DAVID GREENE, HOST:
Many parts of the world continue to battle an age-old and relentless enemy - tuberculosis.
RENEE MONTAGNE, HOST:
Nearly 7 million people are sick with TB today. The most recent count of the death toll, 1.4 million people succumbed to the disease in 2011.
GREENE: TB is normally cured with relatively inexpensive drugs but improper use of these drugs has created forms of TB that are resistant to many and sometimes all of the drugs available.
MONTAGNE: Russia is one place that's facing a public health crisis as it contends with drug-resistant tuberculosis, and for years a really dangerous place to be when it comes to TB is in one of Russia's prisons. Plus, when prisoners are released, they can spread TB into the general community.
GREENE: As part of our ongoing series, looking at TB around the world, NPR's Corey Flintoff traveled to a prison hospital in Siberia, and he sent us this report.
COREY FLINTOFF, BYLINE: Medical and Penal Institution No. 1 sits on a hill overlooking the sprawling city of Tomsk. There's no hiding the fact that it's a prison. It's surrounded by high brick walls, coils of razor wire and watchtowers. But for Russia, it's a model of its kind, a hospital where prisoners are sent to be treated for tuberculosis, including the drug-resistant strains that are a serious problem for the penal system.
Igor Davydenko, first came here in 2001 after he was diagnosed with TB he contracted in one of the area's other prisons.
IGOR DAVYDENKO: (Through Translator) I was losing weight, had the sweats, coughing, in short, all the symptoms. They found it was TB and they sent me here.
FLINTOFF: Prison officials say Davydenko had a typical strain of tuberculosis that responds to normal treatment and that he was cured by the time his sentence was up in 2002. But Davydenko is a drug addict who supported his habit by committing robberies.
DAVYDENKO: (Foreign language spoken)
FLINTOFF: This is his third stretch in prison, this time on a robbery and assault conviction that carries a 10-year term. As prisons go, Medical Facility No. 1 isn't the worst place to be. The warden, Andre Kostarev shows off the bakery, the clean dormitories and the small cafe that serves as a visiting area.
ANDRE KOSTAREV: (Foreign language spoken)
FLINTOFF: Prison officials wear blue military fatigues and the prisoners are in black jumpsuits with reflective tape around the cuffs and across the shoulders. The prisoners have short, buzz-cut hair. Many have elaborate tattoos. In the yard, Warden Kostarev points out a bas-relief mural sculpted by an inmate artist.
KOSTAREV: (Foreign language spoken)
FLINTOFF: It shows a history of Russia, starting with Adam and Eve's expulsion from the Garden and ending with a gallery of recent Russian leaders, from Brezhnev to Putin. There's even a theater where inmate singers are practicing for a yearly talent show with some of the other nearby prisons.
UNIDENTIFIED MAN: (Singing in foreign language)
FLINTOFF: Alexander Leshchyov, the deputy warden, says it's all part of a multipronged approach that combines correction with education, medical and psychological treatment. The key, he says, is getting each patient to the point where he takes responsibility for his own health, and that's not easy.
DEPUTY WARDEN ALEXANDER LESHCHYOV: (Through Translator) It's a very complicated moment that we call compliance. It is such a simple thing but it's incredibly difficult to acquire it.
FLINTOFF: When Igor Davydenko came back here six years ago, the doctors found TB again. He may have picked it up in pre-trial detention. Prison doctors say the variant strain was a little worse than the one he had the first time but still susceptible to the most commonly used anti-TB drugs. This time, the treatment took a year and he was declared cured again, but kept under observation.
In 2011, a routine scan found TB again. This time, drug-resistant TB and he faced a longer, more arduous treatment with fierce side effects. The drugs used to fight resistant tuberculosis are more toxic to human patients as well, and they've been associated with liver problems, giddiness, even hallucinations and depression.
Davydenko is rail thin with dark circles around his eyes that give him a haunted look. He's been through 17 months of a 20-month treatment and says he's feeling better now, in part because the doctors have steadily been reducing the amount of drugs that he has to take. If Davydenko had gotten into the prison system in the 1990s, his chances of survival might have been a lot lower.
LESHCHYOV: (Foreign language spoken)
FLINTOFF: Leshchyov, the deputy warden, says the infection and death rate back then was high. Since 2000, the prison's been taking part in an advanced treatment program in cooperation with Partners in Health, the U.S.-based health NGO supported by The Global Fund to Fight AIDS, Tuberculosis and Malaria. Since the current program began, he says, the rate of infection has dropped seven-fold and the death rate has fallen to single digits.
Davydenko's history, his drug addiction, his crimes, his repeated stints in prison read like a textbook example of why it's so hard to get someone like him to care about himself or anyone else. But Leshchyov says the experience of being treated for the disease can have an effect on an inmate's rehabilitation as well.
LESHCHYOV: (Through Translator) He is an absolutely creative person, which tells us about the fact that during the treatment there comes a turning point. The treatment changes not only the body, but a person's soul.
FLINTOFF: Davydenko says he feels that responsibility now.
DAVYDENKO: (Through Translator) When you get ill, the responsibility is on you so that the other people don't get sick; your family and neighbors and so on.
FLINTOFF: Davydenko is expected to complete his latest TB treatment in a couple of months. He's scheduled to get out of prison in about two and a half years and he seems hesitant to say he's on the path to rehabilitation.
DAVYDENKO: (Through Translator) You see, I'm in here for the third time. How can someone like me say this? No one's going to believe me. I'm here for the third time. And take my age. I'm already 31. I should think about what to do next. I don't know.
FLINTOFF: Prison officials say they have hopes for Davydenko. They say inmate patients like him who've received the full spectrum of treatment have a much better chance not only of recovering their health, but of recovering their places in society. Corey Flintoff, NPR News.
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GREENE: And there are some pretty powerful photographs from the prison hospital Corey visited on our website, npr.org.
MONTAGNE: Plus, later today, be sure to listen as Corey has more in our series with a report on the attempts in a Siberian town to stop drug-resistant TB. That's this afternoon on ALL THINGS CONSIDERED.
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