Fighting or fuelling the tuberculosis epidemic?
That tuberculosis in Ukraine is spreading at an alarming rate is not in dispute. A great many words are spoken about the need to prevent an even worse epidemic, with the only question marks being over the specific measures proposed or the degree to which anything but fine words are being offered.
The measures being undertaken in Kharkiv leave little scope for questions, except maybe whether the authorities are oblivious or simply indifferent to the catastrophic results they are risking through their actions.
The measures envisaged by Order No. 1 from 3 January 2009 in a nutshell:
- Closure of three out of four inpatient units which are part of Kharkivs Anti-tuberculosis Clinic No. 1. This means a reduction from 575 to 230 beds in inpatient units;
- Closure of two out of five outpatient units.
Nor is this all: Kharkivs Deputy Mayor Ihor Shurma warns that the city authorities plan to get rid of the remaining 230 beds altogether by July of this year, and to create one single diagnosis and outpatient treatment unit for the entire city.
Money and football make the world go round?
It would be nice to believe that the reason for this extraordinary decision is success in tackling a terrible disease. Nice and entirely unwarranted.
Shurma pulls no punches: its a question of money. He claims that the city has been spending 15 million UAH per year on maintaining Clinic No. 1 although the funding, in accordance with the Budget Code, should have been provided by the Kharkiv regions budget. The money, he asserts, is now needed for construction work in preparation for Euro-2012.
There is fundamental disagreement between the city and regional authorities. The Deputy Head of the Regional Administration Ihor Terekhov says, on the contrary, that treating city residents in regional healthcare units has cost much more – 43 million UAH, which the city authorities are not reimbursing.
The Regional Department of Health produces assurances that it will use the regional anti-tuberculosis units and sanatoriums, and if necessary create an additional network of places. Yet the 600 beds in the three regional anti-tuberculosis units located in the city are totally full up and how they can accommodate more patients without serious outlay must be in question.
Where is the money to come from?
The most disturbing aspect of these proposed reductions is that beds are being removed, buildings being transferred to the city authorities to be used for other purposes, while the number of people suffering from a potentially fatal and highly contagious disease is in no way falling, and no extra funding is being allocated from the central budget.
How important is football?
This question must be put now to the city authorities who see fit to risk the health not only of people already suffering from tuberculosis, but of the public in general. The decision to reduce the number of outpatient facilities will mean first of all that many patients are forced to travel across the city to receive treatment. It must be clear that people suffering from tuberculosis are often from poorer or more vulnerable groups in society and are most unlikely to be using private cars.
Even if we leave aside the duty of any public officials to protect the life and health of citizens, how can one possibly justify “money-saving measures” that will almost certainly lead to a considerable increase in the number of people contracting tuberculosis?
If the authorities excuse for such irresponsible and short-sighted measures is Euro-2012, then they are forgetting one major point. Very few people would place football higher than their own personal health, and they would simply not wish to come to a city known for its tuberculosis epidemic. That is, of course, if the whole event was not called off, this being entirely conceivable. If the city authorities are prepared to make such preposterous changes and the Ministry of Health and countrys leaders do not stop them, they must not expect doctors and civic organizations, like the Kharkiv Human Rights Protection Group [KHPG], to remain silent over a situation with potentially tragic consequences.
Sound the alarm
This is what the KHPG Patients Legal Aid Centre, as well as local doctors, have been doing, and desperately need to attract media, political and public attention to this seriously dangerous situation.
It should be stressed that nobody is talking about a potential problem. As the doctors state in their open letter of protest, the World Health Organization concluded that Ukraine was experiencing an epidemic spread of tuberculosis back in 1995. The situation has in no way improved.
In 2008 719 Kharkiv residents contracted tuberculosis (this being 50 people per 100 thousand head of population, whereas one speaks of epidemic proportions if this figure is more than 40). Of these, 321 were coughing or in other ways expelling bacteria.
As of 1 January this year, there were 4,728 people with an active form of tuberculosis in the Kharkiv region. Of these around 1500 are coughing up or otherwise expelling contagious bacteria and need inpatient treatment. Of this number 613 (298 in the region and 315 in Kharkiv itself) have a drug-resistant form and need to be in a clinic on a permanent basis.
Each person in this situation could infect 20 others in a year. Nor is there any guarantee that all patients will agree to be transferred from the city to sanatoriums in the region.
One particularly frightening trend is an increase in deaths of TB patients. Over 11 months over 2008 there were 14 deaths per 100 thousand head of population as against 10.8 for the same period in 2007. Moreover, the increase was specifically in the city, with the number of people dying of the disease outside tuberculosis treatment units doubled. It frankly defies belief that the Kharkiv city authorities are planning to reduce facilities for fighting this terrible scourge.
Another aspect should be borne in mind. One of the units in the city which from 2004 has been holding remand prisoners or police detainees suffering from tuberculosis has 4 wards of 20 beds. The Ministry of Internal Affairs spent a lot of money on reconstruction and annual repairs to the building, yet this building has been closed and transferred to city property. The danger that such a decision poses cannot be overstated. To cite but one tragic example: Svitlana Zaitseva died in 2006 of pulmonary tuberculosis contracted in prison, having been tortured into confessing to a murder she did not commit. She was released but died of the disease, leaving three small children. In 2007 her family was awarded 2 million UAH in compensation, this being the largest amount ever awarded by a Ukrainian court over wrongful actions by the law enforcement agencies. The injustice perpetrated against Svitlana Zaitseva clearly focused on the torture she suffered and her wrongful conviction however the fact that she contracted and died of tuberculosis while imprisoned undoubtedly influenced the level of compensation. It is a bitter irony that the city authorities are hampering the police in ensuring the safety of people held in custody.
It is vital that Order No. 1 from 3 January 2009 be cancelled along with any plans to reduce anti-tuberculosis facilities in Kharkiv. It can be easily demonstrated that this Order is in direct breach of a number of Ukrainian laws, as well as the countrys commitment to fight this disease and positive duty to protect the right to life.
The Ministry of Heath must ensure that the confusion over funding of all such units is clarified and that sufficient means are provided.
Both the Ukrainian public and the international community wish to hear more than fine declarations from its politicians and public officials regarding intentions to combat the spread of tuberculosis. The planned measures would demonstrate reckless and arrogant disregard for the health and safety of both Ukrainian citizens and visitors to the country, and must be stopped.
Halya Coynash, KHPG