Health and human security - Environmental and Human Security in the Arctic - page 171

Perelman (2000), outlined below. In practice, the Western anti-tuberculosis
strategy clashes in many ways with the Russian tradition. It is important to
note that the Russian approach to treatment and detection of tuberculosis has
a long tradition and has long been perceived as being very effective.
One of the leading Russian experts on tuberculosis control, Mikhail
Perelman, has articulated the basis of Russian opposition to DOTS in a
two-fold argument (Perelman 2000). First, he claims that certain aspects
of the DOTS regime are not applicable in the Russian setting. Second, he
opposes the use of the acronym DOTS in general, because it is meant to
signify something different from traditional Russian tuberculosis control in
particular. Perelman objects to DOTS because he believes that it excludes
other available tuberculosis treatments and important nuances, such as the
combined use of several drugs and the varying intensities of different phases
of treatment. According to Hans Kluge, WHO manager for tuberculosis
in Russia, the WHO and the Russian institutions reached an agreement
that, in Russia, the terms DOTS and DOTS-Plus will no longer be used
(Perelman 2000:1102).
Perelman's opposition to DOTS reflects more than different approaches
to medicine, and although there are marked differences between the WHO-
sponsored approach and the traditional Russian position (primarily with
regard to the use of hospitalization, radiology and surgery), the tone in which
the article is couched expresses a sense of indignation on behalf of Russia and
traditional Russian (or Soviet) medicine. More than anything, it seems that
Perelman wants to show that the WHO has not invented the TB-wheel with
its DOTS strategy. This sentiment is reflected, for example, in his reference to
'the “new” Western acronym for this well-known principle of therapy'. This
indignation was expressed by one interviewee, a major Russian tuberculosis
expert, located in one of the 'capitals'. She stated:
Ah, this is where [my Western collaboration partners] call me an old
Communist. You know, DOTS consists of five elements … We're not
in any way against any of them. No sensible person would be. And we're
grateful to the West for bringing it here. As a result, tuberculosis has
become an important issue in Russia. But we do have a tradition in
Russia, and not everything about it is bad!
She went on to state that DOTS does not address the social problems asso-
ciated with tuberculosis and points to other states that have solved their
tuberculosis without the use of DOTS, such as Finland, Sweden and Norway.
In other passages in Mikhail Perelman's article there is also a sense of
national pride and resentment towards DOTS, as explicitly 'Western' (not
merely 'foreign'), and to the ignorance of 'Western' experts of traditional
Russian tuberculosis control: