Page last updated at 02:03 GMT, Friday, 9 January 2009

Life in Tajikistan's 'death valley'

By Rayhan Demytrie
BBC News, Tajikistan

Tuberculosis has been the blight of 36-year-old Mirzo Nosirov's life.

Mirzo Nosirov in Karagoch, with a picture of his brother
Mirzo Nosirov has lost 13 family members, including his brother
In the past four years he has lost 13 close relatives to the disease.

"The last to die were my daughter and my brother," he says. "I buried them on the same day."

Mirzo lives in the village of Karagoch, about 200km (125 miles) south of Tajikistan's capital Dushanbe. Almost every household here in "death valley" has a member of their family who is either dead or ill.

TB is rampant throughout the surrounding region of Khtalon, and is one of the biggest public health problems in the country as a whole.

A 2006 World Health Organization (WHO) report estimated that the infection rate was at epidemic levels - 204 cases per 100,000 of the population, compared with about 15 in western Europe.

Figures from the Tajik health ministry paint a less alarming picture. They suggest that in the same year there were just 75 new cases of TB.

But both agree that, since then, cases have risen.

Aid agencies claim the situation is especially bad in rural areas because they are facing more and more cases of TB which is resistant to multiple drugs.

Karagoch in Tajikistan
I personally don't believe it's tuberculosis. How would you explain the fact that it is mainly killing those who are under 30?
Ostankulov Kholmat
Karagoch resident
Its resilience has made some locals sceptical that it is actually TB that is doing the killing.

"I personally don't believe it's tuberculosis. How would you explain the fact that it is mainly killing those who are under 30?" says Ostankulov Kholmat, who has lived in Karagoch all his life.

"It's never been as bad as this," he adds.

Another factor helping the disease to spread is a lack of knowledge about the dangers of infection. Local customs and habits include eating from the same dish and not isolating those who become infected - and many households are poorly ventilated.

Listen to Mirzo - the Tajik man who lost 13 of his relatives to TB - tell his story

Poor man's disease

The principal reason behind the spread of TB is poverty. In rural areas of Tajikistan few can afford to buy nutritious food and medication.

Mirzo says his afflicted family members all received treatment in the local hospital.

"But it didn't help, it only made them feel worse," he says.

The hospital has little to offer. It lacks electricity, central heating and running water.

"This is the main treatment area," says a nurse, pointing at two plastic drips standing in a dark corner of a dingy room.

Next to the drip is an old-fashioned basin with a plastic tray underneath.

Tajikistan's healthcare system has not undergone any major investment since the collapse of the Soviet Union.

According to the WHO's 2008 World Health Report, the Tajik authorities spend less than $100 (67) per person on healthcare.

In a country where more than half of the population live below the poverty line, few can afford proper medical care.

Foreign aid

A number of international donors are supporting Tajikistan in its fight against TB. In July 2008 the German Development Bank allocated more than $3m to finance a TB project in the country.

Young men walk in Karagoch
Poverty is the common feature of those dying from TB
One of the biggest aid agencies operating in the country is the Global Fund to Fight Aids, Tuberculosis and Malaria. It has allocated almost $15m to Tajikistan between 2007 and 2012 to fight TB. Most of these funds go to the national TB programme.

"Since 2003 the Global Fund has approved funding of up to $40m to fight tuberculosis," says Saleban Omar, a programme manager for the United Nations Development Programme (UNDP), which distributes Global Fund money in Tajikistan.

"As international donors, we can provide technical assistance and financial support," he says, while emphasising that the government still needs to address the problem fully.

Fresh graves

Tajikistan's health ministry says the government is aware of the problem and is treating the worst-affected areas. It claims the state is working on a special programme aimed at eliminating the disease by 2010.

In a written statement it even claimed the mortality rate had fallen and that those who died were mainly patients with chronic TB.

Back in Karagoch village, a group of men are emerging from a traditional Thursday ritual to remember the recently deceased.

They cannot explain what is happening in their village, but one man simply says: "Visit our cemetery and you will see many fresh graves there."

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