In Azerbaijan, a jail term for a petty crime can
turn into a death sentence if a prisoner catches tuberculosis from
fellow detainees. The ICRC's Anna Nelson and renowned Afghan/Swiss
photographer, Zalmaï, went behind bars in Baku to discover what's being
done to help tuberculosis-infected inmates.
Salman (left) and Ilham, who both have
contagious, drug-resistant TB, stand in the yard that separates them
from other prisoners, who are responding better to treatment.
On the outskirts of Azerbaijan’s capital, Baku, not far from the
city’s rich petroleum fields, the authorities are racing against time to
stop a silent killer.
For the past 15 years, the country’s prison officials have been working
to stem the spread of tuberculosis (TB)– a deadly disease that infects
roughly 9.5 million people worldwide each year. Globally, around 4,500
people die from it on a daily basis – that’s about one person every 20
seconds.
"A man can kill another man with his bare hands… but he can kill
hundreds of people with TB,” says Nahmat Rahmanov, the lead physician at
Baku’s Special Treatment Institution (STI), which houses around 1,000
infected inmates from across Azerbaijan’s penal colonies.
Rahmanov isn’t exaggerating. Drug-resistant forms of the airborne
illness are spreading at an alarming rate across the globe. To catch any
form of the disease – drug resistant or not – all you have to do is
breathe in the presence of someone who is actively infected with it.
Contrary to what a lot of people might think, childhood vaccines don’t
protect adults against TB.
Rampant disease
At first glance, STI looks much like any other prison – high walls
topped by curls of barbed wire, armed guards in watchtowers and heavy
iron gates separate the thieves, swindlers, drug dealers, murderers and
other assorted criminals from the outside world. But once inside, the
facility feels distinctly more like a hospital than a jail.
The years following the collapse of the Soviet Union saw a sharp
increase in the spread of infectious diseases. When the ICRC started
visiting Azerbaijan’s prisons in 1995, delegates discovered that TB was
the main cause of death among inmates.
Since then, the authorities and the ICRC have slowly but surely managed
to drastically reduce the number of TB cases in detention centres by
improving screening, prevention, treatment and follow-up.
The former summer home of the Nobel Brothers in
Baku is now a rundown treatment facility for TB patients, including
ex-detainees. Located near the Caspian Sea, it’s believed that the fresh
air is therapeutic for the patients.
"In 1999, we had 285 prisoners die from TB. By 2009, we managed to
get the number of deaths down to 20,” says STI Director, Nizami Guliyev,
an austere-looking man, who is visibly very proud of his sprawling
facility.
He shows off the elaborate ventilation system that has been put in place
to provide a maximum of fresh air in the cells and communal sleeping
areas – typically a breeding ground for TB. Posters on the wall explain
through drawings that the disease thrives in dark, confined spaces. In a
new wing, modern surgical equipment will soon be installed, while the
prison already boasts an on-site diagnostics laboratory and pharmacy.
Human dignity
Talking to the inmates – from the petty criminals to those serving life
sentences –
one thing becomes clear: beyond the tablets, x-rays and white coats,
what really makes a difference to their recovery is the fact that they
are treated with dignity and consideration.
Over the years, the wardens have learned that a healthy environment can
have a big impact on a patient’s adherence to treatment and its outcome.
"The main goal of the Ministry of Justice is to cure these patients and
we do everything we can to provide them with treatment and good living
conditions so they can go back to society healthy and not infect others.
We want them to become citizens who can contribute to society,”
explains one prison guard.
At STI, the cells and communal rooms are bright and clean, relatives are
allowed to bring food for their incarcerated loved ones and there is
even a small library, where books are meticulously divvied up into
sections for highly and less contagious readers. Telephone booths
labeled as "positive” and "negative” indicate which phones infectious or
non-infectious detainees can use to call home.
Life on the inside essentially revolves around TB and that suits
prisoners like Salman and Ilham just fine. The pair shares a room on the
severely contagious ward, which is walled off from other sections of
the prison.
"I’m feeling much, much better. Here, we get everything we need. There
is food, heating and decent bathrooms. I can take a shower whenever I
want to. It’s quiet and comfortable,” says Salman.
Their days are spent playing backgammon, tending a small but flourishing
collection of spider plants, watching TV, doing laundry and waiting in
line to take their medicine under the watchful eye of a prison doctor.
Ilgar (left) and Iramal met in the prison
hospital and have remained close friends since being released in 2009.
Both continue to need treatment for multi-drug resistant TB and lean on
each other for support.
Salman has been suffering from TB more than six years. He's already
been treated twice for drug-sensitive TB and is now undergoing treatment
for the multi-drug resistant kind, known as MDR-TB. The medication can
have severe side effects, including liver failure and extreme nausea.
Patients need to stay on it for around two years and it can take more
than two months just to find the right combination of medicine for each
individual.
"Each of us knows what the other is going through, which helps a lot. We
keep each other going,” says Salman of his roommate.
Dilapidated dacha
Not far from the well-appointed prison hospital, closer to the Caspian
Sea, lies the former summer dacha of the Nobel brothers, who got rich
off the country’s oil derricks back in the 1870s.
Today, it is home to a radically different set of "brothers” – Iramal
and Ilgar, who met as prisoners at the TB treatment centre and, like
Salman and Ilham, have formed a close bond. They were transferred to the
dilapidated dispensary after being released in 2009. It is the only
care facility in the country that is willing to take ex-convicts.
"We make sure they get three meals a day and regular checks by the
doctors. The medical staff ensures they don’t skip their medicine,” says
the director of the facility, Ismayilov Habil. "Last month, three
patients died. They had no family, so I used my own money to bury them
in a nearby cemetery. My philosophy is that everyone deserves to be
treated with compassion, so I do what I can.”
The ICRC provides food and hygiene items for the former detainees and
collects their blood and sputum samples for regular analysis. The
organization also offers a modest financial incentive to the nurses, who
are responsible for directly observing patients' treatment.
No doubt the Nobel brothers would scarcely recognize their country home
if they were alive today. Hollow-cheeked patients sleep five or six to a
room and there is little to do while waiting to get better but nap on
metal cots and watch an endless stream of grainy images on the small
black and white TV. Ilgar and Iramal may no longer be behind bars, but
in many ways, they are still imprisoned by their disease.
Ilgar, a repeat narcotics offender, suspects he caught TB during his
first stint in jail back in 2001. He recently completed another 18-month
sentence for drug use and now has nowhere else to go.
"I am alone in this world and homeless,” he says in a hushed, breathy
voice. "I don’t know what I would do if this place didn’t exist. No one
has ever come to see me but luckily, I have Iramal. We lived through
some very hard days together in prison. We will never forget those days
and we will remain friends all our lives.”
Uncertain future
Unfortunately for Iramal, the future remains very uncertain. At 28, he’s
been on MDR-TB medication for more than two and a half years. He has
tried a host of treatments and still there’s a chance he won’t live to
see 30.
He was put behind bars for hooliganism and is now fighting off a virtual
death sentence because of TB.
"I stopped drinking and doing drugs and I’ve started praying,” says
Iramal, whose striking, blue-green eyes match the peeling paint on the
walls. "I haven’t seen my family since I got out of prison because I
don’t want to risk infecting them. All I want is to get better and turn
my life around.”
He and Ilgar tuck their hands inside their sleeves as they step outside
for a breath of air. The two "brothers” bend their arms across their
chests and bow their heads against the bitter, salty wind.
No one can predict how their journey will end or whether they will live
long enough to see their friendship last. For now, they are living,
powerful reminders of the importance of stopping TB from destroying even
more lives, both inside prisons and out.
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