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Moldova Grapples With Whether To Isolate TB Patients


This is MORNING EDITION, from NPR News. I'm Linda Wertheimer.


And I'm Renee Montagne. We heard yesterday about efforts here in the U.S. to fight tuberculosis, often successfully. But in many parts of the world, tuberculosis is not only out of control, the germ is becoming even more dangerous. Strains of TB have emerged that are difficult, if not impossible to treat.

WERTHEIMER: It's reviving an old debate about tuberculosis, whether it's better to isolate patients in a sanatorium or treat them at home. One country grappling with this issue is the former Soviet Republic of Moldova. We continue our series on tuberculosis with this report by NPR's Jason Beaubien.


JASON BEAUBIEN, BYLINE: A chilly breeze drifts through the children's ward of a tuberculosis hospital in northern Moldova. Despite the cold weather, the windows are open slightly to try to sweep airborne tuberculosis bacteria out of the building. The children being treated here are bundled in sweaters. Coarse wool blankets are stretched across the rows of single beds. Dr. Ala Ivanova says the young patients live here for extended periods of time.

DR. ALA IVANOVA: (Foreign language spoken) The shortest period here is two months. The longest period could be six, eight months or a year.

BEAUBIEN: It's lunch time on the ward. The kids range in age from five to 16 years old. They're clustered around wooden tables in the dining area. One teenager sits with a young girl in her lap. Most of the staff wear white surgical masks, but none of the patients do. Some politicians and public health officials in Moldova - including the head of the local health department - believe the country needs more hospitals like this one to deal with the burgeoning problem of multi-drug-resistant tuberculosis.

But there's a growing argument that places like this actually fuel the spread of MDR TB. For example, the head of the children's ward is out sick with tuberculosis.

ANDREI MOSHNEAGA: There is increasing evidence that one of the key factors contributing to that high rate of MDR are actually TB hospitals.

BEAUBIEN: Andrei Moshneaga is with the Center for Health Policy and Studies in Moldova, which works closely with non-profit TB treatment providers in the country.

MOSHNEAGA: Nowhere in the world are there so many TB hospitals or so many TB beds as we have in this region.

BEAUBIEN: Moldova's TB hospital system is a holdover from the days of the Soviet Union. Under the Soviets, patients were housed, treated and detained at sprawling, campus-like TB facilities. Moshneaga says the problem now is that the TB hospitals have fallen into disrepair. There's poor infection control, and drug resistant strains of TB can end up spreading rapidly in the wards.

MOSHNEAGA: The TB hospitals should be closed as soon as possible, and the outpatient treatment should be promoted - not only to save money, but also to prevent the further development of MDR TB.

BEAUBIEN: Roughly 40 percent of tuberculosis cases in Moldova are now classified as multi-drug resistant, and MDR TB can be extremely difficult to treat. Patients have to take up to 25 pills a day. The medications have powerful side effects. Some patients go deaf. Others go insane. The treatment can last up to two years, and it's expensive.

Treating a single drug-resistant TB case in the U.S. or Western Europe can cost hundreds of thousands of dollars, mainly because patients are kept in medical isolation. The bill is not nearly so high in Moldova's overcrowded TB wards, but it still puts a heavy burden on this impoverished nation's health care system.

Moshneaga says once patients have started taking their medicine regularly, they pose little risk of transmitting the disease, and they can be cured as easily at home as in a hospital.


BEAUBIEN: The World Health Organization recommends using a system called Directly Observed Treatment for TB patients. The idea is that a health care professional, a social worker, somebody watches the patient take his or her daily medication. And there are efforts underway to do this in Moldova.


BEAUBIEN: Galina Zoporojan is a volunteer with a TB support group called Speranta Terrei in the Moldovan city of Balti. She's walking up the steps of a ramshackle wooden house on the outskirts of the city to deliver medicine to a 62-year-old TB patient. It's 9 am on a Tuesday morning, but the woman is already completely drunk and doesn't want to take her pills.

UNIDENTIFIED WOMAN: (Foreign language spoken)

ZOPOROJAN: (Foreign language spoken)

BEAUBIEN: Zoporojan is a music teacher by profession. She has no tolerance for children who fail to practice or drunks who refuse to take their medicine. Zoporojan started volunteering to deliver medicine to TB patients at their homes after her own son was sick with the disease. She gets a stipend of just $8 a month for delivering drugs to four patients every day of the week except Sunday.

Volunteers like Zoporojan offer a low-tech, inexpensive, yet highly effective way to get TB patients to follow their medical regimens. She may represent the future of tuberculosis treatment in Eastern Europe and other places grappling with the rising burden of drug resistant TB.

Jason Beaubien, NPR News. Transcript provided by NPR, Copyright NPR.

Jason Beaubien is NPR's Global Health and Development Correspondent on the Science Desk.
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