Behind The Bars — TB in Prisons
by Jean-Pierre Kabuayi & Tristan Bayly
The central prison of Mbuji-Mayi in the Democratic Republic of the Congo (DRC) was built in 1952 and designed to house just 150 inmates, but by 2016, this figure had risen to around 450. The conditions are cramped, hot, and un-ventilated, with many of the prisoners suffering from acute malnutrition.
This is the perfect environment for TB to take hold as the bacterium that causes the disease is spread by very small droplets that are produced when someone with TB coughs or spits. This enables one person to infect many others, especially in confined spaces such as overcrowded prison cells.
Kalonzo Tshibangu from Bakwa Nsumpi began his sentence in Mbuji-Mayi in August 2014. When he arrived he was shocked at the conditions:
“There were so many people, crammed into tiny dormitories. Insufficient food only made the situation worse, it wasn’t long before I got sick.”
According to research, the incidence of TB in prisons is 5 to 70 times greater than in the wider community, which means dealing with TB in prisons must be a critical part of any public health policy that aims to control and ultimately eradicate the disease. In DRC the USAID-funded Challenge TB project is working with staff from ‘Coordination Provinciale Lèpres Tuberculose’ to tackle TB in prisons across the country.
When a Challenge TB team visited the prison, they saw how much Kalonzo was coughing and took a sputum sample to test for TB. The test came back positive and Kalonzo was put on anti-TB treatment for 6-months, after which he was cured.
Then, at the end of 2016, he starting having the same symptoms again, and this time two of his cellmates were also sick. Samples were taken and tested, and they all waited nervously for the results. His two cellmates got their results first and it wasn’t good, they had been diagnosed with drug-resistant TB and needed at least 20 months of intensive treatment. Kalonzo was panicked and feared the worse, but he was ‘lucky’ as it turned out that he didn’t have drug-resistant TB. However, he still needed at least eight months of treatment, with two months of painful daily injections.
TB treatment is tough, it is not only long, but the side effects can often be worse than the disease. The treatment made him very tired, and the injections prevented him from sitting, so he was forced to spend most of the time lying on his stomach.
Two months into their treatment Challenge TB staff recommended that all three inmates should be transferred to the Dipumba General Reference Hospital where they could be treated more effectively, and away from the other prisoners. Thankfully the authorities agreed, and in May 2017 they left the prison to continue their treatment in hospital.
Kalonzo took his drugs diligently, despite the many side effects he had to endure. He suffered from terrible joint pain, pimples developed around his mouth, and stores opened in his mouth and at the corners of his lips. He said: “It was agony but the doctors took good care of me and I managed to continue.”
Challenge TB is working hard to reduce TB transmission in prisons by screening prisoners and teaching them to be vigilant for anyone who displays symptoms. In the past few months, the project has been working in 16 prisons across the country, and all 5,704 inmates have been screened and taught to recognize TB symptoms. As a result of the screening, 604 prisoners with symptoms were identified and tested, resulting in 43 being diagnosed with the disease, 5 of whom had drug-resistant TB. All of them have now started on treatment and are doing well.
Kalonzo is now cured, and he has also served out his sentence. He says he has two plans for the future, the first is to stay healthy and the second is to never set foot in a prison ever again.
For more information on Challenge TB visit www.challengetb.org
Challenge TB is a USAID-funded project that aims to prevent the transmission and disease progression of TB, improve patients’ access to TB care services, and strengthen TB platforms. The Union works on the project’s activities in DRC.
