TB: When the Barriers to Care Are Too High
By Kathleen Kingsbury
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Every year thousands of Ukrainians learn they are living with both HIV and tuberculosis. Kolya, 31, is one of them. For many patients, this dual diagnosis is a death sentence, and doctors at a Mariupol TB clinic have given Kolya little chance of recovery. © World Health Organization/Misha Friedman -
Drug addiction compounds the risk of contracting TB, HIV or hepatitis C. This woman has just injected herself with acetylated opium. Most drugs in eastern Ukraine are easy to find. © World Health Organization/Misha Friedman -
Those TB patients who also take methadone or buprenorphine frequently must leave the TB clinic to travel daily to receive their opiate substitution therapy. In Makeevka, even severely sick patients are required to walk across the road. © World Health Organization/Misha Friedman -
Roza, an outreach worker, kneels in order to counsel Katya, a 37-year-old drug user in Donetsk who is living with HIV and possibly TB. Her legs are scarred from using used needles to inject drugs. Peer outreach workers are the best hope for reaching drug users and convincing them to accept medical help. © World Health Organization/Misha Friedman -
Even when patients are diagnosed with TB, barriers to health are enormous. A seriously ill patient (left), sitting in a ward in Mariupol. is living with HIV, has hepatitis and drug-resistant tuberculosis and uses intravenous drugs. © World Health Organization/Misha Friedman -
People who use drugs are especially under-diagnosed in Ukraine, usually out of fear that doctors will report their drug use to police. Often, TB cases go undiagnosed until it is too late for them to be effectively treated. © World Health Organization/Misha Friedman -
Two fellow patients at a Donetsk clinic assist an older patient. Medical facilities are understaffed. TB patients rely on outreach workers or local NGOs for support. There are no government-paid psychologists on staff in TB clinics in Ukraine. © World Health Organization/Misha Friedman -
Hospital equipment can be outdated. The laundry woman at a TB clinic in Donetsk says the washing machine jokes it is as old as she is—it is used to clean the laundry of 150 in-patients. © World Health Organization/Misha Friedman -
Vladimir (left) and his wife Tatiana play with their son David. They are both former injection drug users and HIV positive. Today, the couple helps other people in Donetsk quit drugs as a psychologist and an outreach worker at a local NGO. Vladimir has also recovered from TB. © World Health Organization/Misha Friedman -
For most drug users in Ukraine, there isn't a happy ending. At a TB clinic outside Donetsk a doctor checks Andrei for signs of life and finds none. He had checked himself into the hospital three days ago. A drug user of many years, he has died at the age 46 from HIV-associated drug-resistant tuberculosis. © World Health Organization/Misha Friedman
Nearly 50,000 Ukrainians are diagnosed with tuberculosis each year, and research suggests that as many as 20 percent of those diagnosed are also living with HIV or AIDS. Drug use not only makes adherence to medication difficult, but also hampers getting quality health care in general. In January 2011, photojournalist Misha Friedman traveled to eastern Ukraine to document the unique challenges that tuberculosis patients in the region face to access treatment.
March 24 is World Tuberculosis Day, an annual event to raise public awareness and remember the 1.6 million people who die of TB each year. To mark the occasion, the Open Society Public Health Program presents a series of blog posts on the struggles of TB patients in Ukraine, especially among the country’s 400,000 citizens who use drugs. This is the first entry.
Misha Friedman is the winner of the 2010 edition of the Images to Stop Tuberculosis Photo Award, organized by the Stop TB Partnership.
Until October 2011, Kathleen Kingsbury was a program officer for communications with the International Harm Reduction Development Program, a part of the Open Society Public Health Program.