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Around the world, new forms of potentially fatal tuberculosis are emerging that are costly and difficult to treat, at times impossible to treat. Drug resistant TB is becoming a major burden in China, India and Eastern Europe. The former Soviet Republic of Moldova has one of the world's highest rates of TB.
This week, we've been hearing about Moldova from NPR's Jason Beaubien. Today, he reports on why TB is so bad there and what challenges it creates.
JASON BEAUBIEN, BYLINE: First, while tuberculosis travels through the air and has the potential to jump indiscriminately from one person to another, TB doesn't really seem to work that way. Tuberculosis gravitates to the poor, the downtrodden, the dispossessed. In the United States, a recent outbreak of TB occurred on skid row in Los Angeles.
Moldova might not be exactly the skid row of Europe but it's the poorest nation on the continent. It has few natural resources and its greatest export is its youth. This is the kind of place where TB flourishes.
BORIS PUGA: (Through Translator) At the moment, the problem of tuberculosis is one of the leading problems in Moldova.
BEAUBIEN: Boris Puga is head of the X-ray department at the government TB hospital in Moldova's second largest city, Balti. Puga has worked in TB since 1977 when Moldova was still part of the Soviet Union. As far as TB is concerned, he says things were much better under the Soviets. TB treatment back then was compulsory but patients were also given stipends to support their families and treated in well-funded hospitals. They were fed six times a day.
Back then, Puga says TB could be treated in a matter of months. Now it takes at least 18 months and, at times years, to cure strains of TB that have grown drug resistant.
PUGA: (Through Translator) More and more, we have people resistant to all the medicines.
BEAUBIEN: After the fall of the Soviet Union, tuberculosis exploded throughout Eastern Europe. In the 1990s, rates of TB in the region nearly doubled. This was in part driven by the collapse of the communist health care system but also the ensuing social and economic turmoil. Moldova's economy still remains stagnant. Roughly 30 percent of Moldovans now work outside the country.
Puga says Moldova's economic woes contribute to the spread of TB.
PUGA: (Through Translator) A patient who is under daily stress, who is always worried, plus has poor nutrition, is at great risk of developing tuberculosis.
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BEAUBIEN: The winters in Moldova are long. The summers are hot. Even in spring, dirty snow banks line Moldova's beat up highways. Ornate Russian Orthodox churches with golden domes standout against the drab Soviet style architecture.
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BEAUBIEN: Since the fall of the USSR, the country can't seem to decide whether it wants to be aligned with the European Union or Moscow. In March, the government collapsed for the fourth time in four years. And amidst this political, economic and social turmoil, drug resistant tuberculosis has found a fertile breeding ground. Currently, 40 percent of TB cases in Moldova don't respond to conventional TB drugs.
ANDREI MOSHHNEAGA: So this is really alarming and puts additional burdens onto the patient
BEAUBIEN: Andrei Moshneaga is with the Center for Health Policy and Studies in the Moldovan capital of Kishinau.
MOSHHNEAGA: Because these forms are much more complicated, they require much longer and much more complex treatment.
BEAUBIEN: They cause devastating side effects including hearing loss, blindness, nausea, aches and severe depression. Moshneaga says a variety of factors have contributed to the growth of drug resistant TB in Moldova.
MOSHHNEAGA: So many reasons are quoted that we had shortage of TB drugs in the '90s, quite bad shortages of TB drugs. Many patients default from treatment, so they interrupt treatment.
BEAUBIEN: They default from treatment because many of them can't afford not to work for months or even years on end. After all, no one else is paying to support the patients' families.
Moshneaga adds that the old Soviet practice of treating patients in large TB hospitals may also contribute to the growth of drug resistance. Infection control in these aging hospitals is often poor, allowing a single patient with resistant TB to spread it to everyone else on the ward.
Veaceslav Batir, the head of the health department for the city of Balti is not just worried about drug resistant TB spreading on the streets of his city, he says it already is.
VEACESLAV BATIR: (Through Translator) This is type of infection already exists. That's why we have a national plan and a city plan to address it. And the mayor himself regularly monitors its progress.
BEAUBIEN: Batir says drug resistant TB is placing huge burdens on the municipal hospitals. Patients stay for extremely long periods of time. Other medical procedures have been moved out of the TB hospitals because even the doctors and nurses are afraid of getting infected.
Until this year, the Global Fund to Fight AIDS, TB and Malaria had been paying for all the TB treatment drugs in Moldova. But that's being phased out. The cost of medicines to treat just one case of drug resistant TB in Moldova starts at $5,000.
Batir says this is money the government simply doesn't have.
BATIR: (Through Translator) It's impossible. It's practically impossible to fight all by ourselves such a disease as tuberculosis.
BEAUBIEN: And the bigger global concern is that if drug resistant TB gets worse in Moldova, it could easily spread through Europe and Russia, as Moldovans are forced to look for work outside their own country.
Jason Beaubien, NPR News.