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MSF in Kyrgyzstan, 2009
Field Staff: 52
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MSF has been running a tuberculosis (TB) treatment project in Kyrgyzstan’s prisons since 2006. The prevalence of this infectious disease is still 20 to 30 times higher in prisons than it is in the general population: 500 new cases of TB are registered each year despite recent prison reforms. Around two-thirds of those infected have drug-resistant forms of the disease (DR-TB) that require a particularly long and difficult treatment program. In recent years, MSF teams have put greater emphasis on ensuring that ex-prisoners are able to continue their treatment correctly after release.
MSF works with the Ministry of Health, the prison authorities and international organizations including the International Committee of the Red Cross to support the treatment of TB in prisons. In 2009 teams treated more than 400 prisoners for TB including 92 patients for the drug resistant form. MSF teams organized training sessions and supplied drugs, constructed laboratories and refurbished the prisons’ hospitals and the patients’ living quarters.
With TB, one of the challenges is maintaining continuity of treatment, because if treatment is interrupted, there is a risk that drug-resistance could develop. In Kyrgyzstan, one out of three prisoners with TB is released before treatment is complete. Outside the prison system, former inmates often struggle for the bare necessities of life, and so do not see the continuation of their medication as their highest priority. Furthermore they may not have the money to reach the nearest TB facility.
In 2007 MSF opened a ‘social support’ office in the south of the country to help ex-prisoners. In 2009, social workers and a network of volunteers supported around 100 former inmates to continue their TB treatment, through counseling, provision of food parcels and transport money.
To highlight the poor living conditions of prisoners and fight against the disease, MSF organized a photography exhibition in the capital Bishkek to raise awareness about the issue and reduce the stigma surrounding it.
An important step in the fight against TB in Kyrgyzstan was made as the country’s application to the Global Fund’s Round 9 of financing was approved in 2009. It included funding for medication for multi-drug resistant forms of TB (MDR-TB) and for systems to be set in place to ensure that former prisoners can adhere to their treatment after their release. However, this financial aid was put on hold because of an audit investigation, and now an adequate supply of drugs is jeopardized because of a lack of funding.
Ruslan, an ex-prisoner who suffered DR-TB
‘It was like a nightmare; you can’t imagine how difficult it was to take those drugs. You want to sleep but you can’t, you feel dizzy, you feel nauseous ... you vomit, but you don’t feel any better. I took the drugs even though I felt awful, but my former cell-mate couldn’t keep going: for him the side-effects were too much. I was released in May 2008, right in the middle of my treatment. While I was in prison, the social workers explained to me how I could continue treatment in the civilian sector. But when I got to the hospital, the doctors looked at me with suspicion. “Ex- prisoner ... drug dealer” they said. But after a while, because of my good behavior, their attitude towards me changed.’
MSF has worked in Kyrgyzstan since 2005.