, who would suppose that coughing, sweating, weakness, and slight fever is not just a common cold but an alarming symptom? The sanatorium staff say they have established cooperation with the police, domicile registration offices, and employment services. For example, migrants without a lung X-ray are denied residence permits in Ukraine, which thereby lowers the risk of TB spreading. There are opposite instances also when a foreign guest comes and asks to be X-rayed, but then the migration authorities say they never heard this name.

Vagrants are a special case. They are brought here from injury-treatment centers or shelters to be checked for tuberculosis: in most cases these suspicions are confirmed. Then the homeless persons are sent to the inpatient ward from which they usually escape. Conversely, some inmates find the sanatorium a paradise. Mr. Stadnyk say many have been living here for as long as three years. Naturally, three free meals a day costing an estimated 7.50 hryvnias — against 2.50 hryvnias at best in other hospitals — is a good deal. Every day the patients are served enough meat, milk, cereals, and sometimes even salads. On the other hand, conditions in the sanatorium are almost nightmarish: fungus-infested and shabby walls, peeling tiles... And no wonder, for this infectious-disease institution has not been renovated for thirty years, and the same X-ray apparatus has been in use for 17 years. Fortunately, there is enough money to supply patients with food and anti-tuberculosis medicines. However, these medicines are no longer effective for 25% of those infected with Koch’s bacillus: the changed bacterial strain has brought about so-called primary stability. Also deficient are remedies against the concurrent diseases which, incidentally, affect practically all the patients, for antibiotics and suppressed immunity cause disorders in the cardiovascular and gastrointestinal systems. We have heard endless promises of additional funding, targeted assistance, and pilot projects, Mr. Stadnyk says bitterly. And where are these mythical millions? What further aggravates the situation is a strange attitude of the authorities toward the TB hospital. They phoned in recently and said they were cutting off its supply of gas for failure to pay nine hryvnias... Yet, the staff continues to work here out of sheer enthusiasm, with a rank-and-file doctor basically earning UAH 150 a month, and risk their lives in the literal sense of the word: 15% of them have already contracted tuberculosis.

INCIDENTALLY

World Tuberculosis Day was observed recently. Ukraine has been experiencing an officially declared epidemic since 1995. Last year TB incidence rose 10.2% over the previous year, while only 33% of the related programs were duly funded. The disease takes an annual toll of 7000-7500 lives, with 14.8% of people dying within less than a year’s stay at the TB sanatorium. Statistics show that patients are mostly represented by ex-convicts (20%), alcoholics (20-50%), migrants (10%), drifters (0.5%), and individuals living in substandard conditions (10-15%).

COMMENT

Mykola PRYZ, deputy chief of the secretariat, Verkhovna Rada Committee on Public Health, Motherhood, and Childcare:

“The relationship between healthy people and a TB patient should be viewed from two angles. If someone does not know he is ill, what can we do? All we can do is encourage proper care for one’s health, regular visits to a doctor, and vaccinations. As to those aware of their plight, the law On Tuberculosis clearly sets out their rights and duties. Patients should stick to the regimen prescribed by the attending physician. If the patient suffers from an acute variety, the lung specialist will naturally prescribe isolation. The law holds one responsible for failure to follow the doctor’s orders. In truth, to be able to apply any sanction, we must first amend the Administrative and Criminal Codes. When the law On Tuberculosis was being passed, this job was given the Cabinet of Ministers. As we see, there are no changes although a year has passed. On the other hand, if we analyze our realities, we will see that most of the TB patients are outcasts and vagrants. By fining them, we will simply be leaving them hungry, literally. Incidentally, for the sake of comparison, Canada even imposes administrative sanctions for refusal to be vaccinated against TB.”