LEAD IN
Two years ago the World Health Organisation declared a regional emergency in Europe as the rates of tuberculosis reached epidemic proportions. And Countries across the region signed a pledge to reduce those numbers. One of those signatories was the Russian Federation.
But now they are facing a crisis with the most virulent form of the disease - drug resistant TB. They call it MDR and XDR. They have the highest levels in Europe and the third highest in the world. Yet they have just thrown out of the country one of the biggest funders of TB programmes - because they were American. And they have told the Global Fund for HIV/TB and Malaria that they do not want their money anymore either.
The results has been the closure of numerous and vital TB projects.
Our health and social care correspondent Victoria Macdonald has been to Siberia to see which projects are the winners and losers in Putin's Russia.
30km outside the Siberian city of Tomsk. Every day - twice a day - a nurse makes the journey to find patients with tuberculosis.
The first on the list - 59-year-old Nadezhda - is being treated for a virulent form of the disease. Mdr - multi drug resistant
tb. It Doesn't respond to the two most common tb drugs -
instead it will take 20 months, 20 pills a
day and injections to cure it.
Sot outsid. How are you feeling. VM: How are you feeling?
Nadezhda told us her legs were hurting and she had high blood pressure.
Where had she contracted the disease? She siad she used to be a nurse in a TB hospital
300 Russians a day are now being diagnosed with tuberculosis - and those are only the ones who are found. The figures is likely to be far higher.
Then it was on to the next patient - another half hour drive away on the dirt road. 39 year old Zemphira who has had to endure not just the treatment but the social stigma this disease carries with it.
sot: husband ... All the neighbours started making a fuss. It was unbearable.
SOT. Zemphira Mavlukayeva: They said I have an open form of TB and I’m infecting everyone. My son was banned from talking to them.
Tuberculosis is a bacteria spread by coughing, sneezing or spitting
It is debilitating and it can kill.
The Rates of the most common form of TB are falling in Russia.
But MDR and XDR - that stands for
extensively drug resistant. are on the rise.
The country now has the highest levels in Europe and the third highest in the world.
This is an epidemic. Often driven by poverty, alcohol, drugs and increasingly HIV.
sot Dr Sergei Michustin..head of TB Tomsk region... 60% impoverished, 40% invalids. Up to 60% alcohol, up to 20% drug users. 90% smoke a lot, so bad lung problems, which also has an effect on the tb.
So in Tomsk - they have been conducting an experiment. throwing millions of dollars of international aid money at the problem.
They call it The Sputnik programme - after the famous Russian satellite. They circle the streets and villages looking for TB patients who are refusing their treament.
And they lure them into clinics and given food parcels -tinned beef, vegetables and jam as an incentive to take their pills. The rates of TB in Tomsk are now half the national average.
sot...patient...We get given the medicines and these rations every day. she told us
It helps a lot to get something to eat.
And again with the help that international funding - the Tomsk project includes its local prison
PTC. What is fuelling the epidemic in Russia is its prisons- in fact one recent report says they have the highest rate of antibiotic resistant TB in the world. so here in Tomsk - this is how they have dealt with it. All prisoners from around the region with TB have been put into that one building. It is effectively a TB prison.
Of the 700 inmates when we arrived - 500 of them have TB or have been successfully treated.
sot Alexandre Leshchev... If he’s not cured he’ll come out into society sooner or later and will infect masses of people – children and all around. And there will be ever more TB, people will be ill and die, as will children.
Attention, the sign says - tuberculosis - heightened danger zone. We were not allowed to go further but
Behind the windows we could see the prisoners with MDR who are still contagious. Thye are Confined for months on end.
They are proud of their facilities - they are certainly better than in most russian prisons
(Shot of me inside talking to camera)
There problem of course is that there are forms of this TB that are so contagious, we can't go in without being completely covered.
MDR and XDR are on the rise - they showed us the figures collected in laboratories - high tech - by Russian standards - with equipment donated from abroad.
Detecting the strain of tb is crucial so prisoners can be started on the correct medication immediately.
ANd even when they are allowed out of the locked wards and back into the open part of the prison they still have to
take their drugs under the watchful eye of a nurse
We were introduced to Ivan - a 28 year old who is being treated for MDR -TB - he almost certainly contracted it in the first prison he was sent to - so he was moved here.
sot VM How do you know you didn't have it before you went to prison?
Ivan... 0042: When you enter the institution you give tests, and I was told that I was healthy. Over the course of the three years I was in prison, I caught TB in the previous prison I was in.
The hope was always that this Tomsk model would be rolled out across Russia.
But now the Federal Govt has taken a decision that has astounded international observers.
It has kicked out USAID - the largest funder of TB programmes - including the Tomsk project
and it has refused help from the Global Fund.
It says it will now pay for Tomsk but dozens of other tb programmes have closed
.
sot OKsana...
Why do you think USAID funding qwas stopped?
0009 OP: For Russia? Because of political reasons, I think that USAID provided financial support for many political organisations - NGOs - and for mass media. I think that is the main reason
And that was what we found as we travelled through Siberia.
In March a USAID funded programme for TB was closed in the city of Omsk. It had cared for nearly 300 patients - more than 10 per cent of them with MDR.
Nothing has replaced it.
sot Svetlana Bondarenko..Sibalt project...It was very sad that because of political events on a national scale, ordinary people were deprived of the help that they could have continued to receive for another two years.
In this grim local hospital, they took us to see Valentina who was being treated for a broken leg that won't heal - partly because of the TB
sot Valentina The state didn't give us any compensation or anything... It helped also because when people went to get medicine they were given food parcels - so it gave them an incentive.
The Russian Government insists it is capable of funding TB programmes. It says it does not need international money because it is now a donor itself.
But few are convinced. HIV funds regularly go missing and TB drugs have failed to materialise in the past.
sot Michel Kazatchkine...USAID, that was a powerful bilateral support to TB programmes in Russia at the same time the change in the system from immediate post SovietTB system to a modern TB system is is occuring at an extremely slow pace.
And yet there is a new urgency - TB rates - including MDR - are rising amongst children.
PTC. If anything serves to underline the size and the seriousness of the problem in Russia, it's encapsulated here in this building. A 400 bed TB hospital in the suburbs of Moscow. It's almost always full anda quarter of the patients being are children.
Whatsmore, they are in increasing numbers being admitted with drug resistant TB. Their treatment can last for months and it is harsh.
but there is no choice.
SOT Irina Vasileva
We have a problem of MDR TB in Russia, so children most often are infected straight away with drug resistant forms - MDR or XDR
If there is someone in the family with this strand everyone will become infected - first of all the chidlren
sot: How difficult is it to treat children
Irina
it's difficult if they have drug resistant form. there are also difficulties with children because they find toxic drugsd harder to cope with than adults, and lots of druigs aren't recommended for children.
20,000 russians a year die from TB.
But tuberculosis is not kept within the confines of hospitals or prisons or contained by borders.
WHich means it is not just a problem for Russia
Its destination could be anywhere else in the world.