International Committee of the Red Cross 22-03-2010 Feature
In Azerbaijan, tuberculosis remains a serious threat
to public health. The situation is made much worse by a drug-resistant
form of the disease. The ICRC is working with the Azerbaijani government
and other organizations to address the problem.
Teymur is 32 and the first ex-detainee to have
successfully completed a new follow-up programme for released prisoners
run by Azerbaijani officials and supported by the ICRC.
Teymur Huseynov, 32, learned that he had tuberculosis
when he was in prison in 2000. What he thought was a simple fever got
gradually worse. "I was coughing day and night and couldn’t sleep. I
lost 20 kilos in six months. But it was only when I started coughing up
blood that I sought medical help."
Teymur received treatment and was later discharged. But his symptoms
returned in 2005. Still in jail, he was sent to the prison tuberculosis
(TB) hospital, the Specialized Treatment Institution, for screening and
treatment. Test results revealed that he had tuberculosis.
Joining forces to fight tuberculosis
In Azerbaijan, where tuberculosis continues to pose a serious threat to
public health, a drug-resistant form of the disease (MDR-TB) has been
identified as a major health problem. The government, supported by the
ICRC and other organizations, has taken steps to curb the spread of
MDR-TB in the country.
Since 1995 the Azerbaijani prison authorities, assisted by the ICRC,
have been carrying out an anti-TB programme in prisons. The programme is
based on the Directly Observed Treatment Short Course (DOTS) strategy
recommended by the World Health Organization (WHO).
In 2004 the ICRC helped the authorities to submit, to the Global Fund to
fight TB, AIDS and Malaria, an application to launch in Azerbaijani
prisons a pilot project based on the WHO strategy called "DOTS-Plus".
The application was approved. The ICRC provides technical assistance for
the implementation of the programme, whose goal is to treat detainees
with MDR-TB, a specific form of TB caused by a bacillus resistant to at
least two of the most powerful anti-TB drugs.
"Entirely man-made, drug-resistant strains of TB represent a significant
threat to the management of the disease. DOTS is the most effective
strategy in preventing the development of MDR-TB," says Nickoloz
Sadradze, head of ICRC's programme of support to the anti-TB strategy in
the prisons.
"It was very difficult to be sick
in prison,” says Teymur. "I had no family around and every day I thought
I was going to die, but then I started treatment. The medication made
me quite sick but the doctors convinced me to stick with it and I’m glad
I did because now I’m cured.”
"It was very difficult to be sick in prison,”
says Teymur. "I had no family around and every day I thought I was going
to die, but then I started treatment. The medication made me quite sick
but the doctors convinced me to stick with it and I’m glad I did
because now I’m cured.”
He adds, "Prisons are not entirely cut off from the civilian
population, and when detainees go back and forth between prisons and the
outside world they bring all their infectious diseases with them,
including TB strains. As such it is vital to include prisoners in
efforts to control the spread of MDR-TB”
Thanks to the anti-TB programme, today all prisoners in Azerbaijan have
access to high quality modern diagnosis and TB treatment,
free-of-charge. As of December, 2009, the DOTS strategy had been used as
a basis for over 10,000 TB-treatments administered to detainees
infected with tuberculosis.
Teymur’s story
A beneficiary of the anti-TB programme, Teymur was put on the DOTS
treatment in August 2005 for a nine-month period. Every morning he would
go to the nurses' room and take his pills in front of his nurse.
However, six to seven months later, his health no showed improvement.
After nine months of treatment, he was still infected with the TB
bacilli and his health was worsening by the day.
"I was coughing constantly. I lost weight drastically and was too weak
to walk. I had to stop every two steps to take a breath. I was told that
my treatment had not helped and I became worse," – Teymur recalls.
He was tested for drug sensitivity. The results showed that he was
resistant to four out of five anti-TB drugs. He had contracted a
multi-drug-resistant form of the disease.
His doctor stopped the treatment because first-line drugs for TB were
ineffective in treating him. He needed second-line drugs to treat
MDR-TB. He was put in a special ward for TB-resistant patients, to await
the launch of the DOTS-Plus programme in prisons.
"In 2007, my health was really very bad. My life was slipping away. But I
heard about a new treatment programme and pinned my hopes for recovery
on it," Teymur says.
Wardens check on the prisoners who are serving
life sentences and suffering from TB. Each detainee is allowed to spend
two hours per day outside their cell in a cage-like courtyard.
In April 2007, Azerbaijan's Ministry of Justice, with the technical
support of the ICRC, started implementing the pilot DOTS-Plus programme
for the treatment of patients suffering from drug-resistant
tuberculosis. So far, over 220 patients have enrolled in the MDR-TB
project.
An MDR-TB treatment takes at least two years and this could have
jeopardized Teymur's chances of joining the programme as he had less
than two years to go in his prison term.. Doctors agreed to enrol him
for the treatment only after he promised to continue with it after his
release. He just told them, "I want to live."
Teymur was put on a course of treatment with second line anti-TB drugs.
"From the first week of treatment I felt an improvement. I had no more
symptoms of TB, no coughing. I became cheerful and felt a surge of
energy. I was even able to run, whereas in the past I could hardly
walk," he recalls.
After one month and a half though, he felt pains in his arms, shoulders
and joints. It was a reaction to the strong drugs. He continued with
his treatment.
In March 2009, Teymur was pardoned by the country’s president, but he
had not yet completed his treatment.
Released but not abandoned
In order to address all aspects of the MDR-TB problem, the ministries of
justice and health and the ICRC signed a memorandum of understanding in
March 2007 to provide MDR-TB patients released from prison with the
necessary treatment in civilian anti-TB dispensaries. As soon as a
person is released, the justice ministry delivers the necessary quantity
of medicines to the health ministry to ensure he continues with his
treatment.
The ICRC covers transport expenses of patients, released from prison,
and provides them with a food ration and hygiene every month. At the
same time, the ICRC provides financial incentives to the doctors in
charge of the patients and even rewards the patients for a successful
completion of the treatment.
Thanks to support from the ICRC over the past 15
years, the diagnostics capacity of the prison lab in Baku has increased
dramatically, helping to save lives.
Representatives of the national TB programme and the ICRC jointly
visit the patients every month to monitor their recovery.
As of December 2009, 15 MDR-TB patients who had been released from
prison were continuing with their treatment in civilian TB dispensaries.
Living proof
An ambulance brought Teymur Huseynov from the Specialized Treatment
Institution to the TB dispensary in his native city, Sumgait. Here the
National TB programme and the ICRC followed up his treatment. Every day
Teymur visited the civilian TB dispensary to take pills and after four
months he was eventually cured of TB.
Today, Teymur is more optimistic. "I was very happy when I finally
tested negative for tuberculosis. Today the days of persistent coughing
are well and truly behind me. I am living proof that TB patients who
respect their treatment regimes and are careful about what they eat can
be cured. It is tough but necessary for those who want to stay alive."
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