TIRASPOL LETTER:Healthcare is a rare luxury in Transdniestria, particularly for HIV-positive convicts
AT 10AM, the skeletal medical team enters the men's prison colony on the edge of Tiraspol, capital of Moldova's rebel enclave of Transdniestria, its own South Ossetia.
We have been briefed there are just two risks: being taken hostage and a prison riot breaking out. In subgroups of three, we are admitted past the first metal barred gate. It closes on us as a cage, and armed prison guards take our passports.
The lock at the other side opens and we pass on out. Two guards in their early 20s are allocated to protect us - this is an open penal colony of dormitories: the convicts are not kept locked in cells. One guard walks ahead of us, the other behind. The door to the prison yard opens and a blinding yellow sun scalds down. We walk on and feel some of the 1,100 pairs of eyes on us.
When you are banged up in jail for years, the arrival of six people from the planet outside comes as a diversion. All the more when four of them are women.
We make our way towards a single-storey building, at the door of which a cluster of men are gathered. One of the convicts does some casual dentistry in a room here. The tilted swivel arm of the drill and lighting device stands in the corner. Rust covers the hacked rim of the goblet into which you spit when you wash out your mouth. Today, the rooms the Médecins Sans Frontières (MSF) team normally uses are not available - instead this Spartan "dental" centre will have to suffice as the Odessan doctor and her assistant devise a temporary weekly clinic.
Some 25 HIV-positive men are down for appointments this morning. In a room across the way, a nurse from Zambia sets up her counselling service. Guard two goes with her, guard one stays with us. In the prisoners come, one by one. A litany of liver trouble, skin rashes, hepatitis, burning feet, low CD4 immunity levels.
Healthcare in Transdniestria has worsened since the collapse of the Soviet Union. The incidence of HIV is four times greater here than that in Moldova. With just 15 per cent of the overall population, Transdniestria has contributed 43 per cent of all new HIV cases in both Moldova and Transdniestria. Yet, while Moldovan authorities include these statistics in their appeals to the international community, they withhold the funds received as a brickbat with which to beat the sundered region.
The HIV/Aids health budget in Transdniestria in 2007 was just a few thousand euro.
These convicts are sealed in a world of barbed wire and concrete: within the prison, the HIV infection rate runs to about 15 per cent, and tuberculosis is rife. As the only international NGO based in the region, MSF has put many of the prisoners on the cocktail of drugs that is the antiretroviral treatment.
Sitting with her back to a filthy sink, the doctor checks they are taking the drugs twice daily at exactly 12-hour intervals. Some are thinking of abandoning the arduous treatment that is prolonging their lives — as less than stringent adherence to the regime is itself dangerous, these are sent across the corridor for counselling.
Every so often, a convict in a dirty T-shirt and with some unrelated ailment bursts in unannounced. The doctor tells them she only has drugs that treat HIV. Then the consultations resume: a man is weighed, his temperature and blood pressure are taken. Again and again. It is explained to each prisoner that an Irish observer and a Ukrainian photographer are present. Some are pleased, almost proud, to have their shot taken. Several more decline.
One speaks plaintively, staring over at us. "He says he does not want people to know he is sick as he is getting out soon," says the translator. "In five years' time."
The doctor explains key details of each man's case to me. I am a freeloader, an unhelpful voyeur of these poor prisoners as I sit there in my borrowed medical team vest, strangled and silenced by what I have seen.
"I have been inside 31 years," says an illustrated man, rolling up his shirt as a stethoscope is applied to reveal a torso covered in tattoos. They tell the tale of the crimes he committed, the places of detention and the sentences served. Another man, smaller and track-suited, maintains the antiretroviral drugs cause him nasal bleeding. He says someone told him they read an article that proved the treatment does not work. He had recently been bitten on the ear by another inmate.
Before the team leaves, we attend the TB ward. Sealed off from the rest of the colony, it is accessed via a locked gate tinselled with jagged barbed wire. Three men are crouched on the ground outside the structure that houses convicts in a cacophony of coughing and spitting. The doctor and assistant set up shop. A sick man enters and dons a towelling mask to restrict his sputum. The convict removes it just once to stick out his tongue for inspection. The guard looks on distracted, toying with a broken medical device until it is time to escort us to the world outside.
That world is one in which Transdniestria forged a military alliance last year with fellow Soviet frozen conflict enclaves South Ossetia and Abkhazia, guaranteeing that they would each come to the others' assistance in the event of attack.
While the largely inactive West expects a diplomatic remedy to the violent exchanges Russia is now trading with Georgia over two of these protectorates, the sick men in the Tiraspol penal colony are at least getting some chance of a more localised cure.