geographic regions. It is higher in the eastern portion of the country, with the highest rates in the Russian Far East adjacent to Mongolia, China, and Japan. Areas in that part of the country have an incidence ten times that of Moscow.
Before the breakdown of the Soviet Union, the prevention and treatment of TB were under stringent federal control. After the breakdown, many events occurred to exacerbate the problem of TB. Dislocations in the economy made the population poorer, and poverty is a risk factor for TB. Unemployment and crime rates worsened considerably, which encouraged the spread of TB in communities and the prison population. High levels of migration into the country also contributed to the spread of TB, as did military conflicts and the overall degradation of the health care system, which loosened previously stringent controls on the level of disease in the population.
Perelman explained that over the last decade, the TB situation in the Russian Federation has slowly improved. The number of new cases is somewhat lower, and both morbidity and mortality have been on the decline.
In 1943−1944, the Soviet Union received its first lot of penicillin, which was used by the military on the front lines. As early as 1944, the chief surgeon of the Red Army wrote about drug resistance after the potency of penicillin had declined substantially. When penicillin was recently reintroduced, however, it was much more effective, said Perelman.
Before drug therapy became available, TB was treated in Russia through surgery, which saved hundreds of thousands of lives. The surgery option also was used extensively in Scandinavia, France, and the United States, as described in journals such as the Annals of Surgery. Today, better diagnostic and surgical capabilities are available, such as surgery using state-of-the-art visual technologies. In Russia, from 12,000 to 14,000 surgical operations for TB are performed per year, and surgical treatment is about 85 percent effective. According to Perelman, however, the need for surgery is at least 25,000 cases, so the number of surgeries needs to double. In addition, surgery is complex and expensive and requires specialized departments and personnel who are aware of the TB problem.3
The proper approach to TB in Russia today, said Perelman, is for every person suspected of having TB to undergo a general medical checkup, including a chest examination. Russia did not accept DOTS
3 In Russia, surgery is considered a component of treating patients with chronic TB that has been unresponsive to antimicrobial therapy, as well as newly diagnosed TB patients with complications, drug resistance, and/or intolerance to anti-TB drugs (Perelman, 2000).