LosingL the fight against TB?
Prisons with high rates of TB infections? Who cares, they’re just convicts, right? Well, TB doesn’t stop at the prison gates. PRISONS are often terrifying plac“The chance of further transmises, rife with abuse and brutality. sion is high,” says Prof Dr Adeeba There is another hidden threat to Kamarulzaman, dean of Universiti life there that often goes unseen Malaya’s Faculty of Medicine, who and uncontrolled: tuberculosis, or is one of the leaders of the study. TB. Going to prison is bad enough;
The level of TB in prisons has being condemned to a possibly been reported to be up to 100 fatal disease is unjustified. times higher than that of the genIf you’re inclined to say so what, eral population, the World Health these are prisoners – think again. Organisation ( WHO) says. In parts TB doesn’t stop at the prison gates. of Eastern Europe, prisons are hotIt’s an infectious, airborne disease. beds for TB epidemics. Someone coughing on an airplane
Prolonged confinement in can spread TB to nearby passenenclosed, crowded, poorly- ventigers. TB remains a top killer in lated cells – together with poor Malaysia, killing far more people nutrition and lack of medical care than, say, dengue. – provide the perfect storm for TB, Last Thursday was World TB which is spread through aerosol Day. Worldwide, almost 10 million droplets from coughing, sneezing people fell ill with TB in 2014, of or speaking. which one in 10 were children;
That “storm” is raging locally. A and despite the availability of a 2014 study in Kajang prison, cure, some 1.5 million died, WHO Selangor, the nation’s largest prisreports. on, and Pengkalan Chepa prison The battle against TB is getting in Kelantan, found grim results: harder. Multi- drug resistant TB, or 89% of prisoners in Kajang and MDR- TB, is tougher, costlier and 88% in Pengkalan Chepa tested takes longer to treat. A course of positive to tuberculin skin tests, standard TB drugs costs roughly which checks exposure to TB. The US$ 20 ( RM80) over six months, rate among prison officers in but treating MDR- TB can cost up Kajang was also high, at 81%. to US$ 5,000 ( RM20,000) and take
Such extraordinarily high figtwo years, WHO says. ures indicate that behind bars, the MDR- TB now plagues most TB epidemic here is thriving. countries.
Worse, there is “extensively drug- resistant” TB, which has turned up in Malaysia; and in India, there is even “totally drug- resistant TB”.
Now this is scary. Untreatable TB? That sends us back to the past, when we were helpless against the muchfeared “great white plague”, which incidentally killed off some of the greatest artists, such as George Orwell, Chopin and the Brontë sisters.
This underscores why everyone with TB should be treated, and treated properly, to prevent drug- resistant TB. Billions of dollars of international funding are given towards free TB treatment every year. Free treatment is critical, because TB often affects the poor, and those at the bottom of society, such as immigrants and prisoners.
In the prison study, half the participants were injecting drug users, who have a high risk of infection of both TB ( for various reasons) and HIV, which in turn raises the risk of TB developing. Also, many prisoners in the study had been previously imprisoned, some a few times, intensifying the likelihood of TB infection.
Despite all this, 92% of participants in the study had never been tested before for TB. That is astonishing. Services to test, prevent and treat TB in prisons must be improved.
Dr Adeeba – who conducted the study with visiting research fellow Dr Haider Al- Darraji, and in collaboration with Prof Frederick Altice from Yale University in the United States – says all prisoners should be tested for TB upon arrival in prison and treated promptly for the disease. Infection control measures, including better ventilation, are also needed.
Dr Adeeba adds that prisoners sick with “active” TB were often diagnosed late. This leaves more time for TB to spread.
Ultimately, there is a “need to consider alternative approaches” to imprisonment, she says. Most of the prisoners in Kajang are there because they took drugs. Is it worth sending them to prison to “reform” when we know they won’t? Without addressing addiction, we can only expect a cycle in and out of prison, and eventual infection with TB, HIV and hepatitis.
An alternative would be local “cure and care” clinics, which offer proper treatment for addiction, such as methadone therapy and counselling. These clinics have shown encouraging results.
The price of inaction is high. Russia, which once had TB under control, failed to deal adequately with TB in prisons after the collapse of the former Soviet Union. Today, Russia has one of the largest TB epidemics and some of the world’s highest rates of MDR- TB.
Let’s hope we don’t go down that route.
Mangai Balasegaram writes mostly on health, but also delves into anything on being human. She has worked with interna tional public health bodies and has a Masters in public health.