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Luis Henry Robles Higinio, 19, has XDR-TB. His right lung was removed due to the extent of the disease, and he had a port implanted in his chest for his twice-daily drip of TB drugs. With the end of IV treatment just two weeks away, he's in a positive frame of mind. Jason Beaubien/NPR hide caption

itoggle caption Jason Beaubien/NPR

Luis Henry Robles Higinio, 19, has XDR-TB. His right lung was removed due to the extent of the disease, and he had a port implanted in his chest for his twice-daily drip of TB drugs. With the end of IV treatment just two weeks away, he's in a positive frame of mind.

Jason Beaubien/NPR

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Diana Corolina Huamani Pasion is a TB nurse with Partners in Health in Lima, Peru. She'll greet a patient with a kiss on the cheek — levels of bacteria are very low after the drug regimen begins, she says. Jason Beaubien/NPR hide caption

itoggle caption Jason Beaubien/NPR

Diana Corolina Huamani Pasion is a TB nurse with Partners in Health in Lima, Peru. She'll greet a patient with a kiss on the cheek — levels of bacteria are very low after the drug regimen begins, she says.

Jason Beaubien/NPR

You sure don't want to get tuberculosis. You'll cough a lot, maybe cough up blood, have fever, chills and chest pain. But most cases of the bacterial disease are curable after taking the two first-line drugs for four to six months.

You really don't want to get multiple-drug resistant TB. That's a strain of the bacteria that resists the front-line drugs. So nastier drugs and a longer treatment span are required. There are roughly 480,000 cases of MDR-TB, as it's called, each year; nearly half of the people with MDR-TB die from the disease.

Worst of all is XDR-TB, or extensively drug-resistant tuberculosis. It's estimated that 9 percent of people with multiple-drug resistant TB are in the XDR category. The treatment is hellish: two daily infusions of IV drugs through a port implanted in the chest, each session lasting about an hour. This goes on for a year. The drugs have horrible side effects, including nausea, permanent dizziness and permanent hearing loss. People are often depressed at the seeming endlessness of it all.

Because the treatment is so harsh, some countries write XDR-TB patients off, don't offer them treatment and just leave them to die. That approach heightens the risk that XDR-TB will be passed on to others. (Like regular TB, XDR-TB is spread when a patient coughs, sneezes or spits, sending bacteria into the air.)

Partners In Health, the global health nonprofit, wants to show that XDR-TB is not a death sentence. So the agency is currently treating 55 XDR-TB patients in Lima, Peru. We spoke with Jason Beaubien, NPR's global health correspondent, who is in Peru reporting on tuberculosis.

How bad are the side effects from treatment?

It knocks some people on their butt. They are exhausted for a year.

It must be hard to convince people to take debilitating drugs for so long a period.

Oscar Ramirez, the PIH coordinator here, said to me, "It's not just about the drugs." It's about nurses coming to visit, talking with them. It's about setting up support groups so these people don't get so depressed. Some patients just drop out.

And if they drop out?

The TB would come back.

How do people earn a living during treatment?

In a lot of places where you've got XDR-TB, there's not a social safety net. Partners In Health has this microfinance loan program to help patients. One woman is now knitting things and selling them. One woman with multiple drug resistant TB got a loan and opened a corner store.

How could she run a store if she's contagious?

Soon after you start treatment, you actually aren't contagious anymore.

That's surprising.

I was astounded. I put on a mask when I went to the first XDR-TB patient house, and the nurse was kissing him on the cheek. She said: "Don't worry. The levels of bacteria once he's been in treatment are so low that he's not contagious."

Can you tell me about some of the people you met?

One woman lives so far out of the capital — 6 1/2 hours away by bus — that PIH is renting a small apartment for her in Lima.

She's Jenny Tenorio Gallegos. She's 35 and her kids are 3 1/2 and 13. She was really heartbreaking. I asked her, "What's the worst part of the treatment?" She said, "I miss my children." She saw them in December and will see them again next month, during holy week.

Were there other patients in a better frame of mind?

I met a guy, Luis, who's 19. His TB was so bad they had to take out an entire lung. He was just two weeks away from finishing one year of the IV treatment. He's just about through the worst. Then there's another year, on pills. He was very upbeat. He had been driving a mototaxi — a three-wheeled jitney cab. He's hoping next year he'll be able to go to school and study to be a professional.

Shots - Health News

What It Takes To Cure Drug-Resistant Tuberculosis

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'How Unromantic It Is To Die Of Tuberculosis In The 21st Century' March 22, 2015

What kind of professional?
I asked him. He said, "Anything other than driving taxis!"

tuberculosis

Infectious Disease

Global Health

General Motors announced last week that it's closing its auto plant in St. Petersburg, and Volkswagen says it will lay off workers and reduce shifts at a plant in central Russia.

The latest auto industry troubles highlight a dismal picture for foreign investment in Russia, which could see a 35 percent drop in sales this year.

Seven years ago, GM was looking at a bright future in the Russian market. Cars sales were taking off and would eventually grow at a rate more than 10 percent a year.

The company promoted its newest auto plant with a video that praised Russian government cooperation with the industry, which had already attracted companies such as Ford, Nissan and Toyota.

Related NPR Stories

The Two-Way

Kerry Warns More Russian Sanctions Possible Over Ukraine

Parallels

Sanctions Intensify Russia's Free Fall Into Economic Crisis

Now, GM has announced that it will close that plant and take a $600 million charge to pay for the restructuring. Like many foreign automakers in Russia, GM is facing a car market that's near collapse.

Low oil prices and Western sanctions, imposed on Russia for its annexation of Crimea last year, drove the ruble down by 40 percent, and with it, consumer buying power, says Mark Adomanis, an analyst who has covered the subject for Forbes.

"Given what Russians' average incomes are," he says, "big-ticket items like cars have never been easy to afford. But if all of a sudden, you make that car 50 percent more expensive, 30 percent more expensive, it's just beyond people's reach."

GM's costs rose more than many other automakers in Russia because the company imported many of its parts, Adomanis says, instead of sourcing them locally.

GM workers in St. Petersburg say the company failed to address a problem that many people saw coming.

Pyotr Letkeman, chairman of the union shop committee, say the workers feel they are being made to pay for management's mistakes.

"As far back as 2013, it was clear that sales were declining in Russia," Letkeman says. "GM had very little localization of production in Russia, so foreign parts became expensive when the ruble lost value. GM couldn't compete."

i

A security guard at the General Motors factory outside St. Petersburg. Opel, the European arm of GM, announced last week it was withdrawing from the Russian market, where sales are falling. Olga Maltseva/AFP/Getty Images hide caption

itoggle caption Olga Maltseva/AFP/Getty Images

A security guard at the General Motors factory outside St. Petersburg. Opel, the European arm of GM, announced last week it was withdrawing from the Russian market, where sales are falling.

Olga Maltseva/AFP/Getty Images

But GM isn't the only foreign carmaker having problems in Russia. Volkswagen announced that it's cutting back. The Korean company Ssangyong says it didn't ship any cars to Russia in January and February, because there simply wasn't a market for them.

The Russia government announced plans to provide carmakers with $166 million in subsidies to help tide them over.

Letkeman says the workers are angry and scared by a closure that will affect thousands of people.

"It's very painful," he adds. "People are calling me, asking 'what should I do? How will I feed my kids? How will I pay my mortgage?' "

Adomanis, the analyst, says that although it's very hard on people who lose their jobs, the overall job loss probably won't be felt in an economy where many people are employed by the government.

He says the real danger is the signal this sends to potential foreign investors.

"The automobile industry is one of the very few where they did a good job of attracting foreign investment," he says, "and to see one of the few industries where they have some real success stories to tell — to see people slashing production or in GM's case, pulling out entirely — is very worrying."

Adomanis says it's a sign that foreign investors no longer see the costs of doing business in Russia as being worth the benefits.

GM's plant closure will stop production of Chevrolets in Russia and wind down production of its German-designed Opel brand.

During its hot-selling days in Russia, Opel hired supermodel Claudia Schiffer to appear in an ad touting the car's engineering.

The ad closes with Schiffer speeding down a ramp in a parking garage.

These days, that downward spiral could just as well represent the auto market in Russia.

auto industry

Russia

General Motors announced last week that it's closing its auto plant in St. Petersburg, and Volkswagen says it will lay off workers and reduce shifts at a plant in central Russia.

The latest auto industry troubles highlight a dismal picture for foreign investment in Russia, which could see a 35 percent drop in sales this year.

Seven years ago, GM was looking at a bright future in the Russian market. Cars sales were taking off and would eventually grow at a rate more than 10 percent a year.

The company promoted its newest auto plant with a video that praised Russian government cooperation with the industry, which had already attracted companies such as Ford, Nissan and Toyota.

Related NPR Stories

The Two-Way

Kerry Warns More Russian Sanctions Possible Over Ukraine

Parallels

Sanctions Intensify Russia's Free Fall Into Economic Crisis

Now, GM has announced that it will close that plant and take a $600 million charge to pay for the restructuring. Like many foreign automakers in Russia, GM is facing a car market that's near collapse.

Low oil prices and Western sanctions, imposed on Russia for its annexation of Crimea last year, drove the ruble down by 40 percent, and with it, consumer buying power, says Mark Adomanis, an analyst who has covered the subject for Forbes.

"Given what Russians' average incomes are," he says, "big-ticket items like cars have never been easy to afford. But if all of a sudden, you make that car 50 percent more expensive, 30 percent more expensive, it's just beyond people's reach."

GM's costs rose more than many other automakers in Russia because the company imported many of its parts, Adomanis says, instead of sourcing them locally.

GM workers in St. Petersburg say the company failed to address a problem that many people saw coming.

Pyotr Letkeman, chairman of the union shop committee, say the workers feel they are being made to pay for management's mistakes.

"As far back as 2013, it was clear that sales were declining in Russia," Letkeman says. "GM had very little localization of production in Russia, so foreign parts became expensive when the ruble lost value. GM couldn't compete."

i

A security guard at the General Motors factory outside St. Petersburg. Opel, the European arm of GM, announced last week it was withdrawing from the Russian market, where sales are falling. Olga Maltseva/AFP/Getty Images hide caption

itoggle caption Olga Maltseva/AFP/Getty Images

A security guard at the General Motors factory outside St. Petersburg. Opel, the European arm of GM, announced last week it was withdrawing from the Russian market, where sales are falling.

Olga Maltseva/AFP/Getty Images

But GM isn't the only foreign carmaker having problems in Russia. Volkswagen announced that it's cutting back. The Korean company Ssangyong says it didn't ship any cars to Russia in January and February, because there simply wasn't a market for them.

The Russia government announced plans to provide carmakers with $166 million in subsidies to help tide them over.

Letkeman says the workers are angry and scared by a closure that will affect thousands of people.

"It's very painful," he adds. "People are calling me, asking 'what should I do? How will I feed my kids? How will I pay my mortgage?' "

Adomanis, the analyst, says that although it's very hard on people who lose their jobs, the overall job loss probably won't be felt in an economy where many people are employed by the government.

He says the real danger is the signal this sends to potential foreign investors.

"The automobile industry is one of the very few where they did a good job of attracting foreign investment," he says, "and to see one of the few industries where they have some real success stories to tell — to see people slashing production or in GM's case, pulling out entirely — is very worrying."

Adomanis says it's a sign that foreign investors no longer see the costs of doing business in Russia as being worth the benefits.

GM's plant closure will stop production of Chevrolets in Russia and wind down production of its German-designed Opel brand.

During its hot-selling days in Russia, Opel hired supermodel Claudia Schiffer to appear in an ad touting the car's engineering.

The ad closes with Schiffer speeding down a ramp in a parking garage.

These days, that downward spiral could just as well represent the auto market in Russia.

auto industry

Russia

It might not sound newsworthy that Charleston, S.C. is getting a new mayor next year. But the last time the city elected a new mayor was 40 years ago, in December 1975.

That mayor is Joe Riley; He's been re-elected nine times since, and now, at 72, has decided to retire. During his tenure, he has palpably changed the look and feel of Charleston and has been praised for taking a stand on racial issues. In 2000, he led a five-day march of hundreds from to Columbia, S.C. to demand that the Confederate flag stop being flown above the state Capitol. Riley spoke recently to NPR's Robert Siegel about that march, urban design and and how he feels about having the city's new baseball park named after him.

Interview Highlights

On changing the look of Charleston

What I saw [in Europe] was that the average person loved and was grateful for a quality public realm in their city. And that is the essence of a city — the buildings, the streets, the squares, the parks, the institutions. It is the duty of the mayor of being the urban designer for his city. The mayor has the power to affect people generations away.

And if you think about it, a society is more healthy when the things we love the most are the things we share ownership with. When the public has a park that the richest and the poorest own alike. Or a main street that's lively and safe and healthy and everyone owns, then we're all better off.

On marching to urge removal of the Confederate flag over the state Capitol

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In 2000, Mayor Joe Riley, right, led hundreds of marchers 120 miles to the Columbia, S.C. demanding that the Confederate flag to be removed from the top of the state Capitol. Mary Ann Chastain/AP hide caption

itoggle caption Mary Ann Chastain/AP

In 2000, Mayor Joe Riley, right, led hundreds of marchers 120 miles to the Columbia, S.C. demanding that the Confederate flag to be removed from the top of the state Capitol.

Mary Ann Chastain/AP

I sought this job ... mainly to help build a bridge between the African-American and the white community. Charleston's a deep Southern city, the Civil War was started here, the 60s and 70s time of change, and that was what brought me to this job.

So having the Confederate battle flying atop the state Capitol, it made no sense and it was an affront to many people in our state. And so I led the march, and it came down. And that was a very important experience for me, and I think it helped our state move forward.

On having the city's new ballpark named after him

I never wanted that. I worked hard to get a baseball park built ... and there was a lot of controversy, and why not put it in the outskirts of town where the land is cheap and all of that. So the city council demanded, against my vote that they name it after me.

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Joseph P. Riley Jr. Park in Charleston, home of the RiverDogs. Streeter Lecka/Getty Images hide caption

itoggle caption Streeter Lecka/Getty Images

Joseph P. Riley Jr. Park in Charleston, home of the RiverDogs.

Streeter Lecka/Getty Images

[When the season starts] I will throw out my last opening day pitch, and work very hard to get it over the plate.

On deciding to retire

It's an intense job, you give it all, everyday, and I just don't want to get into another term where I say 'gee, it would be nice to take it a little bit easier.' So my goal is to finish the last day in office, mentally, like running through the finish line of a road race with a good kick. I've got about 50 active projects I'm working on right now and probably never worked harder in my life.