For about two years after his initial treatment, Sergei felt fine. Rather than being moved back to a regular prison, however, he was offered the chance to stay on at Vladimir and finish his sentence as an orderly. Three years later, he recalls in a low voice, his symptoms returned. A lab technologist prepares a sputum smear for testing. Sergei pauses, looking at the prison doctor. "He's due to be released soon," she interjects, "but he's not responding to therapy." The doctor hands me Sergei's chest X rays, and I place them on a view box. I try not to wince. Long and erratic treatment has done him no good; providing therapy erratically is one of the best ways of inducing the tubercle bacillus to become drug-resistant and therefore one of the worst ways to try to cure TB. In recent months, in fact, there has been a marked enlargement of the cavities in Sergei’s right lung. Spreading inexorably, tubercle bacilli have already reduced half of that lung to Swiss cheese. But in all likelihood, Sergei—along with about thirty other Vladimir inmates—will be sent home this month, carrying infectious pulmonary tuberculosis with him. He’ll spend the harsh Siberian winter cooped up in a tiny wooden house with his wife and children. The one thing that might protect his family is that they may already be infected with latent tuberculosis. For TB is again epidemic across Russia, especially in the areas surrounding its many prisons. Handing the X rays back to the doctor, I smile encouragingly at Sergei and wish him luck. After the doctor and I leave the crowded cell, my questions begin. What drugs are Sergei and the rest being treated with? Are you having trouble with drug supply? Do the prisoners take their medications? Is each dose directly observed? Is there adequate food? My colleague nods patiently. Food is scarce, she allows, but they're managing to scrape by. Some of the guards, although underpaid, share their own food with the prisoners. Sergei is now receiving isoniazid, rifampin, and ethambutol—three of the strongest (or so-called first-line) drugs. The dosage is correct, and the staff directly observe him taking the pills. Yet each month, his doctor explains, microscopic examination of Sergei's sputum continues to reveal signs of persistent tuberculosis.