Dagestan Struggles to Stem TB Scourge

At the tuberculosis day clinic in Makhachkala, clotheslines stretch across a dilapidated courtyard. People with gloomy faces pace around, and a group of women sit by the door, clutching their health reports.

TB is an old scourge in the Caspian Sea republic of Dagestan, one of Russia's poorest regions. Formerly its incidence was up to twice as great as in the rest of the country, but in recent years the situation has got far worse.

Makhachkala, the Dagestani capital, which has about 2,000 TB patients on record, has the dubious distinction of being the only regional centre in Russia without a TB hospital. According to Abdurazak Adziev, head doctor of the main TB clinic, no more than 40 per cent of patients diagnosed with TB are hospitalised in Dagestan - the republic only has 45 per cent of the required number of hospital beds.

More than 300 Dagestanis died of TB in 2002, and 102 children contracted the disease. According to Nikiet Tarkhanova, field supervisor with the International Committee of the Red Cross in Dagestan, her organisation rushed an emergency supply of pharmaceuticals to the region last year to try and stem the spread of the disease.

The World Health Organization, WHO, has stated that the TB rate can be considered low if the number of patients does not exceed 30 per 100,000 of the population.

Dagestan now has an estimated 94 TB patients per 100,000 people. The qualified good news, say doctors, is that it is not getting any worse.

Gusein Guseinov, head of the Phthisiatric Department of the Dagestani Medical Academy, who rang the alarm about a possible tuberculosis epidemic in Dagestan as far back as 1998, is cautiously optimistic.

"Thirty two other regions of Russia have a higher TB rate than Dagestan, and it's spreading faster," he told IWPR. "Not that the situation has improved here, but it has surely worsened in those other places."

Doctors and officials alike say that the anti-TB effort is now getting funding from Moscow and Jamalutdin Gasaev, Dagestan's senior deputy health minister says the epidemic has already passed its peak.

However, a new hospital is still not in prospect. Plans for one have been discussed for years. After the authorities failed to find a suitable building in the centre of Makhachkala, they began construction in the suburbs, but only a foundation pit was dug.

And while proper medical facilities are not in place, many city dwellers are worried by the invisible threat the disease poses. There is an ever-present suspicion that the actual figures for the disease are far worse than the official ones.

"I've been told every sixth resident of Makhachkala has TB," said Aminat, an accountant. "I'm from Charodin area, and many of my fellow villagers are also infected. I worry about my children and make them wash their hands all the time. You never know who you're riding next to on the bus. I took an X-ray test last year. I went in with a cold, and they made me have one."

"I know very little about TB, but I know it's dangerous," said layout specialist Timur. "If one of my friends or family members got it, I would read up on the subject and act accordingly."

Health professionals say traditional hostility to TB patients and local customs are helping TB to spread. In the early Nineties, the residents of Makhachkala suburb Tarki destroyed a local TB hospital, claiming it threatened their health. Eyewitnesses recall that bedridden patients were removed from the building on their beds, and left outdoors for days. Four patients died.

On other occasions, voters have promised they will support those candidates in local elections who pledge to shut down their existing TB treatment facilities.

Enormous weddings and wakes and sprawling street markets also help circulate the disease.

Dagestani doctors recently offered to disinfect the republic's mosques, but clerics are still considering the proposal. Meanwhile, TB patients pray next to healthy parishioners, and leave traces of the disease on the praying rugs.

The highest incidence in Dagestan is among socially disadvantaged groups, with an overwhelming majority of them unemployed. Many TB patients who are aware of their condition, especially ex-prisoners, are reluctant to take treatment.

Only around half of sufferers released from prison report to medical institutions.

Prisoners who contract the disease in jail are usually confined to a special TB colony outside Makhachkala for the remainder of their sentence. Abdulkadir Tutunov, deputy chief of the colony, told IWPR 189 inmates with an active form of the illness were released from the colony during the first 10 months of 2002.

Another at-risk group are women in the remote mountains of the republic. "Women have very poor health in mountain villages: they have to work hard and they don't eat well," said Aishat Magomedova, chief doctor of a charity hospital for women in Makhachkala and head of the NGO Mother and Child Protection League. "We had the hardest time in 1999, when the influx of refugees from Chechnya peaked. Every eight or nine women in a hundred that came to us were suspected to have TB."

The local government recently purchased 18 new mobile digital X-ray machines, which will be dispatched to the remote mountain areas where few locals can afford to travel to get proper treatment.

However, doctors agree that the situation is unlikely to improve while a far worse epidemic rages in Dagestan's western neighbour, Chechnya.

"I'm scared to even look at those figures," said Raisa Shapieva of the social policy department of the Chechen government. "TB is a disaster in Dagestan, but here it's a veritable catastrophe. No one keeps accurate statistics, but we figure there are at least 10,000 patients in Chechnya. Personally, I believe the real figure is many times that. The republic has not had a TB screening in two years."

According to Shakhman Akhmadov, head doctor of the sanitary and epidemic control centre in Gudermes, Chechnya's second city, there is only one X-ray machine in an area with a population of 112,000. To make matters worse, the area currently hosts some 18,000 refugees. There are more than 400 proven TB loci in the Gudermes area, a rate which Akhmadov maintains is fairly typical for Chechnya - and which poses a constant threat for Dagestan.

Nina Agaeva is a journalist with Makhachkalinskie Novosti newspaper