Russia’s epidemic of drug-resistant tuberculosis is one of the worst in the world. The country is considered one of the “hot spots” of drug-resistant TB, rivaling Kazakhstan, several Chinese provinces and some countries in southern Africa.

Economic decline, the breakdown of social safety nets, a growing AIDS epidemic, alcoholism, and a high incarceration rate have combined to trigger a dramatic increase in TB cases and the subsequent rise of drug-resistant strains, especially in the prison sector. Nationwide, Russia reports 84 cases of TB for every 100,000 people, compared to only five per 100,000 in the United States. And 10 percent of new cases are drug-resistant.

In Tomsk, 14 to 16 percent of new TB cases are resistant to multiple medications, making them much more difficult to treat. The TB epidemic is especially complex in the prison system, where drug resistance is even more prevalent. Global Fund support has allowed the Tomsk Oblast Tuberculosis Dispensary, the main hospital for TB patients in the region, to treat more patients who are resistant to the most widely used regimen for TB treatment with second-line drugs. "An uninterrupted supply of first- and second-line drugs means that treatment is much more successful," Dr. Yonova says. "International collaboration is the guaranty of our success. We believe 75 percent of multidrug-resistant cases in Russia can be cured. The other 25 percent of cases will probably develop more resistance."

Marina, 22, is one of the patients for whom drugs alone will not be enough to cure her TB. She believes she contracted the disease when she was living in the dormitory at a nearby university. After a year of unsuccessful treatment with drugs, doctors have decided to perform surgery to remove the infected part of her lung and give Marina the opportunity to rid her body of TB.

Surgeons at the hospital perform three to four surgeries per week and estimate that one in 10 patients who enter the hospital for treatment will need a surgery, especially as cases of the TB that are resistant nearly all of the medications available to treat it continue to rise.