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3:44 pm
Tue July 9, 2013

'Sputnik' Orbits A Russian City, Finding And Healing Tuberculosis

Originally published on Thu July 11, 2013 8:33 am

Russia is confronting one of its most serious public health threats since the collapse of the Soviet Union. The threat is tuberculosis, but with a dangerous twist: Strains of the bacteria are widely circulating that are resistant to ordinary anti-TB drugs, and far harder to cure.

In parts of Siberia, nearly 30 percent of all tuberculosis cases aren't treatable by two of the most potent medications, the World Health Organization reported last year.

One Siberian city is tackling the problem with an innovative health program, called Sputnik, affectionately named after the first man-made satellite launched by the Soviet Union in 1957. The new Sputnik is a mobile clinic; teams of nurses orbit like satellites around the sprawling city of Tomsk, finding and treating patients with drug-resistant TB.

The program is a joint effort between Russia's Health Ministry and the American nonprofit Partners in Health. It's the first mobile TB clinic of its kind, and it allows health workers to fight the disease among the people who are the hardest to reach — the homeless, the mentally ill and drug addicts.

It's a job that's often uncomfortable and, sometimes, not completely safe.

"My parents worry about me in this job," says Yulia Safronova, a nurse affiliated with Sputnik, "not so much because I might catch tuberculosis. But I tell them what sort of patients I have to work with. Maybe that worries them more:"

Safronova's patients all have one thing in common: They can't or won't go to the hospital.

"Have you actually seen a hospital?" Olesia Tarazanova asks. "They've got drunks, dope addicts, ex-cons, crooks. I don't even drink. Why should I stay in a hospital with people like that?"

Tarazanova, 24, is a wisp of a woman with bleached-blond hair, holding her nearly 2-year-old son by the hand.

She meets the health team in their car on the street near her apartment, gets into the back seat, and takes a handful of pills that Safronova doles out from a black gym bag on her lap.

Tarazanova has been in treatment for TB for almost two years, she says. If all goes as planned, she'll complete it in a couple of months.

Safronova rides with driver Sergei Goryunov, who left a safer job seven years ago to work for the Sputnik program. Goryunov is a big man and capable of acting as a bodyguard for the nurses when he needs to.

"I like talking with the patients," he says, grinning. "I like to play tricks on them, joke with them. It's interesting for me, hanging out with alcoholics and drug addicts."

Members of the Sputnik crew spend a lot of their time bumping along rutted roads on the edges of this industrial town, with its oil companies and petrochemical plant.

Drug-resistant tuberculosis is a growing problem in Tomsk. People with the infection often have to take as many as 18 pills daily — including some to relieve the side effects of TB medications, which include psychosis, severe nausea and hearing loss.

Some patients get fed up with their treatment before it is complete. They resist, they hide, they lock their doors to avoid the Sputnik team.

But if the treatment is interrupted, it can give the tuberculosis bacteria a chance to recover and develop more resistance. Safronova and Goryunov often have to cajole people into taking the medication.

The next patient, Sergei Gaptenko, lives with his father in a weathered, run-down house. He's a sometime electrician in his mid-40s, and an alcoholic. He wants to know when scientists will invent something that will cure his multiple-drug-resistant TB in one go.

The nurse Safronova sets out a plateful of pills — just half of Gaptenko's daily dose. Another nurse will come by in the afternoon with the rest.

Gaptenko says he has to stay home to take care of his father, also an alcoholic. That's the main reason he's not in a TB hospital, although he too insists that most patients in the state hospitals are criminals.

Both men are on pensions, Safronova says. When they get their money, they "drink it up," and then Gaptenko becomes a difficult patient, hard to find and uncooperative.

But because of Sputnik, both Gaptenko and his father are getting treatment.

Sputnik is only one of many ways that the city is fighting drug-resistant TB, but it's a crucial one, says Alexander Barnashov, a head physician at the Tomsk Health Department. "If this program didn't exist, there would be a lot more people in Tomsk, in Russia and even in America who could be walking around and infecting others with one of the most dangerous forms of tuberculosis."

The success of Sputnik has prompted other Russian cities to start programs of their own, Barnashov says. Delegations visit from other parts of the country and abroad to learn how it works.

But Sputnik could be in danger, he says.

The Russian government recently imposed a law that requires nonprofits that receive funding from outside Russia to register as "foreign agents." That label is practically equivalent to the word "spy" in Russia. Thousands of charities and other groups around the country have been raided by investigators, demanding to see their records.

So far, Partners in Health hasn't been affected. And the Sputnik team continues rounds its throughout the city.

Safronova admits she might even like her job, although it doesn't pay well. "You know what to expect from the patients, what sort of people they are, and you see them differently, not the way an outsider would," she explains.

And that's what Sputnik seems to be — an irregular orbit for patients who can be treated only by someone who takes the time to really see them.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

AUDIE CORNISH, HOST:

This is ALL THINGS CONSIDERED from NPR News. I'm Audie Cornish.

ROBERT SIEGEL, HOST:

And I'm Robert Siegel.

Russia is confronting one of the most serious public health threats since the collapse of the Soviet Union. It's tuberculosis with an especially dangerous twist: strains of TB that are resistant to ordinary TB fighting drugs and far harder to cure. There is a program that aims to fight TB among people who are beyond the reach of conventional medicine. And NPR's Corey Flintoff went to the Siberian city of Tomsk to learn about it.

YULIA SAFRONOVA: (Through Translator) My name is Yulia Safronova. I'm a nurse in Tomsk. What can I tell you about my job? I work in the Sputnik program.

COREY FLINTOFF, BYLINE: The name Sputnik is one of those Russian words that's very familiar to Americans of a certain age. It means satellite, and Yulia orbits like a satellite around the Siberian city of Tomsk, treating TB patients who might otherwise go unnoticed.

SAFRONOVA: (Through Translator) My parents worry about me in this job, not so much because I might catch TB. But I tell them what sort of patients I have to work with. Maybe that worries them more.

FLINTOFF: Yulia's patients have complicated situations: alcoholism, drug addiction, mental problems and sometimes just an aversion to authority. They all have one thing in common. They can't or won't go to a hospital.

OLESIA TARAZANOVA: (Through Translator) Have you actually seen a hospital? They've got drunks, dope addicts, convicts, crooks. Why should I - I don't even drink - why should I stay in a hospital with people like that?

FLINTOFF: Olesia Tarazanova is 24, a wisp of a woman with bleached-blonde hair, holding her nearly 2-year-old son by the hand.

She meets the car on the street near her apartment, gets into the back seat, and takes a handful of pills that Yulia doles out from a black gym bag on her lap. Tarazanova has been in treatment for TB for almost two years, she says. She's due to finish in just a couple of more months. Yulia rides with driver Sergei Goryunov, who left a safer job seven years ago to work for the Sputnik program.

SERGEI GORYUNOV: (Through Translator) As it turned out, Sputnik was my thing. I like talking with the patients. I like to play tricks on them, joke with them. It's interesting for me hanging out with alcoholics and drug addicts.

FLINTOFF: Sergei and Yulia spend a lot of their time jolting along rutted roads on the edges of this industrial town, with its oil companies and petrochemical plant. Now, in the chilly Siberian spring, some roads are sluggish rivers of mud. The next patient, Sergei Gaptenko, lives with his father in a weathered, run-down house. Drug-resistant tuberculosis is a growing problem here. People who have it often have to take as many as 18 pills and capsules a day, some to combat the disease and some to relieve the side effects of treatment.

Some patients get fed up with taking the medications before their treatment is complete. They resist. They hide. They lock their doors to avoid the Sputnik team. Sergei and Yulia have to cajole them into taking the medication. If the treatment is interrupted, it can give the tuberculosis bacilli a chance to recover and develop resistance to the drugs. Gaptenko wants to know when scientists will invent something that will cure his multiple drug-resistant TB in one go.

SERGEI GAPTENKO: (Foreign language spoken)

FLINTOFF: He's a sometime electrician in his mid-40s and an alcoholic. Yulia sets out a plateful of pills and capsules, half of Gaptenko's daily dose. Another nurse will come by in the afternoon with the rest. He doesn't know, he says, how he got infected with TB. Maybe he drank from the same glass of someone who had it.

UNIDENTIFIED MAN #1: (Foreign language spoken)

GAPTENKO: (Foreign language spoken)

UNIDENTIFIED MAN #1: (Foreign language spoken)

FLINTOFF: You can catch it riding on a trolleybus, his father says. Gaptenko says he has to stay home to take care of his father, also an alcoholic. That's the main reason he's not in a TB hospital, although he, too, insists that most patients in the state hospitals are criminals. Both men are on pensions, Yulia says. When they get their money, they drink it up, and then Gaptenko becomes a difficult patient, hard to find and uncooperative when they do pin him down.

The Sputnik program is a joint effort between the U.S.-based NGO Partners In Health and Russia's health ministry. Dr. Alexander Barnashov manages the administrative connection between Partners In Health and the Tomsk Health Department where he is a deputy head physician.

DR. ALEXANDER BARNASHOV: (Foreign language spoken)

FLINTOFF: He says the field treatment program here in Tomsk was the first of its kind in Russia. Now, delegations come here from other parts of the country and abroad to learn how it works. Barnashov says Sputnik programs have now been started in some other Russian cities. It's only one of many ways that TB is being fought, but it's a crucial one, he says.

BARNASHOV: (Foreign language spoken)

FLINTOFF: If this program didn't exist, Barnashov says, there would be a lot more people in Tomsk, in Russia and even in America who could be walking around and infecting others with one of the most dangerous forms of tuberculosis. But this public health program could be in danger. The Russian government recently imposed a law that says NGOs that receive funding from abroad must register as foreign agents. It's a label that, in Russia, is practically equivalent to the word spy.

Thousands of charities and civil society groups around the country have been raided by investigators, demanding to see their records. Critics say it's a way for the government to crack down on political dissent. So far, Partners In Health hasn't been affected.

UNIDENTIFIED MAN #2: (Foreign language spoken)

FLINTOFF: Back in the car, Yulia and Sergei continue their rounds, meeting patients on the streets, in shacks and shabby apartment blocks. Yulia says she's thought about leaving nursing. It doesn't pay very well.

SAFRONOVA: (Through Translator) But since I've been working here for 12 or, now, 13 years, then maybe I like it since I stay here at this job. You get used to these patients. You know what to expect from them, what sort of people they are, and you see them differently, not the way an outsider would.

FLINTOFF: And that's what Sputnik seems to be: an irregular orbit for patients who can only be treated by someone who sees them differently. Corey Flintoff, NPR News. Transcript provided by NPR, Copyright NPR.

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