Prison conditions can exacerbate the spread of disease through overcrowding, poor ventilation, weak nutrition and a lack of medical care. Catching TB is not part of a prisoner’s sentence, and improving TB control in prisons benefits the community at large.

Igor Tcaci can count his association with TB and prison not in years but in decades. He knew both too well for two decades.

Now at the age of 43, Igor finally feels free of the burdens that marked half of his life. When he was 18 years old, he went to prison for the first time for two years on an assault charge. After his release, he was taken ill with severe coughing and fever and was diagnosed with TB. Igor was treated in hospital for ten months and tested regularly afterwards to confirm that he was cured.

Within a few years Igor was back in prison, this time for eight years. Igor recalls the conditions as deplorable, cramped into a damp basement room with other prisoners. About three years after being released, he was wracked by a cough and fever, coughing up bloody clots. He spent most of the time between 2004 and 2006 in Balti’s TB hospital. In 2007 a drug susceptibility test revealed he was resistant to two of the TB drugs he was taking. Igor was told about the new DOTS-Plus programme available to only a few patients in Moldova and he insisted on being enrolled because he felt it was his only chance of beating TB.

While undergoing treatment for MDR-TB, Igor became involved in Speranta Terrei’s project to reintegrate former prisoners who had TB. He reached out to other ex-prisoners and encouraged them to participate in psychological counselling and job training. This gave them the strength to complete treatment, learn a trade, earn a living and once again belong to society.

“Until this project, we were shunned and people did not want to speak to us. For the first time, former prisoners with TB felt someone believed in them, that they mattered.”

Igor’s MDR-TB treatment was successful and he now advocates for other patients. He has no intention of returning to prison.

“When a patient finds out he has TB, he is overcome with fear. A patient needs more information and explanation about the disease and the consequences of TB drugs.”

Igor says that he defended his right to access appropriate treatment for his drug-resistant TB strain and spoke up. But many patients do not know their rights or what treatment they should receive. He sees patients abandon treatment when a brusque medic does not have time to answer questions or lets a patient linger in the corridor. Igor and Dora have plans for Speranta Terrei to promote the Patients’ Charter for Tuberculosis Care in Moldova, so medics and patients can learn about their rights and duties in TB treatment.

Igor’s message to TB patients is to not lose hope, to continue treatment even through the darkest days. His message to health officials is that TB patients need moral and psychological support, someone by their side.