In the last hundred years there have been three tuberculosis epidemics: in 1936 (after the Holodomor), 1947 (after the war), and 1995 (after perestroika). While in the first two cases the disease was subdued after a year or two, the last epidemic has lasted for over 12 years. At a time when Ukraine is preparing to become a developed European country every single hour one Ukrainian dies and four people fall ill with TB. Statistics show that in recent years, instead of decreasing, the number of people stricken with TB has increased by 2.4 times. Forty-three percent of them are temporarily unemployed able-bodied people, and 13.6 percent are pensioners.
“The underprivileged, homeless people, and ex-convicts are the most vulnerable groups. This is a social rather than medical problem,” says Minister of Labor and Social Policy Mykhailo Papiiev. “To overcome tuberculosis, the first thing we need to do is to boost the standard of living in Ukraine and set up more shelters and social rehabilitation centers for homeless people and ex-convicts. This is because former prisoners, drug addicts, and HIV/AIDS victims, i.e., risk groups, do not have access to medical aid and mass media that warn about the danger.”
The minister believes that in order to improve the financing of anti-tuberculosis programs, Article 90, Point 4 of the State Budget of Ukraine needs to be amended so that social projects are funded from the state budget rather than from meager local budgets. It is also necessary to involve public organizations of which Ukraine has an overabundance (38,000).
Viktor Korzh, Minister for Family, Youth, and Sport and a doctor by profession, is convinced that health and a healthy lifestyle can save the nation from this poverty-linked epidemic. He offers the following statistics: a mere 13 percent of children have access to a network of sports schools; 80 percent of Ukrainians cannot swim; only 400 out of 7,400 swimming pools exist in the country. He has assured that Ukraine will soon have more sports schools, children’s playgrounds, and new stadiums.
But top government officials have promised Ukrainians all kinds of things. The powers that be predict welfare and prosperity for the people, but in practice everything turns out differently.
“A serious problem that is helping the spread of tuberculosis is that children and teenagers become accustomed to tobacco and alcohol early in life. Cigarette, beer, and vodka ads are contributing to this. The most terrible thing is that such famous athletes as Vitali Klitschko and Andrii Shevchenko appear in commercials, thereby creating a link in children’s minds that their success is connected to the consumption of beer. Look at the ads for Khortytsia Vodka, which are appearing in the context of fostering the development of sports in Ukraine! This is why we are planning to launch a social ad campaign in which well-known Ukrainians will be promoting a healthy lifestyle,” says Korzh.
Deputy Minister of Health Valerii Ivasiuk is convinced that tuberculosis is a medical as well as social problem and that it is stalled by delayed diagnoses of the disease.
“In 1936 and 1937 medical science had only streptomycin to overcome this dangerous disease. Now the main problem lies in setting up a system of early diagnostics and adequate social support for patients who test positive for the Mantoux skin test for TB. Before the BCG (Calmette-Guerin bacillus) vaccine was introduced as a preventive measure, tuberculosis was considered a social disease, but now it is more medical. When we began studying the question of why the tuberculosis epidemic has gotten out of hand in our country, it turned out that the Kharkiv-based manufacturer of BCG is producing a vaccine based on a 40-year-old tuberculosis bacillus. This strain has been irrelevant in Ukraine for at least 20 years. What are we vaccinating people with then? The Ministry of Public Health and MPs need to consider who benefits from the sale of poor-quality BCG vaccine in Kharkiv,” Ivasiuk said indignantly.
On the positive side, he noted, a system of mobile X-ray machines was launched this year. It has helped check elderly villagers, who are unable to come to raion centers. The results were shocking: out of 100 people one person had TB and 70 had nonspecific lung diseases that herald this disease. In Ivasiuk’s opinion, the anti-tuberculosis service must be reinforced to be able to combat tuberculosis effectively. High professional risk and low salaries have caused a serious shortage of personnel in this area. To resolve this problem, tuberculosis specialists need to be offered much higher salaries and housing. The deputy minister is also convinced that to stop the epidemic, a law has to be passed requiring forcible treatment and patient isolation until they are fully recovered.
Specialists list a number of key factors in the spread of TB: the population is inadequately informed, people in risk groups have limited access to treatment, the system of purchasing anti- tuberculosis medicine is imperfect and lacks transparency, delayed diagnosis, the epidemic of HIV/AIDS in Ukraine, the high rate of tuberculosis in the penitentiary system, and, of course, the under-financing of anti-epidemic programs.
All these obstacles on the path to creating a healthy nation can be overcome if the state and public organizations join efforts with people who should feel a sense of responsibility for their own health.
