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Tue July 9, 2013
Shots - Health News

Treating The 'Body And Soul' In A Russian TB Prison

Originally published on Tue July 9, 2013 5:41 am

Igor Davydenko is rail-thin with dark circles under his eyes. He has a haunted look, reinforced by black prison overalls with reflective tape on the shoulders and cuffs.

Davydenko could be labeled as a loser in many ways. The 31-year-old is a drug addict, serving time for robbery and assault. He's serving his third stretch in a Siberian prison.

But Davydenko is about to become a winner in at least one way. If all goes well, he will soon be declared cured of one of the deadliest forms of tuberculosis.

In the last decade, Russia has found itself contending with new strains of TB that are resistant to many drugs and hard to cure. For years, prisons were considered to be one of the most dangerous pockets of drug-resistant TB in Russia and a source of the disease in the general community. In 2002, more than 79,000 inmates had active TB infections, and drug-resistant forms were present in about 50 percent of chronic cases.

But the Russian prison system has been working to change that. About a decade ago, it got together with the nonprofit Partners in Health and set up a clinic at a Siberian prison specifically aimed at treating tuberculosis among inmates.

The facility is called Medical and Penal Institution Number One. And, against long odds, it's making progress against drug-resistant TB. The rate of infection has dropped seven-fold, and the death rate has fallen to single digits, Alexander Leshchyov, the deputy warden, says.

There's no hiding the fact that Medical and Penal Institution Number One is a prison. It's surrounded by high brick walls, coils of razor wire and watch towers.

But as penitentiaries go, Medical and Penal Institution Number One isn't the worst. There's a bakery, clean dormitories and a small cafe that serves as a visiting area. There's even a theater, where inmate singers are practicing for a yearly talent show with some of the other nearby prisons. In the yard, a warden points out a bas-relief mural, sculpted by an inmate artist.

Inmate Davydenko first came here in 2001 after he contracted TB in another prison. "I was losing weight, had the sweats, coughing — in short, all the symptoms. They found it was TB, and they sent me here," he says.

Prison officials say Davydenko had a typical strain of tuberculosis that responds to normal treatment, and that he was cured by the time his sentence was up in 2002. But Davydenko went back to a life of drugs and crime that quickly landed him back in jail.

When Davydenko came back here, six years ago, the doctors again found TB, which he may have picked up in pretrial detention. The strain was a little worse than the one he had the first time, but it was still susceptible to the most commonly used anti-TB drugs. This time the treatment took a year, and Davydenko was declared cured again but kept under observation, as he served out his term.

But in 2011, a routine scan found TB again. This time it was drug-resistant, and Davydenko faced a longer, more arduous treatment with fierce side effects.

The key to curing TB in prisonsers is getting each patient to take responsibility for his own health, Warden Leshchyov says. That's not easy. "It's a very complicated moment that we call compliance," he says. "It is such a simple thing, but it's incredibly difficult to acquire it."

Davydenko's history — his drug addiction, his crimes, his repeated stints in prison — read like a textbook example of why it's so hard to get someone like him to take care of himself.

The experience of being treated for the disease can have a positive effect on an inmate's rehabilitation, Leshchyov says. "Davydenko is an absolutely creative person," the warden says. "During the treatment there comes a turning point [when] the treatment changes not only the body but a person's soul."

Davydenko agrees that he has come to feel responsible for himself and others. "When you get ill, the responsibility is on you, so that other people don't get sick — your family and neighbors and so on," he says.

Davidenko has been through 17 months of a 20-month treatment, and he says he's feeling better now. He's scheduled to get out of prison in about 2 1/2.

But he seems hesitant to say he's on the path to rehabilitation."You see," he says. "I'm in here for the third time." He wonders if anyone will believe he's changed. "I'm already 31," he says. "I should think about what to do next. I don't know."

Prison officials say they have hopes for Davydenko. They say that inmate patients, who've received the full spectrum of treatment, have a much better chance, not only of recovering their health, but of recovering a productive place in society.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

DAVID GREENE, HOST:

Many parts of the world continue to battle an age-old and relentless enemy - tuberculosis.

RENEE MONTAGNE, HOST:

Nearly 7 million people are sick with TB today. The most recent count of the death toll, 1.4 million people succumbed to the disease in 2011.

GREENE: TB is normally cured with relatively inexpensive drugs but improper use of these drugs has created forms of TB that are resistant to many and sometimes all of the drugs available.

MONTAGNE: Russia is one place that's facing a public health crisis as it contends with drug-resistant tuberculosis, and for years a really dangerous place to be when it comes to TB is in one of Russia's prisons. Plus, when prisoners are released, they can spread TB into the general community.

GREENE: As part of our ongoing series, looking at TB around the world, NPR's Corey Flintoff traveled to a prison hospital in Siberia, and he sent us this report.

COREY FLINTOFF, BYLINE: Medical and Penal Institution No. 1 sits on a hill overlooking the sprawling city of Tomsk. There's no hiding the fact that it's a prison. It's surrounded by high brick walls, coils of razor wire and watchtowers. But for Russia, it's a model of its kind, a hospital where prisoners are sent to be treated for tuberculosis, including the drug-resistant strains that are a serious problem for the penal system.

Igor Davydenko, first came here in 2001 after he was diagnosed with TB he contracted in one of the area's other prisons.

IGOR DAVYDENKO: (Through Translator) I was losing weight, had the sweats, coughing, in short, all the symptoms. They found it was TB and they sent me here.

FLINTOFF: Prison officials say Davydenko had a typical strain of tuberculosis that responds to normal treatment and that he was cured by the time his sentence was up in 2002. But Davydenko is a drug addict who supported his habit by committing robberies.

DAVYDENKO: (Foreign language spoken)

FLINTOFF: This is his third stretch in prison, this time on a robbery and assault conviction that carries a 10-year term. As prisons go, Medical Facility No. 1 isn't the worst place to be. The warden, Andre Kostarev shows off the bakery, the clean dormitories and the small cafe that serves as a visiting area.

ANDRE KOSTAREV: (Foreign language spoken)

FLINTOFF: Prison officials wear blue military fatigues and the prisoners are in black jumpsuits with reflective tape around the cuffs and across the shoulders. The prisoners have short, buzz-cut hair. Many have elaborate tattoos. In the yard, Warden Kostarev points out a bas-relief mural sculpted by an inmate artist.

KOSTAREV: (Foreign language spoken)

FLINTOFF: It shows a history of Russia, starting with Adam and Eve's expulsion from the Garden and ending with a gallery of recent Russian leaders, from Brezhnev to Putin. There's even a theater where inmate singers are practicing for a yearly talent show with some of the other nearby prisons.

UNIDENTIFIED MAN: (Singing in foreign language)

FLINTOFF: Alexander Leshchyov, the deputy warden, says it's all part of a multipronged approach that combines correction with education, medical and psychological treatment. The key, he says, is getting each patient to the point where he takes responsibility for his own health, and that's not easy.

DEPUTY WARDEN ALEXANDER LESHCHYOV: (Through Translator) It's a very complicated moment that we call compliance. It is such a simple thing but it's incredibly difficult to acquire it.

FLINTOFF: When Igor Davydenko came back here six years ago, the doctors found TB again. He may have picked it up in pre-trial detention. Prison doctors say the variant strain was a little worse than the one he had the first time but still susceptible to the most commonly used anti-TB drugs. This time, the treatment took a year and he was declared cured again, but kept under observation.

In 2011, a routine scan found TB again. This time, drug-resistant TB and he faced a longer, more arduous treatment with fierce side effects. The drugs used to fight resistant tuberculosis are more toxic to human patients as well, and they've been associated with liver problems, giddiness, even hallucinations and depression.

Davydenko is rail thin with dark circles around his eyes that give him a haunted look. He's been through 17 months of a 20-month treatment and says he's feeling better now, in part because the doctors have steadily been reducing the amount of drugs that he has to take. If Davydenko had gotten into the prison system in the 1990s, his chances of survival might have been a lot lower.

LESHCHYOV: (Foreign language spoken)

FLINTOFF: Leshchyov, the deputy warden, says the infection and death rate back then was high. Since 2000, the prison's been taking part in an advanced treatment program in cooperation with Partners in Health, the U.S.-based health NGO supported by The Global Fund to Fight AIDS, Tuberculosis and Malaria. Since the current program began, he says, the rate of infection has dropped seven-fold and the death rate has fallen to single digits.

Davydenko's history, his drug addiction, his crimes, his repeated stints in prison read like a textbook example of why it's so hard to get someone like him to care about himself or anyone else. But Leshchyov says the experience of being treated for the disease can have an effect on an inmate's rehabilitation as well.

LESHCHYOV: (Through Translator) He is an absolutely creative person, which tells us about the fact that during the treatment there comes a turning point. The treatment changes not only the body, but a person's soul.

FLINTOFF: Davydenko says he feels that responsibility now.

DAVYDENKO: (Through Translator) When you get ill, the responsibility is on you so that the other people don't get sick; your family and neighbors and so on.

FLINTOFF: Davydenko is expected to complete his latest TB treatment in a couple of months. He's scheduled to get out of prison in about two and a half years and he seems hesitant to say he's on the path to rehabilitation.

DAVYDENKO: (Through Translator) You see, I'm in here for the third time. How can someone like me say this? No one's going to believe me. I'm here for the third time. And take my age. I'm already 31. I should think about what to do next. I don't know.

FLINTOFF: Prison officials say they have hopes for Davydenko. They say inmate patients like him who've received the full spectrum of treatment have a much better chance not only of recovering their health, but of recovering their places in society. Corey Flintoff, NPR News.

(SOUNDBITE OF MUSIC)

GREENE: And there are some pretty powerful photographs from the prison hospital Corey visited on our website, npr.org.

MONTAGNE: Plus, later today, be sure to listen as Corey has more in our series with a report on the attempts in a Siberian town to stop drug-resistant TB. That's this afternoon on ALL THINGS CONSIDERED.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.