MELNIKOVO, RUSSIA—To properly treat tuberculosis (TB), you must take up to four antibiotics every day for six months under careful supervision. If you are one of the 17 stricken individuals in this small farming community, you can get that care either at the clinic–hospital in the town center or one of the newly opened satellite clinics in outlying neighborhoods.
But none of those were accessible to 85-year-old Lubov Potaskaeva, who lives in a rundown apartment complex for agricultural laborers far from town. The Kyrgyzstani native has no idea how she caught the disease. She only knows that when she was screened for TB as part of her application to enter the area's retirement home—she wanted in because she was always short of breath and could no longer climb the stairs to her second-floor apartment—her test came back positive.
Over the past 10 years, local health authorities in Siberia's Tomsk Oblast (a Poland-size province with about one million people) have built a wide-ranging network for ensuring that people like Potaskaeva get the World Health Organization–recommended treatment for TB, known as DOTS (for directly observed therapy, short course). If they are among the 15 percent diagnosed with multidrug-resistant, or MDR-TB, they get a two-year long treatment with up to six or eight drugs known as DOTS-Plus.
The key to the program lies in reaching out to people who can't or won't go to a hospital or clinic to be "directly observed." Every day, someone comes to them. In this apartment bloc, at the end of a dirt road that had turned to mud from a summer rain on the day I visited, the task fell to one of Potaskaeva's neighbors, who gets paid to watch her take her drugs and then doles out the special food packages that bolster her strength and immune system.
Potaskaeva, appearing spry and in good health, was nearing the end of the grueling regimen. Pointing to Sergei Ilyin, the young physician overseeing her care who had just brought a carload of inquisitive foreigners to her home, she said, "When he told me I had TB, I said, 'You're a liar.'" Then she reached up and pinched his cheeks with both hands. "I can run now. I must thank you."
The jury is still out on the outreach program's effectiveness. Local officials claim last year the provincial TB rate fell to 102.7 new cases a year with 12.2 deaths for every 100,000 population, down from 114.2 cases and 18.6 deaths in 2002. But that's still at more than twice what it was in 1990, before the crumbling of the Soviet Union unleashed an epidemic of TB. Today, Russia, like the rest of the world, is off track for meeting a goal of halving TB deaths by 2015 that was adopted by the World Health Organization (WHO) in 2006. About 1.7 million people died from the disease worldwide in 2007, compared with 1.5 million in 1990.
"It's still bad," admitted Mikhail I. Perelman, the national health ministry's top TB doctor. A surgeon, he champions Russia's traditional approach toward TB treatment, which involves frequent changes in drug regimes depending on individual patient response and often a quick resort to lung surgery. He has only lately and grudgingly supported the WHO-style programs in Siberia.
"We're talking about marginalized people—alcohol and drug users, poor people," he says. "If we improve the economy, TB will largely disappear. People need good apartments, good food and good working conditions. These are the most important factors for treating TB."