ANAMNESIS

"Speak up for those who cannot speak for themselves"


Bible, Proverbs 31

I

Every hour 4 cases of tuberculosis are recorded.

Every day about 30 people die from the disease.

Each year TB kills over 10,000 people.

Statistics in Ukraine for 2012.



Public health systems of some economically unstable countries of the former Soviet Union are unable to provide independently reliable treatment for tuberculosis patients. Not fully recovered after the collapse of the Soviet Union, they suffered from poor funding, lack of training, and cumbersome bureaucracy. A source of pride and envy, a centralized system of TB control despaired along with the division of the Soviet Union. Multiple drug-resistant tuberculosis – is a very disturbing phenomenon and the scourge of the Healthcare Service of the former Soviet republics.

“We really thought in the past that we could overcome the TB. But now everything looks hopeless."


Valentina works as a phthisiatrician since 1980.
Corridor, department #1, here patients with MDR TB get treatment. Kherson TB hospital, July 2011.

Corridor, department #1, here patients with MDR TB get treatment. Kherson TB hospital, July 2011.

Vasily, 1951. Had a TB. Kherson, August 2011.

Vasily, 1951. Had a TB. Kherson, August 2011.

Was born in Belarus. Graduated from the Faculty of Philosophy graduate school in Moscow. After this was allocated to Kherson, where he had written his dissertation on "The Contradictions of Socialism”. After the defense was going to continue scientific work in Moscow, but with the collapse of the Soviet Union, his scientific studies became irrelevant. Soon he was laid off from the institute.

His left leg was amputated because of the vascular disease. Now he lives in a dorm room with no running water or in door bathrooms and is forced to carry buckets of water to the second floor every day. He doesn’t know where he got tuberculosis.

Now is fully healthy.

Yenakiieve TB hospital, Donbass, December 2010.

Yenakiieve TB hospital, Donbass, December 2010.

A laboratory assistant is making a sputum analysis.

Prisoner Boris, 1983. Diagnosis: TB. Zhdanovka penal colony #3, Donbass, February 2011.

Prisoner Boris, 1983. Diagnosis: TB. Zhdanovka penal colony #3, Donbass, February 2011.

Is under detention in a TB hospital. Doctors oversee him during fluorography in an X-ray room.

X-ray film developing. Zhdanovka penal colony #3, February 2011

X-ray film developing. Zhdanovka penal colony #3, February 2011

The doctor is doing this with old method because of the lack of modern X-ray equipment mostly in all TB hospitals and prisons.

Valentina, works as a phthisiologist since 1980. Novozburevka TB hospital, August 2011.

Valentina, works as a phthisiologist since 1980. Novozburevka TB hospital, August 2011.

Previously, she worked as a neurologist in Severodvinsk (Russia). When she was 30, her husband was transferred to Novozburevka and she moved with him. As there was no place for a neurologist, became a phthisiatrician. For a while she worked in a jail #7 with TB patients, but returned to the hospital where works till now.

Drying of X-rays. Zhdanovka penal colony #3, Donbass,  February 2011.

Drying of X-rays. Zhdanovka penal colony #3, Donbass, February 2011.

The doctor is doing this with old method because of the lack of modern X-ray equipment mostly in all TB hospitals and prisons.

Valentin, 1972. Diagnosis: MDR TB + HIV.  Feodosia TB hospital, July 2012.

Valentin, 1972. Diagnosis: MDR TB + HIV. Feodosia TB hospital, July 2012.

In Soviet times was convicted for 8 years for theft of state property. Under the TB treatment is for the third time. Now he is a homeless.

Novozburevka TB hospital, August 2011.

Novozburevka TB hospital, August 2011.

Valentina has already worked in a TB hospital laundry for 25 years.

Nikolay, 1945. Diagnosis: TB.  Novozburevka TB hospital, August 2011.

Nikolay, 1945. Diagnosis: TB. Novozburevka TB hospital, August 2011.

Way back in the USSR worked as a combiner in Kazakhstan. His wife died, among relatives has only a nephew. Earlier he lived in the nursing home in Kakhovka, Kherson region, which remained concentration camp, everything was prohibited and all pension was taken. There he has gotten the TB and was sent into a hospital. In the hospital he also was made a surgery, because of problems in urology. Doctors put a catheter into the bladder, which eventually had to be removed.

He broke his leg, all the belongings and documents were stolen by ex-convicts. Doctors didn’t prevent this. He is not able to receive a pension without documents. Surgery in urology, which cost 400 UAH ($50), doctors refused to do without money.

Now it's too late and all his following life Nikolay need to be with a tube and a plastic jar. ‘Every day in a bed you are begging to die quickly’.

Nikolay’s things on the drawer unit near his bed. Novozburevka TB hospital, August 2011.

Mikhail, 1948. Diagnosis: MDR TB.  Kherson TB hospital, July 2011.

Mikhail, 1948. Diagnosis: MDR TB. Kherson TB hospital, July 2011.

Four years ago his wife died, it lead to a stroke. He began to use a crutch and could hardly talk. In the days of USSR he worked as a bricklayer on a construction. After surgery on the stomach, he went for medical examination, doctor found spots in the lungs and sent him to the hospital. He has gotten a TB since 1983. In autumn while exacerbation he stays in hospital for the prevention. In USSR times he got treating once in a 2-3 years. The food was very good, all drugs were available. But nowadays food and medications should buy his son and to prepare food in a ward.

Alexey Mironov, 1943. Diagnosis: MDR TB. Dzerzhynsk TB hospital, January 2011.

Alexey Mironov, 1943. Diagnosis: MDR TB. Dzerzhynsk TB hospital, January 2011.

Alexey worked as a bulldozer driver in the mine. His wife died while he was being treated for tuberculosis for the second time in the TB hospital. While Alexey is in the hospital, his daughter lives with an ex-prisoner in his apartment. Each month they demand the pension of Alexey, supposedly for his grandson needs.

Andrey, 1974, and Inna, 1969. Diagnosis: MDR TB. Yenakiieve TB hospital, Donbass, December 2010.

Andrey, 1974, and Inna, 1969. Diagnosis: MDR TB. Yenakiieve TB hospital, Donbass, December 2010.

They’ve got acquainted in the dispensary during the treatment. Call each other domestic husband and wife. He has been recently liberated, got ill in “the zone”. While he was in prison, his mother died, house was robbed and everything stolen, including documents. Since he has no housing habitation, he cannot get an official residential registration, and they cannot register their marriage. A couple sleep in different wards, sees each other only in the daytime. They hope one day to register their marriage and to have a family.

Helen, 1954. Diagnosis: spinal TB.  Donetsk TB hospital, Donbass, December 2010.

Helen, 1954. Diagnosis: spinal TB. Donetsk TB hospital, Donbass, December 2010.

Surgical removal of the spine parts affected with TB.

The operation was successful.

II

I started to investigate the problem of tuberculosis in Ukraine in December 2010. For that moment I knew nothing about it and had the same stereotypes as other people. The first region I went to was Donbas, Eastern Ukraine, and I was greatly influenced by what I saw. One of the first patients I photographed was suffering from gastrointestinal tuberculosis. He was lying naked on a hospital bed and staring at the ceiling. A week later, I was with him in the last hours of his life. He couldn’t move or talk, his body was like a skeleton covered with skin. He clutched a cross to his chest and prayed. Shortly thereafter, I met his wife and she told me how he walked around the house with a torn stomach and intestines dragging across the floor, and because the ambulance refused to transfer him to a hospital, she had to call a taxi.

"Every day in a bed you are begging to die quickly."

 
Nickolay, 1945. Diagnosis: TB. A combined driver in the past.
Gennady, 1962. Diagnosis: MDR TB + HIV. Donetsk TB hospital, Donbass, December 2010.

Gennady, 1962. Diagnosis: MDR TB + HIV. Donetsk TB hospital, Donbass, December 2010.

He worked in the mine. In 2007 pulmonary tuberculosis was discovered. Doctors prescribed the treatment. As soon as he felt really good he started to drink a lot of alcohol. In 2010 the acute abdominal pain appeared. The numerous ulcers formed in the bowel, intestinal TB was diagnosed. Doctors demanded to transport the patient to a TB hospital or home immediately, they didn’t allow him to stay in a post-operational department. He was transported by a taxi, as an ambulance also didn’t want to help. After operation all the sutures on his stomach diverged because of multiple ulcers. Doctors told that he could probably live just a couple of days. The family decided to take the dying man home. He was walking around the apartment and brawling during the whole month with an open wound on his stomach. The wife had to beg doctors to take him to the hospital. He died in December 23, 2010. This photo was made two hours before his death.

Irina, 1967. Diagnosis: MDR TB. Dzerzhinsk TB hospital, Donbass,  January 2011.

Irina, 1967. Diagnosis: MDR TB. Dzerzhinsk TB hospital, Donbass, January 2011.

There is no separate room for the donation process of sputum, patients do this in the treatment room by an open window in the presence of medical staff.

Yuri, 1955. Diagnosis: extrapulmonary MDR TB. Yenakiieve TB hosp

Yuri, 1955. Diagnosis: extrapulmonary MDR TB. Yenakiieve TB hosp

He has been receiving treatment for urogenital TB for 20 years. In 2009 the gangrene was formed on his leg. After failed amputation of the leg, the wound began to putrefy, a large tumor appeared. Previously was in the department of urology. After its closing he has been transferred to the pneumonic department. Periodically he goes alone on public transport for urogenital examination.

Yenakiieve TB hospital, Donbass, December 2010.

Yenakiieve TB hospital, Donbass, December 2010.

A laboratory assistant is making a sputum analysis.

Corridor, department #1, here patients with MDR TB get treatment. Kherson TB hospital, July 2011.

Corridor, department #1, here patients with MDR TB get treatment. Kherson TB hospital, July 2011.

Mikhail (left), 1948. Diagnosis: MDR TB. Four years ago his wife died, it lead to a stroke. He began to use a crutch and could hardly talk. In the days of USSR he worked as a bricklayer on a construction. After surgery on the stomach, he went for medical examination, doctor found spots in the lungs and sent him to the hospital. He has gotten a TB since 1983. In autumn while exacerbation he stays in hospital for the prevention. In USSR times he got treating once in a 2-3 years. The food was very good, all drugs were available. But nowadays food and medications should buy his son and to prepare food in a ward.

Oleg, 1974. Diagnosis: MDR TB + HIV. Kherson TB hospital, August

Oleg, 1974. Diagnosis: MDR TB + HIV. Kherson TB hospital, August

A childhood friend Sergey, giving him some water with a spoon. Sergey’s story: Oleg was a drug addict and was in prison twice. He worked in the port after jail release. His mother died, father doesn’t want to know him. Only elder brother helps. For a long time was treating an ulcer not knowing that had TB, till brother hadn’t brought the dying Oleg to the hospital. Soon he began to walk, got an appetite. But after his friends came for the birthday with vodka he rapidly became worse and couldn’t got up from the bed. He died in a three days, in August 14, 2011.

Konstantin, nickname "Salman", 1969.  Diagnosis: MDR TB + HIV. Kherson TB hospital, August 2011.

Konstantin, nickname "Salman", 1969. Diagnosis: MDR TB + HIV. Kherson TB hospital, August 2011.

As a child he was beaten by his stepfather, so he tried to shoot himself, but the bullet passed through leaving a blind right eye. After resuscitation, he was using drugs for 25 years. The dose reached to 5 cubes of opium and 2 cubes of amphetamine. He delivered the poppy from Western Ukraine. In the prison he stopped to use drugs. In the second year of being there the polio appeared. X-rays were taken and the diagnosis was tuberculosis. In tuberculosis colony ones began to make TB drugs injections. He was treated for four month. His mother was coming every evening, bringing food and medicine.

He died in a month on this bed, August 24, 2011.

Leonid, 1933. Had a TB. Kherson TB hospital, July 2011.

Leonid, 1933. Had a TB. Kherson TB hospital, July 2011.

He worked in a mine in Krasnyi Luch, Luhansk region, since 1949. During the blow at the mine his backbone was broken and a lung was injured. It caused TB. He had been taking 10 courses of treatment during 8 years. His legs were failing, and he was taken for examination again. Tests didn’t show TB.

Next day his family took him home, but in a month and a half he died.

Self made kitchen in a ward is a normal thing. Kherson TB hospital, August 2011.

Self made kitchen in a ward is a normal thing. Kherson TB hospital, August 2011.

Almost in every ward there are electric ranges, patients use them to prepare something. The doctors know about them, but don’t mind them because the food is not enough.

Irina, 1967, and Natalia, 1978. Diagnosis: MDR TB Dzerzhinsk TB hospital, January 2011.

Irina, 1967, and Natalia, 1978. Diagnosis: MDR TB Dzerzhinsk TB hospital, January 2011.

Irina and Natalia are resting after morning procedures. There is no TV for patients or another ways for spending time in a hospital. Every day a man from the local church comes here with dairy products to improve patients’ nutrition.

Kherson TB hospital, August 2011.

Kherson TB hospital, August 2011.

The appearance of the TB hospital building.

Vasily, 1940. Diagnosis: TB. Novozburevka TB hospital, August 2011.

Vasily, 1940. Diagnosis: TB. Novozburevka TB hospital, August 2011.

He wets his bed, so in summer he is moved to the hospital yard, and in winter – corridor. Speech is fumbling, thinks that is at work. Says he is waiting when the head doctor signs his resignation notice.

According to rumors, relatives took his flat and sent him to the hospital. Once in a month, an unknown woman comes to him with a bag full of food. She denies that is his relative.

Novozburevka TB hospital, August 2011.

Novozburevka TB hospital, August 2011.

Valentina has already worked in a TB hospital laundry for 25 years.

Novozburevka TB hospital, August 2011.

Novozburevka TB hospital, August 2011.

Doctors are watching through the window of the sputum screening.

Valentina, works as a phthisiologist since 1980. Novozburevka TB hospital, August 2011.

Valentina, works as a phthisiologist since 1980. Novozburevka TB hospital, August 2011.

Previously, she worked as a neurologist in Severodvinsk (Russia). When she was 30, her husband was transferred to Novozburevka and she moved with him. As there was no place for a neurologist, became a phthisiatrician. For a while she worked in a jail #7 with TB patients, but returned to the hospital where works till now.

Sergey, 1971. Diagnosis: MTB. Novozburevka TB hospital, August 2011.

Sergey, 1971. Diagnosis: MTB. Novozburevka TB hospital, August 2011.

He has a chronic TB and needs an operation, which costs money. So he doesn’t agree to do it, because gives everything to his four children. He has been treated in the hospital for three years and doesn’t want to go home, not to infect his family.

He died a month after the shooting.

Alexander, 1957. Diagnosis: TB.  Novotroitsk TB hospital, July 2011.

Alexander, 1957. Diagnosis: TB. Novotroitsk TB hospital, July 2011.

The medical staff story: He was severely beaten, lost his memory and his mind. We couldn’t find his relatives. He is very noisy and aggressive. They are waiting for a psychiatrist from the region to take him to the psychiatric hospital for TB patients.

The patients’ story: My name is Bukarev Alexander Mikhailovich. Was born in 1957. I work in the Kherson furniture factory. Have a flat, wife and two children. The rest of the talk is very difficult to understand.

Olga, 1965 and Leonid,1954. Diagnosis: MDR TB. Novozburevka TB hospital, August 2011.

Olga, 1965 and Leonid,1954. Diagnosis: MDR TB. Novozburevka TB hospital, August 2011.

Have met each other in 2001 in this hospital during treatment. All doctors know them and call husband and wife. The first time when they felt better after treatment went together to Leonid’s home, but in autumn 2011 came back because it became worse.


Way back in the USSR Olga worked on the farm for 12 years, after the collapse of the Union had no work. She lived with her parents in the village, grew vegetables. Olga and her son have gotten the TB in 2000 from older daughter, who was dating a guy with TB. Daughter started treatment on time, but Olga and her son only a year later.

Leonid was married and has a son. Way back in the USSR he was an electrician and a shoemaker. Has gotten TB in jail #59. Was taken to the hospital after temperature rising, which kept for a month. After examination TB was diagnosed. In prison he received medical treatment and felt better. After he was released, became worse, couldn’t walk. Brother brought him to the TB hospital. Four months later he slowly began to walk.

Leonid, 1954, and Anatoly, 1936. Diagnosis: MDR TB.  Novozburevka TB hospital, August 2011.

Leonid, 1954, and Anatoly, 1936. Diagnosis: MDR TB. Novozburevka TB hospital, August 2011.

Anatoly, 1936. Diagnosis: MDR TB.  Novozburevka TB hospital, August 2011.

Anatoly, 1936. Diagnosis: MDR TB. Novozburevka TB hospital, August 2011.

Anatoly has gotten TB in a nursing home. His wife died, has no children. In 1975 graduated from Kharkov Military Officers School with honors degree. After it served in the Navy aviation regiment in Stargrad (Poland), was a pilot of supersonic fighter aircraft MIG-19. After a year of service, during one of the missions, a junior mechanic made a mistake and Anatoly without checking sign it. Big trouble in the military caused nervous stress. After medical check-up spots in lungs were found. He was sent to the flight school, where worked until 1965, re-training pilots, but later transferred to the reserve for health reasons. After that he entered the Institute of Journalism. Worked as a journalist in the newspaper Zarya in Volgograd area (his homecity). He wanted to publish his books. Copies of his books were kept in the Council of writers in Rostov-on-the-Don. After the breakup of the Soviet Union his manuscripts disappeared. "I was a big man, and became nobody." Now because of sclerosis and bad eyesight he couldn’t write. Every day does morning exercises, but this makes him giddy. But to live he wants more than a young man.

One of his poems, which he could remember, "I want to die in Russia":


I want to die in Russia

Where grass rustle in the steppes

Where is a blue sky over the Don

Where the shackles of the old-time.


I want to die in Russia

Where in the steppes turns pink everlasting flower

A sign that there are more good than death

Christ will pave the dawn himself.


I came from eternity and to eternity will go

I will take away the smell of grass forever

The smell of morning roses, fragrant roses

All the sufferings of the faith.


And my soul will soar

And meet with poets of the century

To assemble for the battlefields Great Grail

For the salvation of man's destiny.


I want to die in Russia

Where grasses rustle in the steppes

Where a blue sky over the Don

Where the shackles of the old-time.

Nikolay, 1945. Diagnosis: TB.  Novozburevka TB hospital, August 2011.

Nikolay, 1945. Diagnosis: TB. Novozburevka TB hospital, August 2011.

Leonid, 1954. Diagnosis: MDR TB. Novozburevka TB hospital, August 2011.

Leonid, 1954. Diagnosis: MDR TB. Novozburevka TB hospital, August 2011.

Alexander, 1954. Diagnosis: TB.  Konstantinovsk TB hospital, Donbass, December 2010.

Alexander, 1954. Diagnosis: TB. Konstantinovsk TB hospital, Donbass, December 2010.

A homeless man decided to wait out cold winter and undergo TB treatment.

Svetlana (left), 1959. Diagnosis: TB.  Feodosia TB hospital, July 2012.

Svetlana (left), 1959. Diagnosis: TB. Feodosia TB hospital, July 2012.

Svetlana was a doctor. How and where she contracted TB doesn’t know. She is on a treatment for 10 months. She is afraid to tell this her friends and acquaintances, because of stereotypes against people who recover from TB. Her long stay in the hospital, she explains of false treatment of the tumour.

A week later, was discharged from the hospital. She is completely healthy. “If the government doesn’t want to overcome this disease, it means that someone makes a profit of the situation that we don’t have good jobs and we feel like outcasts on our own land."

Matrena, 1923. Diagnosis: TB. Novotroitsk TB hospital, July 2011.

Matrena, 1923. Diagnosis: TB. Novotroitsk TB hospital, July 2011.

She worked as a nurse for 18 years. Her husband died a few years ago. Son beat and raped her, but soon he was jailed. She was taken to the old age home, where director took her pension.

During medical examination TB was found. In a TB hospital she is for a couple of months. Has no money for medicaments as director didn’t return her pension book. Doctors tried to contact him, but without success.

Georgy, 1956. Diagnosis: MDR TB. Feodosia TB hospital, Crimea, J

Georgy, 1956. Diagnosis: MDR TB. Feodosia TB hospital, Crimea, J

The lawyer in the past. “Without a doubt, someone makes a profit on patients, on the disease and the epidemics!”

III

Children’s TB is a huge problem: over the past decade, the number of TB cases among children increased by three times. It has become a norm that kids become infected with persistent forms of TB. Such progress depends not only on a lack of attention to this issue by the state but also on the parents' indifference. Many of them believe that their child is fully protected naturally, and that vaccination can only hurt him or her. As a result, every year during medical checks, about 200000 under-aged children are identified with a latent form of TB.

“I’m not just telling you the story, it’s a heart's cry. I don’t want my grandson to live in a TB state!”


Svetlana, 1959. Diagnosis: TB. A nurse in the past.
Jaroslav, 2011. Diagnosis: suggestion on TB. Tsurupinsk children’s TB hospital, September 2011.

Jaroslav, 2011. Diagnosis: suggestion on TB. Tsurupinsk children’s TB hospital, September 2011.

He was 10 days old when mother left him in Nova Kakhovka, Kherson region. Child was admitted to the hospital with acute pneumonia. When his mother was found, doctors discovered that she had TB, for this reason there is a suspicion that a child also has TB. Doctors found some abnormals, but exact diagnosis will be said in a 2 months after the next x-ray. Now he is treated a TB. Systematically coughs. Baby is five months old, if the diagnosis will confirmed, next 12 months he will be on a medication. Mother never came, and hasn’t call. After the amendment will be sent to the orphanage.

Kristina, 1988. Had a TB. Feodosia, July 2012.

Kristina, 1988. Had a TB. Feodosia, July 2012.

Mother left me when I was 8. Still can’t understand, why? With father’s new wife couldn’t make friends. Because of constant scandals all the time after school I spent with new friends, started to use alcohol, tramodol, marijuana, opium. I ran away from home and appeared only to steal something and buy a dose.

Then all was like in a delirium: drugs completely engulfed me. Permanent weakness, profuse sweating, temperature 41 degrees, seizures, asthma. I became better only after the next dose. Life was divided into two parts, or withdrawals, or good. At that time my husband was put to the prison, my baby was taken away. I continued taking drugs, even when I was almost paralyzed. With last effort, I got home on all fours. I didn’t realize that was dying. I never had heard about the TB and HIV. My father took me to the hospital. Body rejected all medicines, vomiting didn’t stop.

A terrible night ... I call doctors, but no one can hear me, maybe I cry too quietly. Withdrawals, fell out of bed, crawl down the corridor, stairs, climbed up on all fours on the couch. I want a new dose.

TB of the lungs was diagnosed. I was brought to the TB hospital and placed in a hospice ward. All my thoughts were about drugs, I thought that after the dose I’ll become better. Wanted to smoke, but restrained myself, the doctor said that the lungs began to unravel. Over time, I started to get up. When I could walk and felt good, ran to the store for a bottle of vodka and cigarettes. “I am healthy!” - I thought.

But soon HIV and hepatitis were diagnosed too. I ran away from the hospital and went on a bender. Parents begged me to continue treatment. But what for? There is no healthy place on my body! I want to die quickly, and everyone will be better. But my grandmother persuaded me to come back and get treatment in a rehabilitation center. She really believed that it can safe my live. Soon I quit smoking, drinking and using drugs.

It's been one and a half years since then. I have no TB, got married and work as a social worker. I do all I can to return my son Dima, from the first marriage.

In a period of my drug addiction, mother-in-law deprived me of parental rights and keep Dima away from me. I can only watch in a distant as he plays with other children in the kindergarten. Now I don’t blame her, my constant withdrawals, wandering in a brothel, could only disturb my son. I can’t make friends with him for the moment, but I hope that my real life will prove him that I have changed and can’t hurt Dima.

 Tsurupinsk children’s TB hospital, September 2011.

Tsurupinsk children’s TB hospital, September 2011.

The girl is crying in front of doctor with TB injections.

Tsurupinsk children’s TB hospital, September 2011.

Tsurupinsk children’s TB hospital, September 2011.

Doctors put the boy with TB on a drip.

Maxim, 2005. Diagnosis: suggestion on TB, Bourneville  disease. Tsurupinsk children’s TB hospital, September 2011.

Maxim, 2005. Diagnosis: suggestion on TB, Bourneville disease. Tsurupinsk children’s TB hospital, September 2011.

An orphan, has a rare Bourneville disease. He was admitted to TB hospital with pneumonia from the children's orphanage.

After the treatment was no positive dynamics, so was sent to a TB hospital. Is on medication for three weeks.

Tsurupinsk children’s TB hospital, September 2011.

Tsurupinsk children’s TB hospital, September 2011.

The boy with TB while taking medication.

IV

The map of Kherson city, where Kherson penal colony #61 is mapped. This is the only colony, where the highly dangerous criminals and life-sentenced prisoners with TB are sentenced. It’s located right in the center of the city and is surrounded by a promenade, a public park, and alleys where families with children rest. After asking people, it turned out that very few of them knew about such a colony right in the center of the city.


The prisons have practically become a breeding ground for TB disease in Ukraine. The incidence of TB in them is about 50 times higher than among the civilian population, and the mortality rate is 30 times higher. Many prisons, not to ruin their mortality figures, release seriously ill prisoners. As a consequence ex-convicts dissolve among the population without registering with the health-care authority.

“When I came to the hospital, all patients were 50-60 years old, but nowadays, more and more young arrive! It is very bitter, sad, and scary."


Emma works as a physiologist since 1978.
Kherson maximum security prison #61, July 2011.1

Kherson maximum security prison #61, July 2011.1

The penal colony #61. This is the only colony, where the highly dangerous criminals and life-sentenced prisoners with TB are sentenced.

Monitor security cameras for life prisoners.

Monitor security cameras for life prisoners.

Kherson maximum security prison #61, July 2011.

Prisoner. Diagnosis: TB.  Kherson prison #61, July 2011.

Prisoner. Diagnosis: TB. Kherson prison #61, July 2011.

Prisoner. Diagnosis: TB.  Kherson prison #61, July 2011.

Prisoner. Diagnosis: TB. Kherson prison #61, July 2011.

Life-term prisoner Vasily 1959. Diagnosis: MDR TB.  Kherson maxi

Life-term prisoner Vasily 1959. Diagnosis: MDR TB. Kherson maxi

Vasily is in a TB department of a maximum security prison for recidivists and life-term prisoners. He contracted TB in 1995 in a prison. In 2001, after the release, he treated in a TB hospital. Four years ago received life imprisonment for intentional homicide. He takes care of his cellmate who was paralyzed after a stroke.

Donetsk remand prison, Donbass, February 2011.

Donetsk remand prison, Donbass, February 2011.

The attendant holds bypassing the jail.

The remand ward #2414.  Donetsk remand prison, Donbass, February

The remand ward #2414. Donetsk remand prison, Donbass, February

In the foreground is Rolan, 1975, drinking a chifir (very strong tea) out of a plastic cup of sour cream. Just over one month is in custody and under investigation in the TB department of remand prison, TB was diagnosed here. Near the window on the left is Timur, 1983, has already spent half a year, TB also was diagnosed here. Near the window on the right Andrew, 1973, and Nicholay, 1989, are smoking and watching TV.

Prisoner Alexandr, 1972. Diagnosis: MDR TB + HIV, asthma. Zhdano

Prisoner Alexandr, 1972. Diagnosis: MDR TB + HIV, asthma. Zhdano

Is under detention in a TB prison, where he was contracted.

Died one and a half week after in this ward.

Zhdanovka penal colony #3, Donbass,  February 2011.

Zhdanovka penal colony #3, Donbass, February 2011.

Prisoners are keeping warm under a blanket in the TB prison.

Starozburevska penal colony #7, July  2011.

Starozburevska penal colony #7, July 2011.

Prisoners with droppers in the treatment room of the TB department in a prison.

Gennady, prisoner, 1967. Diagnosis: MDR TB + HIV.

Gennady, prisoner, 1967. Diagnosis: MDR TB + HIV.

Diagnosis: MDR TB + HIV.

Starozburevska penal colony #7, July 2011.

Is under confinement in a TB department of a penal colony. First time was imprisoned in 2003 for a fight in a cafe when he stood up for girl. Got TB in prison. In this period his parents died, only two sisters left who supported him after release. Got a job as a delivery driver in Kyiv, met a good woman. Every three months had a medical examination, but once a relapse of TB was identified. Was forced to go for a treatment at his native town. There the situation worsened, the lack of work and very expensive treatment prompted him to go on the offense, for which he was prisoned again. To the TB department was brought 4 months ago in a gravy condition. Due to the doctors efforts and second-line drugs his health improved. Now hopes to recover fully and return to his wife with child. After his release, wants to resolve problems with money to raise the child and family, but nowadays it's very hard. He is sure, if he don’t recovers here in jail, he can’t do this at large, as the second-line drugs are very expensive. In the past he was a thieve, after being disappointed with the thieves' law, which according to him, no one observes, has become a "goat" (head of household). On the back is the tattoo – 12 riders of the Apocalypse.

Zhdanovka penal colony #3, Donbass, February 2011.

Zhdanovka penal colony #3, Donbass, February 2011.

Medical check-up of a TB prisoners. 

Zhdanovka penal colony #3, Donbass,  February 2011.

Zhdanovka penal colony #3, Donbass, February 2011.

Medication intake by prisoners of a TB jail.

Natalia, 1974. Diagnosis: MDR TB + HIV.  Kherson remand prison,

Natalia, 1974. Diagnosis: MDR TB + HIV. Kherson remand prison,

According to Natalia: I had a great loving family. I was my daddy's little girl. At 42 years old he drown. My younger sister needed money to pay for college. The economy was bad at the time, no one was getting paid. That’s how I got into drugs. To provide for my family and pay for sister’s education, I gave up my music education and started selling drugs. Soon I began to take drugs myself. That’s how I contracted HIV, and later - TB.

Her sister got married, gave birth to a daughter, and now lives in Moscow. Natalia don’t accuse somebody in what has happened to her.

She died in August 16, 2011.

Prisoner Stepan, 1950. Diagnosis: MDR TB.  Kherson prison #61, J

Prisoner Stepan, 1950. Diagnosis: MDR TB. Kherson prison #61, J

He is in a maximum security prison for recidivists and life-term prisoners. After an insult lost his speech and was partially paralyzed. Now is in post-procedure department.

Alexander, 1967. Diagnosis: TB. Yenakiieve TB hospital, Donbass,

Alexander, 1967. Diagnosis: TB. Yenakiieve TB hospital, Donbass,

Until 2000 he was a miner. TB was diagnosed while on health examination. His friends turned away from him. He received treatment at home while living with his wife and children. After the birth of his grandchild, moved to the TB hospital. Has never hold her in his arms.

V

At the time of the shooting, 2010-2012, Ukraine had the highest burden of tuberculosis in the European Region, second only to Russia. Only 50 percent of TB patients were recovered. Each year 40 000 TB patients were registered officially for the first time, 10 000 of them died. Every hour 4 cases of tuberculosis were recorded and each hour one of such patients died. Hospitals were in terrible conditions. Medicine equipment was either out of date, either absent at all. The government did nothing to stop the problem, even if there was some help it came from volunteer organizations. Patients with drug-resistant tuberculosis had to use public transport to get medications and food. Those who had no money just died in their beds. Unfortunately, now the situation isn't getting better. People don’t guess that modern Auschwitz is nearby them. While politicians play politics, people die of tuberculosis in hospitals without drugs, adequate nutrition, and proper care. The epidemic of TB became one of the national problems.

“In a holiday time a lot of TB patients work in cafes, on the beaches, and no one controls this situation.”


A physiologist of TB hospital in Feodosiya, Crimea.
Diagnosis: MTB. Novozburevka TB hospital, August 2011.

Diagnosis: MTB. Novozburevka TB hospital, August 2011.

“This disease can’t be excluded, it should be treated.”

Emma, works as a phthisiologist since 1978. TB hospital, Crimea 2012.

Emma, works as a phthisiologist since 1978. TB hospital, Crimea 2012.

“In a holiday time a lot of TB patients work in cafes, on the beaches, and no one controls this situation.”

Vasily, 1940. Diagnosis: TB.   Novozburevka TB hospital, August 2011.

Vasily, 1940. Diagnosis: TB. Novozburevka TB hospital, August 2011.

He wets his bed, so in summer he is moved to the hospital yard, and in winter – corridor. Speech is fumbling, thinks that is at work. Says he is waiting when the head doctor signs his resignation notice. According to rumors, relatives have taken his flat and sent him to the hospital. Once in a month, an unknown woman comes to him with a bag full of food. She denies that is his relative.

Leonid,1954. Diagnosis: MDR TB Novozburevka TB hospital, August 2011.

Leonid,1954. Diagnosis: MDR TB Novozburevka TB hospital, August 2011.

Arriving to hospital in a two months, I had found that Leonid got worse. He stopped walking, lost his appetite.

Alexander, 1956. Diagnosis: MDR TB. 
Feodosia TB hospital, Crime

Alexander, 1956. Diagnosis: MDR TB. Feodosia TB hospital, Crime

How and where he contracted TB, doesn’t know. Diagnosed with TB in 2005, since then has admitted to the hospital 4 times (in 2005, 2007, 2009 and from 2011). The first time didn’t complete his cure because of the need to work to get money for drugs. As a result formed a stable form of TB. Previously, he worked as a welder, mechanic, porter, now his health failed. During the summer season can make a little money, declined to say where. But this is the only way to continue the treatment. Doctors understand and permit him at any time to go.


It’s a usual thing in this hospital that patients make a little money working at the beach and market, of course without saying that they are from TB hospital.

Novozburevka TB hospital, August 2011.

Novozburevka TB hospital, August 2011.

The nurse is carrying a drip down the corridor. Most TB hospitals don’t have solution for intravenous or intravenous themselves, only pillar left from Soviet times. IV put only those who are able to pay for it.

Feodosia TB hospital, July 2012.

Feodosia TB hospital, July 2012.

Doctors have put TB patients in an IV.

Victor, 1975. Diagnosis: MDR TB + HIV.  Kherson TB hospital, Jul

Victor, 1975. Diagnosis: MDR TB + HIV. Kherson TB hospital, Jul

He worked as an operator of the polyurethane machine, made ice plants. Then he contracted pneumonia and came home for treatment. Two weeks later he got to the TB hospital. He was discharged after 7 months, not being fully treated. So now he is on treatment for the second time. Once a week his wife arrives with medicaments and food. Hasn’t seen his 14 year-old son since was taken to the hospital. While his wife and mother didn’t raise a scandal in the hospital, he was treated only with the first row of tablets. But after doctors put him in an IV every day. Here was also diagnosed HIV positive status. His doctor didn’t recommend taking medication for HIV, saying that the body can’t sustain such a large number of medicines. So he began to treat HIV only two months ago. He died 2 months later on September 07, 2011.

Igor, 1972. Diagnosis: MDR TB + HIV. Kherson TB hospital, July 2011.

Igor, 1972. Diagnosis: MDR TB + HIV. Kherson TB hospital, July 2011.

He contracted TB in a prison. After jail delivery he got treatment in the TB hospital. Frequent scandals with alcoholic wife and bad nourishment caused recurrence. For several months he couldn’t manage a fever because of no money for the medicine. He died after 10 days, July 28, 2011.

Mortuary. Cherson TB dispensary, August 2011.

Mortuary. Cherson TB dispensary, August 2011.

A cemetery near Novozburevka TB hospital, where patients who died from TB are buried. Novozburevka TB hospital, August 2011.

A cemetery near Novozburevka TB hospital, where patients who died from TB are buried. Novozburevka TB hospital, August 2011.

Often TB hospital has to bury the dead who don’t have family or the relatives don’t want to come. As hospital don’t have money for the coffins and monuments, the TB patients are the ones who dig the graves.

Nowadays there is a huge danger of TB expansion. The war on the East of Ukraine and annexation of the Crimea by Russia, increased the number of refugees from Crimea and Donbas, over 1,2 million people. Thousands of tuberculosis patients on the East were left without treatment, many prisoners were released and taken to the separatists’, pro-Russian army. Because of the lack of medical treatment, medicines, devastation, and poorness, the TB epidemic increases day by day in the East of Ukraine.


EPILOG

FRIENDS OF CHILDHOOD

Valera, 1970. Had a TB. Kherson, July 2011.

Valera, 1970. Had a TB. Kherson, July 2011.

Valera shows the scar from the surgery to remove the right side of the lung. After the operation, his whole life has been changed dramatically, and he still feel very sorry about it.

Valera contracted TB during potato harvest. The treatment didn’t help, as a result one lung was cut out. He was kept on morphine and the wound was cleaned off pus for a month. The pain disappeared only with morphine, but soon he started taking synthetic drugs. After two years of that, Valera’s wife sold the apartment, took their kids with her and moved to Russia, and until now they don’t want to see him. Valera understood that he had to end this. With time he got rid of the addiction himself by using a dropper with the solution Haemodesum. He had to tie himself down to the bed, while setting up the drip, because the withdrawal was too bad. But he did it, he doesn’t use drugs anymore, and is fully healthy.

Valera, 1970 and Gena, 1969. Gena’s diagnosis: MDR TB + HIV. Kherson, 2011.

Valera, 1970 and Gena, 1969. Gena’s diagnosis: MDR TB + HIV. Kherson, 2011.

I met Gena in the courtyard, where together with Valera, his best childhood friend, they usually drank some beer. Valera introduced us. For that moment, I had no idea that that brief acquaintance would have such serious consequences for both of us. We were sitting on an abandoned couch, drinking beer and chatting. He told me that was having a TB for already six years and had no idea how got it. Before, he worked on a fishing boat on Kamchatka, but after receiving a letter from his mother telling that she was dying, he came back to Kherson. But actually, mother just wanted him to come back. In his native town Gena couldn’t find a job, so started drinking. To earn a bit of bread, he continued fishing in Kherson. At the same time he systematically came to the hospital for treatment.

We saw each other almost every week, I came to Kherson TB dispensary to see him and take photos. As time passed, Gena’s disease progressed, he started using a walking stick. I remember, once a man came near me in a TB hospital and said cheerfully: “Hello, Max! How are you?” At that very moment, I didn’t understand that that was Gena. He stood in front of me with a bare-chested, his bones were covered with skin, his face was unfamiliar to me, maybe because of the fact that he had shaved off his hair, or because he had lost a lot of weight. That was about a month after we were drinking beer in the courtyard.

Valera and Gena in Kherson TB hospital.

Gena with his mother in Kherson TB hospital.

Once I met Gena’s mother in the hospital. She told me that she had to sell all belongings and gather bottles for recycling to be able to pay for her son’s treatment and food. Unfortunately, the treatment was unsuccessful. Soon developed complications, fluid was pumped from his lungs, and Gena was transferred to the postoperative ward. He could no longer stand up and lost his appetite. I remember I came to the hospital with Gena’s favorite strawberry juice and fruit puree. He felt very bad. We talked for a couple of hours. That was the last time, I saw Gena alive.

Three days later I phoned Gena. His mother picked up the phone and said with tears that Gena died. When I came, he was already lying in a cold morgue, a brick under his head, hands were stuck on his chest with the note: “Soloviev, died at 8:30 AM” (October 12, 2011).

Next day was the most difficult. I had to accompany Gena’s mother to the funeral parlor to choose a coffin, sepulchral cross, and wreaths. She cried all the time, so I went with her everywhere and did most of the talking. Probably everybody thought that I was her grandson. On the day of the funeral, we went to the morgue to take Gena’s body home for orthodox funeral service and after to the cemetery. I and driver placed the body in the coffin ourselves, as couldn’t find any other able men around. Valera helped to put the coffin on two stools in the yard before Father would read the burial service and neighbors, friends would be able to say goodbye to the dead.

One minute later a coffin was covered with a lid and hammer blows were heard. Soon, a landslide and a wooden cross were the only reminiscents of her son. That was a very modest funeral, about ten people came to say goodbye to Gena. There were only three men to carry the coffin, so I had to help them. The line between me, as a photographer and as a common person disappeared.

After the funeral, we went to Gena’s mother home. According to the Slavonic tradition, all the relatives and friends gather to remember those who have died. Mother showed us family photos, told stories and smiled, but at the same moment, she was crying and wailing, not believing her son was dead. I couldn’t imagine such human grief. Gena was dead. I remember he often called me Maksik and was always glad to see me. He was cheerful up to his final moment.

Mother is tearfully talking with the photo on which she sits with her son in the hospital yard. When I was doing it, I did not even suspect that it would be their last group photo.

On the photo: Gena with his son and mother.

On the photo: Gena’s wedding.

On the photo: Valera (left side) and Gena (on centre).

On the photo: Gena with his farther and mother.

On the photo: Valera (left side) and Gena (on centre) celebrating their friend’s birthday.

Valera, a year after Gena’s death, he stands in the basement and watches on a light through the window. He lives in this basement, which is located in the house where he grew up, in Kherson. In the beginning, the locals didn’t like the idea of him living in their house, as no one believed that he was fully recovered, but after we placed his medical report on each building entrance, people changed their attitude toward Valera.

After Valera’s recovery I tried to help him by taking him to the national TV program, where Kherson authorities and deputies promised on a camera to help him with a flat, work and money, so that he could return to normal life. But it turned out that no-one was really going to help Valera. Once the TV program came to its end, everybody left the studio without even saying a word to Valera. All those talkings were just talkings for program’s and authorities’ ratings.

Today Valera still lives in Kherson in a basement, works as a construction worker and as a janitor. He remodeled the basement himself, installing a shower and a toilet, bought a TV set, some of the furniture was donated by locals or found in a landfill. Most in the world he regrets that while TB treatment he started using drugs, and lost his previous life and family.


FACES OF TUBERCULOSIS

My hospital room in Novozburevka TB hospital, one of the hospitals where I worked on my project. I lived there during shootings in this hospital, August 2011.




EXHIBITIONS


VIDEOS

If you use a laptop for viewing, I recommend you use headphones or external speakers


Lumix Festival for Young Photojournalism, Hanover, Germany, 2012
Center for Documentary Photography FOTODOC, Moscow, Russia, 2012
Art-Donbass, Donetsk, Ukraine, 2012
Bursa Photo Fest, Bursa, Turkey, 2011
Alexander, 1957. Novotroitsk TB hospital, July 2011.
The medical staff story: He was severely beaten, lost his memory and his mind. We couldn’t find his relatives. He is very noisy and aggressive. We are waiting for a psychiatrist from the region to take him to the psychiatric hospital for TB patients. 

The patients’ story: My name is Bukharev Alexander Mikhailovich. Was born in 1957. I worked in the Kherson furniture factory. Have a flat, wife, and two children. The rest of his talk is very difficult to understand.