World governments must take immediate action to prevent an epidemic of tuberculosis in the former Soviet Union from spreading, say a group of authors in the April 12 issue of the Journal of Women's Health and Law.
"World organizations can't continue to ignore this epidemic any longer," says the article's lead author, Dr. Michael Schull, president of Doctors Without Borders/Médecins Sans Frontières (Canada) and an assistant professor of medicine at the University of Toronto. "Western governments and the United Nations need to put pressure on the government of Russia to make crucial reforms necessary to stop the epidemic from spreading within Russia and beyond."
Since 1995, Médecins Sans Frontières (MSF) has implemented TB diagnosis and treatment programs in Russian prisons, but Schull believes the impact of MSF's efforts will be minimal because of the inefficient court system, drastically overcrowded and antiquated prisons and a general deterioration in TB control. Legal reforms and medical interventions, he says, will also be required to address the problem.
"The breakdown in TB control reflects many factors, including worsening poverty, poor nutrition, insufficient funding for health programs and limited access to effective health care," say the authors, all associated with MSF. "Furthermore the continued use of inadequate (and often highly questionable) treatments for TB has meant that both the overall incidence and the severity of TB have increased in all parts of the former Soviet Union."
Even for drug resistant strains of TB, prompt diagnosis and adequate treatment is required, yet neither is being done. Poor tracking of infected prisoners in and out of jail lessens the effect of TB treatments - which can last up to 22 months. The needed drugs are up to 200 times more expensive than conventional ones, much more difficult to obtain and their serious side effects require more intensive medical care.
In an accompanying editorial, Dr. Jennifer Leaning of Harvard University suggests MSF needs to assume a more political role because many of the reforms they call for are political in nature. "What lies ahead for MSF and for all other humanitarian players in civil society is to figure out how to mobilize their considerable influence in order to affect the global trends that determine who suffers, where, and for how long."
The authors, however, are more cautious. "We recognize as a non-governmental organization that we can't solve all of these problems," says Schull, also a scientist at the Institute for Clinical Evaluative Sciences and an associate in emergency medicine at Sunnybrook and Women's College Health Sciences Centre in Toronto. "We're calling on political actors - governments and UN agencies - to take on these serious responsibilities which sometimes fall on our plate because nobody else will intervene."
In addition to the epidemic of tuberculosis, the article details three other controversial areas in which humanitarian medicine, gender and the law interact: female genital cutting, rape and corporal punishment. The other authors are: Richard Bedell, a clinical associate at St. Paul's Hospital in Vancouver, B.C. and a medical officer for MSF; Katrien Coppens, Leslie Lefkow and Hanna Nolan of MSF (Holland); and Leslie Shanks, a physician in Iqaluit, Nunavut and a member of the board of directors of MSF (Canada).
MSF is the world's largest private medical humanitarian non-governmental organization. Founded almost 30 years ago, the organization sends more than 2,000 volunteers to missions in more than 80 countries and was awarded the 1999 Nobel Peace Prize in October.
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