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Reemerging threat, renewed commitment

Reemerging threat, renewed commitment

Helping Ukraine put tuberculosis back in the box



 In a hospital meeting room, 15 physicians assemble for a training session: “Interpersonal communication and counseling.” These doctors are some of Ukraine’s finest and most seasoned, and they aren’t sure what’s in this for them. If patients don’t follow their orders or return for further treatment, it’s unfortunate, they reason, but there’s nothing they can do.

Then, during a role-playing exercise, two of their colleagues demonstrate a typical interaction between a doctor and a patient with tuberculosis. The dramatization hits a little close to home, causing one attendee to speak up, “Oh my goodness! This patient will never come back after being treated this way. Do we really act like this?” Many of the doctors nod in agreement, acknowledging the need for change. As the training continues, they participate with renewed commitment.

The communication skills that doctors learn in sessions like this one are essential to stemming the tuberculosis epidemic in Ukraine. Because treatment depends on patients adhering to a rigid, months-long schedule of drug therapy, patients need to feel welcomed and supported—not alienated or judged. Although most doctors are sympathetic and want only to help, it doesn’t always come across to patients, many of whom fear discrimination.


The training is just one of several activities that PATH has been undertaking to help Ukraine’s national tuberculosis program get control of the disease.

Tuberculosis reemerges


Tuberculosis, or TB, was once considered to be on track for global eradication, along with smallpox. By the late 1980s, however, a disturbing upswing in the number of new cases was detected worldwide. A report by the World Health Organization released in March 2005 shows the number of new TB cases stabilizing or even declining in most regions of the world, but not in Africa or Eastern Europe. Today:

  • Every second, a person is newly infected with TB.
  • Around 1/3 of the world’s population—nearly 2 billion people—have TB.
  • An active, untreated TB case can infect up to 15 more people each year.


In Ukraine many factors fuel the TB epidemic. The number of TB strains that are resistant to multiple drugs is higher in parts of Eastern Europe than almost anywhere else, making treatment difficult. The rising rates of HIV infection also are beginning to influence the number of new TB cases (TB is the most common opportunistic infection and the leading cause of death among AIDS patients). In addition, the country’s health systems suffered a setback during years of political, social, and economic transition. As a result, TB detection in Ukraine is based on an outdated screening technique—miniature chest x-rays instead of simpler, less expensive lab tests. Finally, infected individuals who do not get treated may pass the disease to others.

Conflicting perspectives

One of PATH’s ongoing roles in supporting Ukraine’s national tuberculosis program is to furnish accurate information to health care providers, patients, the public, and policy- and decision-makers. Conducting surveys and focus group discussions with these groups helped us better understand their knowledge and attitudes, so we know what information they need.

We found that many individuals with TB experience discrimination because TB is considered a disease of poverty, associated with the homeless, drug users, alcoholics, and prisoners. Infected individuals fear that if they are officially diagnosed, they may lose their job. Some women are afraid that their husbands will abandon them. Many also wrongly believe that TB is incurable or that treatment is expensive.

Doctors feel hampered by poor diagnostic equipment, supply shortages, and lack of funding. They also have trouble finding up-to-date information in their native language. Many of them do not have all the information they need about DOTS, a strategy for TB control recommended by the World Health Organization.

Collective commitment

Having identified attitudes and information gaps, PATH is devising communication strategies for reaching out to each group. We started with physician training, providing doctors with updated clinical information and helping them with communication and counseling skills, so they can effectively convey their support to patients. We have also created and distributed health messages and educational materials for patients, their families, and the larger community as well as for health care providers. We will continue to advocate for national policies that match international standards of care.

PATH has been implementing these and other TB-related activities in Ukraine since 2003, with funding from the United States Agency for International Development. Together with local partners, we are helping Ukraine harness the collective commitment of its citizens, health care providers, and government to control tuberculosis and lay a foundation for better health care and healthier communities.