The Consumption Problem in Ukraine

Into his adulthood, grandfather had three siblings--two sisters and a brother. 

One sister got married to a local attorney in Sengottai.  Not too long after that, she was diagnosed with one of the most dreaded diseases of those days: tuberculosis. This was way back early in the 1940s and true to its other name of "consumption" the disease killed her. 

The brother, who was in his early twenties, also fell ill.  Yes, the same dreaded tuberculosis.  Soon, he was also gone. 

Grandfather was now left with only one sister.

A few years later, my grandparents celebrated the wedding of their first daughter--my mother.  A couple of months after the joyful day, my mother was diagnosed with tuberculosis.  Fortunately for her (otherwise, I would not have been born either!) science and medicine came to the rescue.

India has not eliminated tuberculosis.  But, what I did not know until I heard on NPR is this:

TB — a serious bacterial infection of the lungs — is a big problem in Ukraine. According to the World Health Organization, the country has the fourth highest incidence of the disease in Europe. And it has one of the highest rates of multidrug resistant TB anywhere in the world.

Anywhere in the world.  Even worse than India is Ukraine's rate of multidrug resistance TB!

Once we know this, it does not take a brainiac then to worry about the war's impact on the refugees and the internally displaced, and the countries that take in the refugees.

This briefing in Nature notes that "an estimated 32,000 people there develop active TB each year, and about one-third of all new TB cases are drug resistant."  In such a context:

Drug-resistant TB arises when people don’t adhere to their arduous regimen of daily drugs. “If you have TB or HIV, no one has time to get their treatment and run with it, they barely have time to get their kids and run,” says Papowitz. “Any interruption of treatment will lead to drug-resistant TB, including MDR TB,” Ditiu says. “After 5 years without treatment, 50% of people with pulmonary TB can die. Meanwhile, you infect many others around you.”

The supply chain crisis affecting new home construction in this country pales against such problems!

European public health experts are well aware of this:

Meanwhile, with more than 3 million people having fled the country since the start of the invasion, the risk of TB among refugees has also come into focus. In a report released earlier this month, the European Centre for Disease Prevention and Control (ECDC) urged Ukraine's neighbouring states to ensure refugees had access to health-care services to help in the early detection of infectious diseases. 

Teymur Noori, ECDC expert in migrant health, said the organisation was “worried about TB, especially MDR-TB” among refugees but stressed the institution's recommendations were made with refugees, not local populations, in mind.

How did Ukraine become a country with so many TB cases?

It dates back to the collapse of the Soviet Union.  Across the entire region, most former republics of USSR faced a collapsing economy and society, from which they had to rebuild.

Unemployment soared. Crime escalated, which sent a lot of people to prison. And that created a kind of "epidemiological pump," says Dr. Salmaan Keshavjee, director of the Center for Global Health Delivery at Harvard Medical School. 

"Some people had TB," he explains. "It spread in the jails and in the prisons. And then they went back to their community, of course, when they were released. So the TB also went back to the communities."

I, for one, had no idea that TB continues to worry even a country like Ukraine.