Tough measures in Russian prisons slow spread of TB.

When Russian billionaire Mikhail Khodorkovsky was sent last October to a remote Siberian labour camp near a uranium mine to serve an eightlyear fraud and tax evasion sentence, friends and relatives accused the Kremlin of trying to ruin his health. Yet Anatoly Rusin, who was released from prison last year, told the Bulletin that Khodorl kovsky had better worry about a far less exotic threat to his health. “I have not heard of inmates dying of radiation, but I have seen them die of TB,” Rusin said. Until the 1990s, Soviet authorities kept tuberculosis (TB) unl der control. With the collapse of the Soviet Union, falling living standards, mass migration and a crumbling health system contributed to a 7.5% annual increase in new cases from 1991 to 1999. Professor Margarita Shilova, Head of the Tuberculosis Epidemiology Department at Moscow’s Phthisiopull monology Research Institute, recalls those days with horror. “Suddenly, the money stopped. There were no drugs, communication with local hospitals broke down as telel phones were cut off over unpaid bills, there were no stamps or envelopes to send letters, doctors could not use a car to see their patients, it was impossible to transport patients to hospitals, the system broke down,” Shilova said. “Discipline among patients and doctors — which is key to treating the disease — was no longer there,” she told the Bulletin. By the end of the 1990s, tuberl culosis had reached alarming proporl tions, particularly in the country’s vast penal system. Virtually every prisoner was exposed to tuberculosis. Many became sick, many died, and thousands of I have not heard of inmates dying of radiation, but I have seen them die of TB.