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MSF in Kyrgyzstan, 2011
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The underfunding of prisons in Kyrgyzstan is affecting medical services: many prisoners with tuberculosis (TB) are not receiving the care they need. The incidence of TB among prisoners in Kyrgyzstan is estimated to be 20 to 30 times higher than among the general population, and mortality rates can be 60 times higher. Poor conditions make inmates more susceptible to the disease and encourage its spread.
Working in collaboration with the Ministry of Health and prison authorities, Doctors Without Borders/Médecins Sans Frontières (MSF) began providing TB care in detention centers in 2006. Teams work in two centers (Sizo 1 and Colony 31) near the capital Bishkek, and treated 370 patients in 2011. They also worked to improve infection control standards and living conditions, and renovated the TB wards.
Multidrug-resistant TB (MDR-TB)
In one detention facility, MSF installed a new machine that tests for TB, which facilitates better and more rapid detection of drug-resistant TB, and enables patients to start treatment earlier. MDR-TB is either transmitted directly from another person with the disease, or develops when a patient with drug-sensitive TB, either through mismanagement or misuse of medication, becomes resistant to at least two of the standard TB drugs. Treatment for MDR-TB is much harsher than for TB: it takes up to two years and causes severe side effects.
Kyrgyzstan is one of 27 countries listed by the WHO as having a high level of MDR-TB. MDR-TB is even more prevalent in prisons because close proximity makes it difficult to implement infection control measures, and because high-risk behavior such as drug or alcohol addiction is more common among prisoners, making adherence to medical treatment more difficult. As a result, around two-thirds of TB patients in Kyrgyzstan’s prisons have drug-resistant forms of the disease.
MSF has set up a support system for patients who are released before finishing their treatment for TB or MDR-TB, to help them keep taking their medication. Volunteers living close to the patients visit them regularly and offer support until the treatment program is successfully completed. A hotline is also available, so that patients can call if they need help. Between January and October, a network of 20 volunteers helped 192 TB and MDR-TB patients to complete their treatment.
After the 2010 riots
Political unrest and interethnic violence in 2010 aggravated conditions of poverty for many people in Kyrgyzstan. During the unrest, MSF donated drugs and medical supplies, and facilitated access to health services for those who were afraid to travel to health centers.
Between December 2010 and April 2011, teams continued to offer assistance to people in Osh, the second-largest city in the country. Staff held more than 1,000 medical consultations, some 1,800 mental health consultations, and distributed 5,900 washing kits, 11,900 blankets and 800 cooking kits. In July, the team started to develop a new TB programme in Kara Suu district, Osh province.
At the end of 2011, MSF had 94 staff in Kyrgyzstan. MSF has been working in the country since 2005.