Drug-resistant form of TB spreading to remote Kyrgyz villages

By Bakyt Ibraimov
For CentralAsiaOnline.com
2010-03-09

Dr. Tursun Zhusupbaeva examines a patient with multi-drug resistant tuberculosis at a new Osh TB clinic. The 50-bed facility will help improve the treatment of patients in the Osh area. [Bakyt Ibraimov]

OSH, Kyrgyzstan – A new 50-bed unit has opened in the Osh Oblast Anti-TB Centre to treat patients suffering from multidrug-resistant tuberculosis. It is the only hospital in southern Kyrgyzstan that treats the disease.

The facility is treating 220 patients, including some from neighbouring regions. According to construction and repair co-ordinator Angelina Adler, re-equipping its laboratory cost the centre KGS 900,000 (US $20,134).

“With power supply disruptions being fairly frequent in southern Kyrgyzstan, it is essential that electricity and water supplies to our laboratory remain uninterrupted”, senior nurse Gulnara Sagynbayeva said. “That will enable us to identify TB cases in good time and to scan the test samples we receive from various districts with a high TB incidence”.

But one TB specialist, speaking on condition of anonymity, said the centre’s per capita spending on food (KGS 87.5/US $1.95 per day) and drugs (KGS 52/US $1.16 per day) is insufficient to meet demand.

“The patients need to be given anti-TB drugs in concert with medicines to treat accompanying illnesses; we also must be sure that the (multidrug-resistant) TB patients, especially those who are in prison, are fed well”, he said.

Matkasym Isakulov, 42, from a remote village in Alai District, Osh Oblast, is one of the centre’s patients.

“A year ago I was released from detention and stopped taking medicines because I couldn’t afford them”, Isakulov said. “When I turned for assistance to the hospital in the district centre of Gulcha, they gave me some pills that somehow did not help”.

Isakulov’s condition worsened and local TB specialists directed him to Osh for treatment. Doctors there diagnosed him as having a resistant strain of TB.

“With the newly renovated laboratory in operation, the scanning of TB tests has become more efficient, and diagnostics and treatment are now available to more (multidrug-resistant) TB patients”, said Galina Likhoded, deputy director of the Anti-TB Centre in Osh.

She said test samples come to her laboratory from all TB clinics across southern Kyrgyzstan, because they lack the ability to identify the resistant strain of TB. Likhoded said the resistant strain of TB is very difficult to treat and carries the risk of incurability.

Isakulov is now sorry he did not immediately consult doctors. “I’m afraid I may have infected my family – my wife and three kids”, he said. “I went to the district centre only because of a very bad cough and blood-spitting. Now my relatives need to be examined for potential infection, too, or I will never forgive myself“.

“(Multidrug-resistant) TB patients are compelled to take six or seven pills as a one-time dose and to continue that course of treatment for a long time“, Gegam Petrosyan, the medical delegate to the International Red Cross mission in Kyrgyzstan, told Central Asia Online.

According to Avtandil Alisherov, director of the National Phthisiology Centre, the most common treatment for resistant TB is ofloxacin. A bottle of that costs KGS 300 (US $6.69) for a two-year treatment for one patient. Other medicines cost a total of US $9,000-$13,000 per year and are co-financed by The Global Fund to Fight AIDS, Tuberculosis and Malaria and other international organisations.

Petrosyan said the Red Cross is concerned that many discharged prisoners return to ordinary life without completing treatment.

“Therefore, we think it is important to strengthen ties between the penal system and the Kyrgyz Health Ministry’s National TB Programme, which has already resulted in the renovation of the Osh laboratory”, he said. Of the 7,500 prisoners in Kyrgyzstan, about 350 (5%) are prone to TB infection.

“Today, we are dealing with 11 TB cases, including one (multidrug-resistant) TB patient”, Darygul Israilova, a physician with Pre-Trial Detention Facility No. 5, told Central Asia Online. “They are provided with highly nutritious food, including meat, eggs, milk and sugar”.

According to her, the failure of former inmates to eat well after their release seriously undermines their health. In addition, those who backslide seldom seek proper attention.

“We have tried to register and monitor the TB patients (with the resistant strain) who are out of prison”, Rakhima Gainazarova, the Red Cross representative in Osh, said. The group monitors 40 people in Osh, supplying them with food and medicine.

In Chui Oblast, Special Colony No. 27 is for inmates with drug resistant TB. Likhoded said data show the incidence of TB in Osh Oblast has decreased from 142.7 cases per 100,000 residents in 2000 to 101.3 cases per 100,000 in 2009, with budget allocations for treating TB steadily growing.

Likhoded said Osh Oblast has other TB treatment centres – a 30-bed hospital in Gulcha, another with 80 beds in Karasuu and a 150-bed clinic for children. District centres have hospitals that can treat ordinary TB but are helpless in the face of the resistant strain.

There are 5,335 registered TB patients throughout the country, of whom 3,111 are inpatients. Of the 1,290 with the resistant strain, 97 are in prison. According to the Health Ministry press service, the number of TB infections identified in 2009 was down 1% from 2008.

Petrosyan said Kyrgyzstan has the 20th worst per-capita incidence of the resistant form of TB – an ailment that primarily afflicts prison inmates and the poor.

While Kyrgyzstan is making progress in its fight against TB, the World Health Organization’s online database says the country-wide incidence of TB was 121 cases per 100,000 residents in 2007, the last year listed in the database. That level, and Osh Oblast’s 2009 rate of 101.3 cases per 100,000 residents, are more than double the 50 cases per 100,000 people the World Health Organization defines as an epidemic.

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