Kyrgyzstan's quiet health revolution

By Imogen Foulkes
BBC News, Kyrgyzstan

The women's health committee in Simisbel

High in the mountains of Kyrgyzstan, a quiet health revolution is under way.

Narin province is the poorest region in a country which is now among the poorest of the former Soviet states.

The population lives primarily from sheep farming. Tiny villages, at altitudes of 1,500m (4,900ft) and more above sea level, each with just a few hundred people, are spread out across a wide area.

Even in a rich country, health care would not be easy to deliver in such terrain. In Narin province, the collapse of the Soviet Union and the abrupt end of funds from Moscow led to an almost complete collapse of the health system.

"In Soviet times there was a very extensive network of primary health services in each village," explains Tobias Schueth, of the Swiss Red Cross.

"They even used to fly helicopters up to the high pastures to do vaccinations.

"And they had a very extensive hospital system. But with the collapse of the Soviet Union that whole system broke down."

Decaying hospital buildings

The Swiss Red Cross (funded by the Swiss and Swedish governments) is now implementing a project to improve primary health care in Narin province - and that is a challenging task.

Schoolgirls in Kochkor

Kochkor is the largest town in Narin, and right at its centre is clear evidence of the collapse of the health care system. Of 20 hospital buildings, just three are now in use.

"This was typical for Soviet times - very big hospitals, and huge bed numbers," says Tobias.

"The hospitals got their resources according to their bed numbers. And now this is all that is left of a hospital that once had 400 beds."

We have had to learn for ourselves how we get ill, and we are learning how to prevent these illnesses Akjoltoi Majikova

But the lack of hospital beds need not have disastrous consequences for public health.

The Red Cross has devised a project which allows local people to identify their biggest health problems, and then the project provides support to tackle them.

The scheme relies on the formidable energy of village health committees, primarily women, elected by their local communities.

"We are on our own now," explains Akjoltoi Majikova, who is chairwoman of the committee in the village of Simisbel.

"We have had to learn for ourselves how we get ill, and we are learning how to prevent these illnesses.

"In Soviet times everything was free, we had medical specialists - we got used to having everything done for us."

Not anymore: the committees have identified several problems which they say are damaging the health of their communities. Chief among them is anaemia, which is caused by poor diet. Alcohol abuse and iodine deficiency are also high on the list.

Checking out the gardens

To tackle anaemia, the project has paid for seeds for vegetables such as sugar beet, and the committee has distributed them to householders.

A Muslim cemetery - many aspects of life haven't changed for centuries

But it doesn't stop there. Committee members have been checking out each garden, and counting how many sugar beet have been planted. It is all carefully documented in handwritten files.

To tackle iodine deficiency, the women have visited local shops, and demanded the right to test all the salt on sale.

Villagers have been encouraged, in no uncertain terms, to boycott the non-iodised variety.

These no-nonsense women are unapologetic about what some might call their nosiness.

They point instead to their results - a drop in levels of anaemia, and the fact that 98% of households in Narin are now using iodised salt.

Goodbye to vodka

But when it comes to cutting alcohol consumption, the committees have a harder task in achieving that level of success.

"It's common to consume vodka at all sorts of occasions here" explains Tobias Schueth. "From funerals, to parties celebrating the birth of lambs."

And in this frequently cashless rural society, vodka is often used as payment for work done.

Tackling such entrenched traditions sounds difficult but the committee women are undaunted.

The committee meeting room in the village of Arakul boasts an enormous chart.

In exhaustive detail, it lists every bottle of vodka consumed, at every funeral, lamb party, wedding or any other occasion over the last two years.

And faced with such tenacity on the part of the committees, it begins to become clear why alcohol consumption in Narin is indeed falling.

In Arakul, under the watchful gaze of committee members, the practice of paying for work in vodka has almost completely died out.

And the level of alcohol consumed at festive occasions is falling too, although more slowly.

"People don't get exactly angry with us when we ask about their alcohol consumption," laughs Akjoltoi Majikova.

"But if they've got a bottle of vodka at home already for a party or something, they tell us they'll just drink that one and then give up. Promises, promises!"

Nationwide project

And despite confronting such tricky subjects as vodka drinking, the committees enjoy widespread support in Narin province.

The women clearly enjoy their work and there is no shortage of committee members, despite the fact that they do not receive any payment.

"I want our village to be healthy, I want our schoolchildren to be healthy so I don't mind working for free," explains Burul Chomokova, from Arakul.

"I'm doing it from the bottom of my heart. It's one of our sayings here in Kyrgyzstan you know: 'health is the first wealth'. "

Such is the success of Narin's village health committees, that the Kyrgyz government has decided the project should go nationwide.

Hundreds more committees are being set up across the country, so those Kyrgyz villagers who still enjoy a vodka or two better watch out because the committee ladies are coming.