Igor Davydenko is rail-thin with dark circles under his eyes. He has a haunted look, reinforced by black prison overalls with reflective tape on the shoulders and cuffs.
Davydenko could be labeled as a loser in many ways. The 31-year-old is a drug addict, serving time for robbery and assault. He's serving his third stretch in a Siberian prison.
But Davydenko is about to become a winner in at least one way. If all goes well, he will soon be declared cured of one of the deadliest forms of tuberculosis.
In the last decade, Russia has found itself contending with new strains of TB that are resistant to many drugs and hard to cure. For years, prisons were considered to be one of the most dangerous pockets of drug-resistant TB in Russia and a source of the disease in the general community. In 2002, more than 79,000 inmates had active TB infections, and drug-resistant forms were present in about 50 percent of chronic cases.
But the Russian prison system has been working to change that. About a decade ago, it got together with the nonprofit Partners in Health and set up a clinic at a Siberian prison specifically aimed at treating tuberculosis among inmates.
The facility is called Medical and Penal Institution Number One. And, against long odds, it's making progress against drug-resistant TB. The rate of infection has dropped seven-fold, and the death rate has fallen to single digits, Alexander Leshchyov, the deputy warden, says.
There's no hiding the fact that Medical and Penal Institution Number One is a prison. It's surrounded by high brick walls, coils of razor wire and watch towers.
But as penitentiaries go, Medical and Penal Institution Number One isn't the worst. There's a bakery, clean dormitories and a small cafe that serves as a visiting area. There's even a theater, where inmate singers are practicing for a yearly talent show with some of the other nearby prisons. In the yard, a warden points out a bas-relief mural, sculpted by an inmate artist.
Inmate Davydenko first came here in 2001 after he contracted TB in another prison. "I was losing weight, had the sweats, coughing — in short, all the symptoms. They found it was TB, and they sent me here," he says.
Prison officials say Davydenko had a typical strain of tuberculosis that responds to normal treatment, and that he was cured by the time his sentence was up in 2002. But Davydenko went back to a life of drugs and crime that quickly landed him back in jail.
When Davydenko came back here, six years ago, the doctors again found TB, which he may have picked up in pretrial detention. The strain was a little worse than the one he had the first time, but it was still susceptible to the most commonly used anti-TB drugs. This time the treatment took a year, and Davydenko was declared cured again but kept under observation, as he served out his term.
But in 2011, a routine scan found TB again. This time it was drug-resistant, and Davydenko faced a longer, more arduous treatment with fierce side effects.
The key to curing TB in prisonsers is getting each patient to take responsibility for his own health, Warden Leshchyov says. That's not easy. "It's a very complicated moment that we call compliance," he says. "It is such a simple thing, but it's incredibly difficult to acquire it."
Davydenko's history — his drug addiction, his crimes, his repeated stints in prison — read like a textbook example of why it's so hard to get someone like him to take care of himself.
The experience of being treated for the disease can have a positive effect on an inmate's rehabilitation, Leshchyov says. "Davydenko is an absolutely creative person," the warden says. "During the treatment there comes a turning point [when] the treatment changes not only the body but a person's soul."
Davydenko agrees that he has come to feel responsible for himself and others. "When you get ill, the responsibility is on you, so that other people don't get sick — your family and neighbors and so on," he says.
Davidenko has been through 17 months of a 20-month treatment, and he says he's feeling better now. He's scheduled to get out of prison in about 2 1/2.
But he seems hesitant to say he's on the path to rehabilitation."You see," he says. "I'm in here for the third time." He wonders if anyone will believe he's changed. "I'm already 31," he says. "I should think about what to do next. I don't know."
Prison officials say they have hopes for Davydenko. They say that inmate patients, who've received the full spectrum of treatment, have a much better chance, not only of recovering their health, but of recovering a productive place in society.