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KAI RYSSDAL: For decades during the Cold War, Ukraine was probably best known as the breadbasket of the Soviet Union. Its crops helped feed the rest of the country. And farming's still important. But since the break-up of the Soviet Union, Ukraine's earned another, less positive, distinction. It's home to one of the largest pools of tuberculosis in the world.
In the second part of our series on the resurgence of TB worldwide, Frank Browning has this report on private money and public health.
FRANK BROWNING: For 20 years Mikhail, who at 71 worked in the mines around Donetsk. Then he became a plumber. A little over a year ago his health began to fail.
MIKHAIL: During three months -- June, July and August -- I felt myself bad. I was weak. I didn't want to eat, and I began to lose weight.
Mikhail spoke to me through a medical mask at the local TB hospital. He was being treated for Multi-Drug-Resistant, or MDR, TB, which is especially virulent and hard to manage. Each year more than 40,000 Ukrainians come down with TB, 16 percent of them with MDR TB, giving Ukraine one of the worst MDR epidemics in the world. But now Ukraine's richest -- and some say shadiest -- oligarch, Renat Ahkmetov, is putting his own money into fighting the disease.
Anatoli Zabolotny runs Akmetov's Foundation for the Development of Ukraine.
Anatoli Zabolotny: We plan to spend $20 million for the next five years. We buy equipment, we buy medicine, we repair the tuberculosis hospitals, but at the same time we change the medicine system. We make it more effective.
The idea is to engage business directly in rebuilding Ukraine's public health system.
ZABOLOTNY: Most businesses do not like to deal with tuberculosis. But we do.
One of the foundation's first projects was to measure public awareness of TB.
ZABOLOTNY: In Ukraine, we have epidemic for about 15 years, but only 28 percent of the population know about this.
KATYA GAMAZINA: Almost all adult population is infected with tuberculosis.
That's Katya Gamazina, who directs training programs in Ukraine for PATH, a global company based in Seattle that promotes private participation in public health projects. Gamazina says only 10 percent of those who carry TB bacteria are likely to get sick. But, they are increasingly young men shooting IV drugs and infected with the AIDS virus. There is another problem -- that's politics.
A recent report from the World Health Organization cited bureaucratic wrangling between the old Soviet TB hierarchy and the current health ministry's HIV program as a major barrier to controlling the epidemic. The problem is compounded, says PATH's Katya Gamazina, by general political instability.
GAMAZINA: I could not even tell you how many ministers of health used to work during my time have passed. So, probably, I don't know, 15 or more.
Vladimir Muscovi is the chief doctor in the Akhmetev foundation's campaign. He says early diagnosis and keeping patients on treatment are key, so they don't develop the more serious MDR TB, which was rare in the old Soviet system.
Vladimir Muscovi: The doctors could go and find out all patients with TB. Now, if someone doesn't want to be treated, he doesn't go to the hospital and nobody worries about it.
In Donetsk, the foundation has actually taken over direct management of the TB program. That's in part, says Anatoli Zabolotny, because of chaos in the official public system, even down to the lack of patient registrations.
Anatoli Zabolotny: The Ministry of Health [has been] talking about the system for years, but nothing changed. And we have to create the system to get the real numbers, which doesn't exist. How many people are treated, how many people get healthy, how many people die.
At the World Health Organization, Marcos Espinal directs the Global Partnership Against TB, and he has tough words for Ukraine.
Marcos Espinal: The main issue for Ukraine is the political commitment. TB is not a medical problem, it's an economic problem. TB effects people between the ages of 19 and 55 years of age -- those economically productive. If we don't put that in the minds of the political leaders, then the problem will not be solved.
Lest Americans believe that they are protected by wealth and distance from Ukraine's troubles, there are major Ukranian communities in the United States, and these Ukrainian-Americans visit their homeland all the time, sharing their health and their airborne illnesses with the whole world.
In Donetsk, Ukraine I'm Frank Browning for Marketplace.