TB thrives amid Russian chaos

AN EPIDEMIC of tuberculosis has broken out in Siberia since the collapse of the Soviet Union, a British medical team has found.

The team, which visited the city of Tomsk last month, estimates the incidence of the disease in the region is 2,000 cases per million, or 40 times the rate in Britain. It is expected to spread rapidly, especially among children and teenagers.

The problem has been aggravated by the economic difficulties and confusion that have accompanied the dismantling of the totalitarian state.

Malnutrition and crowded living conditions in Siberia, with much time spent indoors because of the harsh climate, make the population particularly vulnerable. Doctors are virtually helpless in treating the disease because of the collapse of the health structure, lack of funds to buy the right drugs, and inadequate knowledge of how to administer them.

Christopher Besse, head of the non-governmental agency Merlin (Medical Emergency Relief International), and a member of the team that visited Tomsk, described some of the methods which Siberian doctors have developed in desperate attempts at treating the disease. They include 'ultraviolet autotransfusion of irradiated blood': 'They tap some of the blood out of the arm, put it under an ultraviolet light, and then inject it back in again,' Dr Besse explains. 'They seem to think the light will help kill the bacteria.'

Another method is 'intrabronchial catheterisation' where a tube is inserted via the nose into the chest and large amounts of drugs are pumped in, while the patient is told not to cough.

'In the old days, the state used to supply everything,' Dr Besse says. 'With the arrival of the supposed market economy, like in Britain, hospitals now have to buy their own drugs. They can't afford them. They've also had to learn everything from scratch. There is no centralised system in Moscow to take care of things any more.' Even where the drugs are available, they are often administered incorrectly, he says.

Tomsk is an isolated city of 500,000 inhabitants. The site of one of Siberia's biggest nuclear installations, during the Cold War it was a closed city and a place of forced exile for political prisoners.

Siberia is the latest region in the world to suffer from the revival of tuberculosis, a disease doctors once thought could be eradicated. The World Health Organisation has recently declared TB to be a global health emergency that is expected to kill about 30 million people by 2004.

'It was downgraded as a priority becuse people thought they knew how to cure it,' said a WHO spokesman. 'That led to the neglect of TB as problem. It is now one of the most important diseases in the world.'

Last week Britain's minister for health, Baroness Cumberlege, disclosed that the Government was considering screening immigrants and refugees for TB in an effort to combat the return of the disease to Britain.