National vs. Global Perspective

Tuberculosis in Russian prisons affects both Russia and the rest of the world, though one might view tuberculosis in Russian prisons different that the other, here I compare and contrast the issue from Russia and the world's perspective.

Russia's Perspective:

• Government money needs to be allocated to expensive TB medicine in order to treat patients meaning there's less money for the prison to address other issues. Tuberculosis treatment costs approximately $2,000 per patient. Some of these funds come from taxes, so the Russian citizens are paying for the TB treatments of prisoners.
• Prisons risk losing staff because they become infected from prisoners, this costs more money to replace staff or leaves the prison short-staffed. Nurses that hand out the medication are separated by bars in order to be a bit farther from the patient to avoid sickness. 
• Infected prisoners are released back into Russia run a high risk of infecting others. Tuberculosis spreads through the air, as easily as a cold, so when someone with TB coughs in a confined space, the bacteria stay in the air for hours, so someone else can walk into the space hours later and find themselves infected with TB. 
• Prisoners often have MDR-TB which costs even more money to treat than regular tuberculosis, up to $250,000 dollars per patient, which costs the prison, or if the person is released, the victim's money.
• Prisoners sometimes die from TB. Russian prisoners are 28x more likely to die from the disease than the average Russian citizen and citizens risk losing their family or friends if they're in prison. 

Drugs used to treat TB. (From left to right) isoniazid, rifampin, pyrazinamide, and ethambutol

Global Perspective: 

• Prisoners released from Russian prisons don't just stay in Russia; they travel. By travelling they've spread tuberculosis to other countries. For example, a Russian man with tuberculosis traveled by plane to New York in order to be treated with medicine he viewed as more helpful. On the way their, he coughed on the plane and infected thirty-four passengers. 
• Some foreigners are less likely to travel to Russia there to avoid contracting the disease since it spreads from there. This can affect Russia negatively in an economic way but it can also negatively affect people outside of Russia who want to enter to visit family or stay for some other purpose.
• Other countries risk infection and mortality rates in their own countries when infected travel to their countries. Since some countries don't have access to TB treatments, their mortality rates are likely to be higher. 
• Other countries also have to decide what to do with infected patients (quarantine, allow to do as they please, etc.) and possibly how to help pay for treatments that not everyone can afford if the disease spreads to their country.

International Russian Airplane

Ethical Dilemma

I needed to create an ethical dilemma on the issue on which I chose, which was that Russian prisons are breeding grounds for tuberculosis. Here's the hypothetical scene that involves this issue:

On this day, a prisoner has finished serving their sentence and is waiting to be released. Before their release, their results from the prison clinic return and confirm that they have Tuberculosis. If the person is released from prison they're going to directly infect and kill seven other people through Tuberculosis, but if it's decided that the person should be isolated, it would have to be in prison with the other infected inmates to avoid the chance of spreading the disease through transporting the person. Due to the isolation with infected inmates, the person will never get better and will die in prison. Should we let the person go and infect and kill seven people? Or do we isolate the person in prison, effectively killing the prisoner even though the person has already served their time?

Information in support of release:

• http://www.youtube.com/watch?v=W-WumllRPLI (explains the evolution of tuberculosis in prisons and that it that might eventually give the person a more dangerous strand of tuberculosis)
• http://aspe.hhs.gov/hsp/prison2home02/haney.htm#II (psychological impact done by prison)
• http://www.who.int/mediacentre/factsheets/fs104/en/ (how deadly TB is (for the prisoner))

Information for on support of isolation:

• http://www.who.int/mediacentre/factsheets/fs104/en/ (how deadly TB is (for the population if the prisoner infects others))
• http://www.cdc.gov/TB/TOPIC/basics/default.htm (how TB spreads over the globe and country)
• http://www.youtube.com/watch?v=W-WumllRPLI (explains how easily TB spreads)

Impact of Tuberculosis in Russian Prisons

Impacts of Russian prisons being a breeding ground for tuberculosis:

Societal:

• Prisoners convicted of minor crimes are dying: Russian laws and codes are so severe that stealing a phone or "hooliganism" warrants prison time, so there are many Russian prisoners that are in for minor crimes. In these prisons, they have a 58x higher chance of catching the disease than the average Russian citizen, and are 38x more likely to die from it. As a result, many people who have committed minor crimes have essentially been given a death sentence; the punishment in these cases tends to not fit the crime.   
• Avoidance when released: Once the prisoners are released, and they have TB, they're still not really free. The prisoners are often confined to their homes to avoid spreading infection. They also seldom receive visitors apart from perhaps a nurse who would bring medicine, because TB spreads very easily. Someone infected with TB could cough in a room and the disease stays in the air, so someone could walk in a few hours later and be infected.
• Prisoners are quarantined: Inside the prisons, prisoners who are sick are all grouped together in one area to avoid spreading illness to the other prisoners. This isolates the prisoners even further, they are surrounded by death and are given their medicine between bars. This can have a detrimental effect on the minds and bodies of the prisoners.
• Government money needs to be allocated to expensive TB medicine in order to treat patients meaning there's less money for the prison to address other issues. Tuberculosis treatment costs approximately $2,000 per patient and up to $250,000 if it's MDR-TB. Some of these funds come from taxes, so the Russian citizens are paying for the TB treatments of prisoners.

Separation between nurse and prisoner

Environmental:

• Russian prisoners are creating a new type of tuberculosis: Russian prisons are a place where Multidrug-Resistant Tuberculosis (MDR-TB). Due to faulty health care or improperly treated TB, a mild case of tuberculosis can become harder to treat by becoming MDR-TB. The medicine prisoners are given is designed to cure them, and the more they take it the better they're supposed to get, but sometimes this doesn't happen. The first few doses get rid of most of the TB bacteria, but if the medication isn't correct or the prisoners stops taking their medication because they feel better, the only bacteria left are the ones resistant to the drug. Those multiply and create an even deadlier type of TB: Multidrug-Resistant, which is much more expensive and difficult to treat. In some cases, people need to take 20 pills a day for years in order to be rid of the disease. This disease doesn't just affect prisoners, since the disease spreads outside of prison, people everywhere can contract MDR-TB.
• The sick stay sick: Russian prisoners with TB are all quarantined together, this includes the time while they're taking medication. You can catch TB more than once, so it's almost impossible to fully recover in quarantine because once you feel better, someone can just cough and infect you once more. In 2004, prisoners accounted for 12% of Russia's TB cases. 
• Russian prisoners are infecting the population: Prisoners are very likely to catch TB in prison, and once their sentence is up they're released back into Russia where they, and other faculty from the prison can spread the disease. They can also go to other countries and have infected people in that way. Tuberculosis spreads very easily, for instance, one man took a flight from Russia to New York in order to access better medication, but he coughed on his plane flight. As a result of a cough, thirty-four people on the flight were infected with TB.

Lungs with TB (left) vs. healthy lungs (right)

Tuberculosis in Russian Prisons

I changed my mind about the disease and issue I was going to focus on. Originally I was going to focus on how only the U.S. and Russia have vials of Smallpox and whether or not we should keep them, but that wasn't really a problem I could make an ethical situation out of. Instead, I'm going to be focusing on how Russian prisons are a breeding ground for tuberculosis.

Smallpox

Recently I received a new assessment about how specialized roles affect a greater organization. I have to pick a pathogen that my Sophomore class has discussed so far this year causing a current issue; I decided to research Smallpox, the disease I had been researching recently for my paper in Humanities.