Few young doctors in my own country France would currently wish to specialize in phtisiology. Actually, and for over 30 years, the word “phtisiology” had disappeared from the letterheads of lung diseases divisions in hospitals. The focus of pneumology these days is on chronic lung disease and cancer much more than on tuberculosis (TB).
So it came as a surprise to me to hear medical students in Tashkent, Uzbekistan’s capital city, claiming in a unanimous voice that they see “phtisiology” as the most exciting professional future they wish to consider at the end of their studies.
Earlier this year I visited the Republican Scientific and Practical Centre of Phtisiology and Pulmonology in Tashkent as part of a broader mission devoted to HIV/AIDS, TB and Multi- Drug Resistant Tuberculosis (MDR-TB) in the country.
The Institute is a large campus with an adult in-patient facility of 800 beds or so, ambulatory sections, a pediatric section, remarkable laboratory and imaging facilities, and access to most of the latest technologies and structural hospital requirements for TB and MDR-TB. Professor Tillyashaikhov Nigmatovich, the Head of the Institute, can rightly be proud of this institution, the reference point for TB in the country.
On the other hand it is at the same time somewhat unsettling to discover why Uzbekistan has built an institution such as the Centre of Phtisiology and Pulmonology and why young doctors perceive TB care as an attractive and contemporary field of medicine.
Uzbekistan is one of the high burden countries for TB globally and one of the 27 high burden countries for MDR-TB in the world. The number of new MDR-TB cases annually is close to 9000 cases, with 15 per cent of newly diagnosed TB cases being resistant to at least two conventional TB drugs.
And that is the case in almost all countries in Eastern Europe and Central Asia. The World Health Organization’s Euro Bureau reports that fifteen countries in the region are among the high burden countries for MDR-TB in the world, which leaves only very few of the countries out of that list.
Although new technologies are now available to diagnose TB and test for TB drug susceptibility / resistance, the reality is that less than 50 per cent of the estimated new cases of MDR-TB are diagnosed across the region. And only half or less of those patients in need of treatment are actually treated and cured. Those who are not treated remain contagious and they also die. This nothing short of a crisis, one we have to stop neglecting.
One other episode struck me at that hospital in Tashkent. As I entered the room where doctors and students were examining X-Ray and CT scans of patients in the ward, I saw an X-Ray of a diffuse form of pulmonary TB and asked about the physician in charge about the patient’s story. He was a young man in his late twenties who had traveled to Saint Petersburg seeking a job as waiter in one of the growing number of fashionable restaurants in the city. The TB was diagnosed on systematic X-Ray screening and he was immediately sent back to Uzbekistan for treatment. The CT scan from another patient showed a nodular form of pulmonary TB. This was another young man of similar age who was diagnosed upon systematic screening as he was enrolling in a University program in Almaty, Kazakhstan. He also returned shortly after the diagnosis to Tashkent for care.
Migration is a major issue in this region that sees so many students and sees millions of workers move every year in between countries in the region, with a lot of movement to Russia. Migration is a key issue in terms of public health but one that demands asensitive response given it touches on a fragile intersection of the economic, human rights and political arenas in a region where no transborder agreement on the provision of treatment for AIDS and TB currently exist. Tuberculosis is at a crisis point in Eastern Europe and Central Asia and it is a crisis that the West can no longer afford to ignore and it is my hope that the issue begins to receive the attention it deserves at international forums such as the upcoming 45th Union World Conference on Lung Health in Barcelona.