TB care in Kyrgyzstan

MSF, alongside other international organizations, especially the ICRC, and national institutions, is facing the TB epidemics in Kyrgyzstan's prisons, where the incidence is estimated 25 times higher than in the civil society. Over 50 percent of the patients are infected with resistant forms of TB. Inside the penal system, TB is the major cause of death. Despite the penal reform, initiated by the authorities, the cells remain overcrowded. Conditions in the prisons are dire, with poor ventilation and scarce light, which create a breeding ground for the quick spread of TB. MSF introduced infection control at the entrance to the penitentiary system of Kyrgyzstan, the pre-trial detention centers. In the main center, the patients also receive free DOT (Directly Observed Treatment). In 2007, MSF reconstructed the hospital in the TB prison-colony ##31, which now ensures good isolation of highly infectious and drug-resistant patients from recovering patients. MSF also equipped and maintains a laboratory in the hospital. Some 555 DOT patients were enrolled into the MSF programme in prisons; they receive additional highly nutritious food. The organization is involved in both active and passive case finding activities. Together with its partner organizations, MSF is dealing with the growing problem of drug resistant TB in prisons. MSF fully supports the treatment of poly-drug resistant TB patients and provides diagnostics for multi-drug resistant tuberculosis. MDR-TB patients are further referred to the specialized colony ##27, where ICRC treats TB with multiple drug resistance. MSF is providing medicines for this treatment. Lack of well-trained medical personnel is a huge problem of the national healthcare system. Another systematic problem is poor follow-up treatment after release from prison and the stigma attached to these patients. In December 2007 MSF organized a photo exhibition, which showed life and treatment of TB patents behind bars, and which happened to be the first event of this sort to unveil this hidden world to the broad public in Kyrgyzstan. A similar exhibition is opening in March 2008 in colony ##31.