What little progress there is here hasn't come easy. Promoters of the program had to overcome initial skepticism by a Russian TB establishment, which has a long, proud and idiosyncratic approach to treating the disease. Even now, Russia's top TB doctor, the octogenarian surgeon Mikhail I. Perelman, scoffs at the notion that the Tomsk model and NGOs' contributions will lead to dramatic changes. "DOTS—this system was developed for the poorest countries of Africa. These places are not like Russia," he says.
But TB thrives anywhere there are high levels of unemployment, poverty, alcoholism, drug abuse or co-infections like HIV—conditions that know no borders. And when people are living in close quarters under chronic stress and with poor nutrition—such as existed in Russia's prisons in the 1990s—the danger of an outbreak is ever present.