A short jail term can mean a death sentence if a prisoner
catches tuberculosis from fellow detainees. In Azerbaijan
and Georgia, the ICRC works with authorities to tackle the
problem inside prisons and out, helping to give former inmates
a chance for freedom from a deadly disease.
IT’S A
FOUR-FLOOR WALK up to the dark, cramped apartment that 30-year-old
Rati shares with his brother, sister-in-law and three nephews
in the Georgian capital, Tbilisi.
A grungy pair of child’s
grey sweatpants serves as a doormat for wiping dirty shoes
at the entrance. Inside, an old electric heater on the floor
struggles to stave off the cold. The light socket in the
ceiling is empty so one of the boys is sent next door to
borrow a bulb from a neighbour.
Rati sits down with a heavy
sigh and speaks between laboured breaths. The light bulb
never arrives, so someone pulls out a flashlight as the afternoon
light fades to dusk.
“I was sent to prison for theft
in 2007. While in jail, I started to cough up blood,” he
explains. “It took a while to confirm it was tuberculosis.
I think I probably infected others before I was transferred
to a penitentiary hospital for treatment.”
Prisons
are notorious breeding grounds for tuberculosis, or TB, due
to the cramped quarters, over - crowding, poor nutrition
and a lack of health services. People serving a few years
for a relatively minor crime can wind up with a virtual death
sentence if they catch a drug-resistant strain of the disease
while locked up.
Danger to society
In the 1990s, following
the collapse of the Soviet Union and national medical infrastructures,
the ICRC discovered large numbers of detainees dying of TB
in countries like Georgia and Azerbaijan.
Over the past decade
and a half, delegates have been working with local authorities
in both countries to successfully stem the spread of this
silent killer among prisoners and former convicts.
“It’s
a mistake to think that prison health has nothing to do with
broader public health,” says ICRC TB specialist Nikoloz
Sadradze, who worked in Georgia for many years and is now
based in the capital of Azerbaijan, Baku. “Staff and
guards go in and out of jails, families come to visit and
eventually, people are released and go back into the community.
If they don’t get medication and stay on it, they become
a real danger to society.”
The treatment for multidrug-resistant
TB, or MDRTB, is lengthy, costly, complicated and painful.
Patients must take a cocktail of different pills, powders
and injections for up to 24 months and generally feel much
worse before they start to feel better.
The side effects,
which include severe hearing loss, liver problems and stomach
pain, offer little incentive to stick with the treatment,
but experts and patients agree that a healthy dose of compassion
and support from family and friends can go a long way in
helping former prisoners to not only recover physically but
also rebuild their lives.
Sticking with it
No one knows this
better than 32-year-old Teymur, who lives with his mother
in an abandoned kindergarten in Azerbaijan’s seaside
city of Sumgait. Displaced by the armed conflict in Nagorno-
Karabakh at the age of 13, he was thrown in jail several
years later for fraud.
Today, he is the first person to have
successfully completed a fledgling follow-up programme for
released prisoners run by Azerbaijani officials and supported
by the ICRC.
As in neighbouring Georgia, ex-convicts in Azerbaijan
are given free access to MDRTB drugs, which they must take
six days a week under medical supervision. The ICRC provides
motivation in the form of food and hygiene packages, as well
as visits to the patients each month.
“It was very
difficult to be sick in prison. I had no family around and
every day, I thought I was going to die, but then I started
treatment. The medication made me quite sick but the doctors
convinced me to stick with it and I’m glad I did because
now I’m cured,” explains Teymur.
He flashes a
shy but self-satisfied grin as he shuffles around his ramshackle
kitchen, preparing a cup of tea. While the water boils on
the ancient gas stove, Teymur tidies up, neatly arranging
a pair of slippers and smoothing the covers on his bed in
the living room.
“For a long time, my mother has taken
care of me and been by my side. Now, I want to get my licence
as a taxi driver and be able to take care of her and raise
my own family.”
“I keep hoping”
As was
the case in Rati’s apartment, the lights aren’t
working in Teymur’s home. For some reason, the electricity
is out. But on this particular day, it doesn’t seem
to matter much.
A sliver of sunshine comes through the dusty
window as Teymur settles back on a pillow and sips his tea
with an air of cautious optimism, knowing that both this
terrible disease and prison are squarely behind him and the
future is bright enough, for now.
Some 500 kilometres away
in Tbilisi, Rati has similar aspirations. He recently finished
a shorter and less aggressive course of antibiotics for traditional
TB, which lasts on average around eight months. His wife
left him while he was in jail and his daughter is now living
with his mother in another part of Georgia, so life is far
from perfect.
But like Teymur, Rati says he is grateful to
have family around whom he can lean on and wants to get back
on his feet and start earning a living as soon as he can.
“I
just want to feel better, move on with my life, see my little
girl more often and avoid getting TB ever again,” he
says. “I keep hoping.”
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