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. Last Updated: 07/27/2016

MAILBOX: On Less TB, More Democracy and Bad Musicians

In response to a Reuters article, "International Effort Fails to Check Tuberculosis," published Aug. 7.


We wish to call to your attention to factual errors and misleading statements that could cause your readership to draw incorrect conclusions regarding tuberculosis control efforts in Ivanovo and TB control strategies for Russia.

The first two paragraphs state that the effort to halt the spread of TB in Ivanovo, Central Russia using the World Health Organization TB strategy, has proven ineffective. In fact, TB rates between 1995 and 1997 increased more slowly in Ivanovo than in other parts of Russia. Deaths from TB are actually decreasing in Ivanovo, though they are still increasing in other parts of the country. Finally, implementation of the WHO's strategy has led to increases in cure rates in Ivanovo, even though these rates are decreasing in most other regions.

The magnitude of the multi-drug resistant TB problem in Ivanovo should also be kept in perspective. Only 5 percent of new TB patients in the Ivanovo region from October 1995 through December 1998 had MDR TB. Furthermore, the type of MDR TB we studied, primary MDR TB, usually reflects program problems in previous years rather than the current situation. It may take up to several years for someone who is infected with TB to actually develop the disease, and what we are seeing now likely reflects problems that occurred prior to starting the WHO's TB strategy.

Further, the third paragraph states that cases of MDR TB rose during an "experiment." There was no "experimentation" of any kind on Russian citizens. This study was simply an evaluation of the program based on a careful, systematic review of existing medical records. Also, it should be pointed out that the implementation of the WHO strategy was performed not by outsiders, but as a collaboration between WHO and the Central TB Research Institute, the Ivanovo Region TB Dispensary and the Health Ministry.

Elsewhere in the world, evaluations of the WHO TB control strategy have provided convincing evidence that - where it has been implemented faithfully - the rates of MDR TB decline. As has been the experience in the United States and elsewhere, however, the strategy needs to be adapted over time to local circumstances. Even in the absence of MDR TB, TB patients in Ivanovo and elsewhere in Russia are unusually difficult to treat due to high rates of alcoholism, unemployment, incarceration, homelessness and limited resources for TB control. These factors result from the political and economic crises in Russia in recent years. In response to the situation identified in Ivanovo, efforts have already been initiated to further improve the program and to provide treatment of patients with MDR TB.

J. Peter Cegielski, MD, MPH

Kayla F. Laserson, DSc

Nancy J. Binkin, MD, MPH

Malgosia Grzemska, MD

Mario Raviglione, MD

U.S. Centers for Disease Control

Musical Chairs


President Boris Yeltsin's decision to sack yet another government reminds me of his statement a few weeks before sacking the Yevgeny Primakov Cabinet. Yeltsin, having decided that the ministers had taken seats not according to their hierarchy, said: "Ne tak sidim!" or "We're sitting in the wrong way!"

It's a pity that Ivan Krylov, renown Russian fable writer, cannot quote his own famous work, "The Quartet." In this fable, which schoolchildren used to learn by heart, four musicians quarrel over their musical performance, and then try to improve it by changing places. The moral has been well translated into English: "However much you change positions/My friends, you'll never make musicians."

Viktor V. Kabakchi

St. Petersburg

Results, Not Numbers


The U.S. Congress is bringing at least 2,000 young Russian political leaders to the United States for 10-day visits this summer. The goal is to complete the program before Russia's Dec. 19 State Duma elections - or at least before the 2000 presidential elections. It is hoped that this exchange will help strengthen democracy in Russia and U.S.-Russian relations.

The intent of the exchange is laudable; however, such brief visits can actually do more harm than good. Ten days is not enough time to learn anything of any real consequence about U.S. democracy. The participants are not likely to discover anything that will help them persuade skeptics back home that democracy is what Russia needs.

At the same time, participants in the exchange who believe that a democratic system is not suited to Russian realities will be able to claim that they've been to the United States (at U.S. invitation and expense) and did not find anything of political value.

Brief exchanges of large numbers of people look good on paper: See how many people we've served. But they seldom achieve meaningful concrete results.

A substantial portion of the millions of dollars being spent on brief exchanges should instead be devoted to much longer stays. Two hundred carefully selected and prepared future Russian political leaders who spend at least a year in the United States will do more to enhance Russian understanding of how democracy works than 2,000 who stayed in the United States for 10 days.

In this connection, thousands of young Russians are already spending extended periods in the United States where they are learning firsthand about the U.S. system. But here, the U.S. government, in the form of the Consular Service, often undermines the positive features of this experience by rudely, and often arbitrarily, denying visas.

Congress should look carefully at the operative rules it has fostered. To a large extent, these do not promote U.S. interests. For example, the Business for Russia Program has brought thousands of Russians to the United States for five-week stays. The goal of this program is to help foster small business. Yet, out of the approximately 100 participants in this program from the Vladimir region, I am not aware of a single one who has actually started or expanded a business as a result of their stay in the United States. Everyone I've talked to has agreed that five weeks is not enough time to learn to operate a business or to establish solid contacts with prospective U.S. joint-venture partners.

Under the Business for Russia program, bureaucrats can point to thousands of people served, but very few successful businesses. As a result, in the eyes of many Russians, the claim that small private businesses can make a major contribution to the country's economic recovery has been undermined and the wisdom and effectiveness of U.S. government aid has been brought into question. But the large number of participants make the reports to the U.S. Congress look impressive.

The U.S. government's current efforts are not only much less effective than they should be, they are often counterproductive. Responsibility for this lies first and foremost with the U.S. Congress. Senators and Representatives can and should change the operative rules of the game for the U.S. State Department, USAID and the other "alphabet agencies" and the private organizations they fund. Congress must insist that much more emphasis be placed on the results achieved rather than the numbers served.

Ronald R. Pope

Associate Professor of Russian Politics

Illinois State University


Serendipity: Russian Consulting & Development, Ltd.