Fighting Tuberculosis: Western Myths and Belarusian Reality
A Belarus TB hospital patient in 2011
Last week, Mario Raviglione, director of WHO's Global TB Programme, singled out Belarus and parts of Russia as being part of a developing "disaster situation" due to the high rates of multi-drug resistant tuberculosis.
He warned that migrants from these countries pose a threat to Western Europe, where multi-drug resistant tuberculosis (MDR-TB) is exceedingly rare.
The good news is that these fears are exaggerated. Research indicates that post-Soviet migrants account for a mere 1.7% of TB incidence across the EU border.
What is more, Belarus may pose less risk to Europe than countries like Moldova, where overall TB rates (although not MDR-TB rates) are more than twice as high. Unlike Belarusians, Moldovans no longer need to obtain Schengen visas for short-term visits.
Research to date suggests that imposing medical testing requirements for long-term visa applicants from post-Soviet states, a practice followed by many western countries, leads to nothing but stress and bills for the applicants.
Why MDR-TB is a Public Health Emergency
Belarus still has much to worry about. Between 1990 and 2000, TB incidents nearly tripled. Alarmingly, one third of the newly diagnosed and two thirds of returning TB patients have MDR-TB.
This is the highest MDR-TB rate ever documented in the world. MDR-TB infections continue to grow, despite significant efforts to curb them.
MDR-TB is a form of TB resistant to at the least two of the most powerful drugs currently available.
With ordinary TB, patients get better after a few weeks or months on mainstream antibiotics. With MDR-TB, patients require second-line drugs, which are much more expensive and less effective. Fewer than half of MDR-TB patients are ever cured.
High incidence of MDR-TB speaks to the poor management of TB patients. Drug resistance evolves when patients receive some treatment, but are not cured completely, for example, because they forget to take their medicine, leave treatment programmes early, or take the wrong drugs. MDR-TB strains can then easily spread to other people.
MDR-TB and Belarus Healthcare System
At first glance, Belarus’s health care system has performed reasonably well. The WHO ranks it 53rd out of 190 countries, which is the highest ranking in the CIS. The number of per capita hospital beds and per capita physicians in Belarus is much higher than in the West.
However, Belarus continues to use technologically backward practises, ones common to all countries of the former Soviet Union, which may have contributed to the alarming rates of MDR-TB incidences.
All of these countries used to conduct annual mass screening through tuberculin skin testing, which is considered an ineffective and costly diagnosis method. None of them maintained electronic databases of their TB patients.
More alarmingly, noninfectious TB patients were often unnecessarily treated in hospitals and involuntarily isolated. This not only burdened the health care system financially, but also imposed a psychological and physical burden on the patients.
Living conditions in Belarusian TB hospitals are often deplorable, which undermines any potential treatment objectives and encourages the infected to avoid hospitalisation. In several instances, TB patients went on hunger strikes to protest hospital conditions.
Perhaps the best known case was a 2011 hunger strike by the activist of the Belarusian Christian-Democratic Party, Valery Gancharenka, who was treated at the Bogushev TB hospital. The strike prompted an investigation by the human rights organisation Viasna.
Viasna found that the hospital had seen no renovations since the 1960s. The walls were reportedly covered in mould; the facility had no running hot water throughout the year. Similar conditions were reported in two other provincial TB hospitals in 2008 and in 2010.
Halting Progress in TB Treatment
With some guidance from international organisations, Belarus’ TB programme has reached several important milestones. Among other things, Belarus revised its TB and MDR-TB treatment and control guidelines and reorganised its national laboratory network. It also integrated TB care into primary health care and increased the level of supervision for facilities delivering TB services.
However, significant challenges remain. Despite substantial financial infusions, funding for tuberculosis and other social diseases remains limited.
2011 Currency devaluation made imported equipment prohibitively expensive. Salary of health workers involved in TB care remains low and does not reflect occupational risk. Doctors and nurses lack financial incentives to be involved in TB care and provide high-quality assistance to patients.
As part of its Soviet era inheritance, the current Belarusian health care system is centralised. The ultimate management power lies within the central government. Even so, TB planning has been conducted at the rayon (district) level and taxes are collected locally. This produces imbalances in the quality of care and issues with funding, which regularly dries up. Greater centralisation could allow for the pooling of resources and distributing them more effectively.
TB and the Politics of Exclusion
TB bacteria can lie dormant for months and even years, causing no illness in most of the infected. If the infected move to another country, there is some risk that the latent disease will develop into active TB in the first few years after immigration.
To guard against this possibility, many western nations require applicants from the former Soviet Union to undergo TB screening prior to applying for a long-term visa. This year, the United Kingdom introduced TB screening requirement for long-term visa applicants from Belarus. The recent WHO warnings may encourage other countries to impose a similar requirement.
However, a 2013 study by the researchers at the European Centre for Disease Prevention and Control focused on the 10 EU countries at the EU’s Eastern border has shown that in 2010 a mere 0.5% of all TB cases indeed originated in the countries bordering the EU to the East.
The distribution of these cases by the country of origin suggests that Belarus accounted for 0.1% of all notified TB cases (or 33 out of 47, 433 cases). Belarusian migrants present a far lesser risk to the EU than often previously assumed.
While TB is indeed more prevalent among migrants, albeit primarily those who come from Africa and South Asia, another study, focused on the UK, has shown that less than a quarter of TB cases are diagnosed within two years of an immigrants’ arrival. Thus, poor living conditions in the host country, rather than prevalence of TB in the country of origin, may be driving up the numbers of migrants with TB.
Indeed of combating the spread of TB, the alarmist warnings about Eastern Europeans may contribute to their already negative perception in Western Europe. Portraying migrants from post-Soviet states as diseased will further strengthen prejudice against this group.
Belarus Prioritises Latin America, Talks to the US, Influences Development Goals – Belarus Foreign Policy Digest
Vladimir Makei and Raul Castro - photo MFA Belarus
Over the past couple of weeks there was marked and clear pause in the active working-level engagement between Belarus and many EU countries. Belarus has focused on strengthening its existing ties, while developing new ones in other regions, mostly Latin America and the CIS.
With their multilateral policy mandate, Belarusian diplomats have persisted in promoting the country's core initiatives, i.e. traditional family and trafficking in human beings.
Belarus also seeks to avoid or downplay any references to democratic values as well as political and civil rights in their official communications and documentation.
Latin America in Focus
Latin America came into clear focus for the Belarusian foreign policy establishment in the second half of June of this year. Foreign Minister Vladimir Makei paid official visits to three Central and South American countries – Cuba, Ecuador and Nicaragua. All three countries are at varying stages of development with regards to their relationship with Belarus.
Cuba is Belarus' oldest and staunchest ally in the region. It is not by mere chance that cooperation in international organisations has again taken centre stage in their bilateral talks. Belarus is eager to make use of Cuba's weight among other third-world countries. Cuba, for its part, values Belarus as one of its few European allies.
Both countries also seek to develop mutual trade. Currency-stripped Cuba has agreed to sell its high-quality pharmaceuticals to Belarus in exchange for Belarusian farming machinery supplies. The two countries have also signed a bilateral trade agreement to this effect.
Ecuador is Belarus' new darling in South America. Here, Belarus seeks to build a relationship similar to the one it has been able to develop with Venezuela. As with Venezuela, the focus is on oil, military and technical cooperation as well as agriculture.
Lukashenka has recently appointed Igor Poluyan, the country's presumably best expert on Latin America, as his first ambassador to Quito. Ecuador will soon reciprocate by opening its first diplomatic mission in Minsk.
Vladimir Makei, in his interview to with the main Belarusian state TV channel, insisted that the two countries had made a great deal of progress in implementing the agreements they reached earlier through their presidents. Visa-free travel between Belarus and Ecuador seems to be the most resonant advancement to date. Not many ordinary Belarusians will be able to take advantage of this arrangement, though, as travel costs will be prohibitively expensive.
Belarus is still at quite an early stage in its relations with Nicaragua. With Makei's visit, Minsk hopes to take the dialogue to the highest level.
In immediate practical terms, Belarus seeks to participate in the construction of the Nicaragua Grand Canal, an inter-oceanic waterway that will connect the Pacific and Atlantic oceans. Belarus could supply its heavy duty BelAZ lorries and road-building machinery for this project.
Minsk is eager to develop military and technical cooperation and sell farming machinery and other industrial goods to Nicaragua. They are also interested in trying to enter other Central American markets through Nicaragua.
Strengthening Ties with Azerbaijan
On 20 June, President Alexander Lukashenka received Artur Rasizade, the Prime Minister of Azerbaijan and Ilham Aliyev's right hand, in Minsk. A political veteran himself, Rasizade has held his office only two years less than Lukashenka.
Lukashenka stressed the prioritised nature of Belarus' relations with Azerbaijan. He also expressed satisfaction with the current level of cooperation in all spheres. Speaking with Rasizade, Lukashenka emphasised his country's openness to investments from Azerbaijan.
It is worth noting that no reports about this meeting in Belarusian and Azerbaijani media outlets go beyond a short communique from Lukashenka's press service. No other events related to Rasizade's stay in Belarus have been reported on whatsoever. It is possible that the Azerbaijani Prime Minister was in Minsk on a private trip or on a special mission from Ilham Aliyev.
Two days before this odd meeting took place, First Deputy Foreign Minister Alexander Mikhnevich visited Baku to hold foreign policy consultations. Mikhnevich met with his counterparts in the Azerbaijani foreign ministry as well as with several parliamentarians.
The parties discussed the full spectrum of their bilateral relations with economic issues, evidentally, dominating the agenda. Besides expanding its exports to a fast-developing Azerbaijan, Belarus is actively seeking to attract investment from the former Soviet Republic.
In his recent interview to the Azerbaijani newspaper Respublika, Belarusian ambassador Mikalaj Patskevich to Azerbaijan made a pitch for Belarusian investment opportunities. He emphasised the advantages of the vast market of the Customs Union as well as the transit infrastructure of Belarus.
Bogus 'Visit to the US' and Sustainable Development Goals
The Foreign Ministry's press service depicted Deputy Foreign Minister Rybakov's recent trip to New York as a 'visit to the US'. This choice of wording normally implies a bilateral event. In fact, no visits at this level are yet possible at this stage of relations between two countries.
Valentin Rybakov went to the UN headquarters to attend a meeting of the Open Working Group on Sustainable Development Goals. The Group has the mandate to formulate sustainable development goals for the next 10 to 20 years, a plan that is to be approved at the UN summit later this year.
Belarus actively sought to influence the wording of the final document. At this meeting, Rybakov presented a proposal based on the existing working document. The declared intention was to present the goals in a more concise and easy-to-understand way.
Two amendments introduced by Rybakov stand out. First, Belarus sought to avoid any reference to democracy and human rights, even through the already emasculated the wording by pushing for 'rule of law and an effective and capable institution'.
Besides this, Belarusian diplomats continued to promote its favourite topic of traditional family values. This time around they confined themselves to the cautious language of a 'family-supporting environment'.
However, another Belarusian delegation brought up this topic in a more straightforward way at a high-level meeting of the ECOSOC, which is also dedicated to sustainable development.
Belarus and the US: Discussing International Security
The same week that Deputy Foreign Minister Rybakov debated the sustainable development goals in New York, Belarusian and American diplomats met in Washington, DC to hold the first-ever bilateral consultations on international security. Ambassador Vladimir Gerasimovich, Head of the Foreign Ministry's International Security and Arms Control Department, represented Belarus at this meeting.
The two parties discussed a wide range of issues affecting global and regional security. This list included the non-proliferation of WMDs, export controls, disarmament and disposal of chemical weapons.
Two deputy assistant secretaries of state represented the US at these talks. Currently, this is the highest possible level for the US in its contact with Belarus. Considered alongside the very fact of such consultations, it shows that despite the presence of serious problems in political relations, the United States is willing to maintain a close dialogue with the Belarusian government on issues of international security that may affect the US' own national security.
