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Prescription — compassion

 

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.”

Anna Nelson, ICRC



Shedding light on the plight of people such as Rati could weaken social stigmas that isolate patients and discourage them from getting proper treatment.
©Zalmaï/ICRC

 

 

 

“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.”
Former TB patient and ex-detainee Teymur

 

 

 


Rati is no longer behind bars and he’s free of TB after an eightmonth treatment regimen.
©Zalmaï/ICRC

 

 

 


A prisoner in Azerbaijan takes MDRTB medicine under the watchful eyes of prison doctors.
©Zalmaï/ICRC

 

 


“It’s a mistake to think
that prison health has nothing to do with
broader public health.”

Nikoloz Sadradze
ICRC TB specialist

 

 

 


Serving a life sentence in Baku, this prisoner and TB patient awaits lung surgery.
©Zalmaï/ICRC

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