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Last Updated: Wednesday, 16 November 2005, 16:27 GMT
Grim reality of Turkmen health care
By Sian Glaessner
BBC Radio 4's Crossing Continents

The extravagant nature of Turkmenistan's recent Independence Day celebrations were a marked contrast to the grim reality of life - and death - in this secretive and repressive state.

Turkmenistan celebrates its Independence Day in Ashgabat, 27 October 2005
The country has turned away from the world since independence

It took hours for her to die, and there were no trained medical personnel in the hospital.

The doctors had been sent into the fields to pick cotton, so when the girl was brought in after the car crash, there was no-one to treat her.

It was two days after her 16th birthday.

She had broken her collar bone and kept crying "I can't breathe", but the staff at the hospital could only watch as she slowly died.

That is just one story told to us by one of the few people in Turkmenistan brave enough to speak out, but the experience, apparently, is common.

A paediatrician told us that diarrhoea in children is treated not with oral rehydration salts, but with an expensive, yet ineffective, combination of blood transfusion and a massive cocktail of drugs.

Lucy Ash reports undercover from Turkmenistan on Thursday, 17 November, 2005 at 1102 GMT

In Turkmenistan's 14 years since independence, the medical system has deteriorated.

A US-funded survey of one region, carried out in 2000, found that the child mortality rate was on a par with some of the poorest parts of Africa.

All this in a country with the world's fifth-largest gas reserves.

Potentially lucrative deals with Western oil and gas companies have floundered as successive ministers involved in negotiations were sacked.

And what income there is from deals with Russia are poured into the capital's showcase projects.

Spiritual writings

An image from the Ruhnama
The Ruhnama is a 400-page blend of history, myth and philosophy

A systemic lack of trained personnel and an ideological drive behind modern medical care has resulted in the musings of a medieval philosopher, Avicenna, becoming required reading for all doctors and pharmacists.

They also have to sit exams in President Saparmyrat Niyazov's spiritual writings, the Ruhnama.

Under these circumstances, it is not surprising that those medical professionals who can have fled the country.

There is a hospital in Moscow known as "the Turkmen hospital" because there are so many Turkmen doctors working there.

Coupled with frequent rounds of job cuts in healthcare, this has brought a system that was already in a poor position under the Soviet Union, to its knees.

Some problems have been acknowledged by the Turkmen regime, which has this year alone spent 10m on drugs and equipment.

Its success in the area of child vaccination is internationally recognised, and the regime takes the health of its population seriously, at least in rhetoric.

Walk of health

Turkmenistan President Saparmyrat Niyazov
The president is known as Father of the Turkmen, or Turkmenbashi
President Niyazov himself initiated an anti-smoking campaign, and encourages his people to enjoy the "Walk of Health", a newly constructed mountain path with stunning views of the capital, Ashgabat.

As of this summer there is a programme under way to create a network of "baby-friendly hospitals" throughout the country. Several new medical facilities, including a cardiology centre, have been built.

But the problems run deeper than a simple lack of money or equipment.

Education is the main problem and the simple lack of trained staff is responsible for countless deaths.

In one hospital, we were told there was a case where an 18-month-old child had been seriously ill with pneumonia, but had recovered. Two days later she was dead.

The doctor we spoke to said it was because there is such a shortage of trained paediatricians.

He said a doctor without the relevant training had been on duty, had seen the child in distress and prescribed an adult dose of diazepam, which killed her.

The victims have no redress.

Underground medicine

Three Turkmen boys
Rural communities are served by few able doctors and little medicine
In Turkmenistan when you fall ill, it is very important you have friends in high places.

We met one dentist who, like many, was sacked suddenly one day and has since taken to practising out of his flat.

Medicine has gone underground.

People prefer not to go to hospitals if they are ill, but furtively ask their friends if they happen to know a good doctor.

Gulsum - not her real name - was eager to speak to us about the grim reality she has seen in her work as a health inspector.

She revealed a system of under-reporting of infectious diseases, which has tragic human consequences.

She said that in her organisation all infectious illnesses are covered up.

It is done informally, and the management makes it clear to all involved that it would be better for them if the reality does not appear on the reports.

Bubonic plague

That is why on paper the situation is a happy one. TB is in decline, the country is free from syphilis and Aids, and there have been no reported outbreaks of bubonic plague.

The reality is somewhat different.

Gulsum claimed there had been an outbreak of bubonic plague last year in which 69 people died.

And she talked of cases where people have died of TB because they did not have the money to pay for treatment, in a country where the government claims there is free healthcare accessible to all.

She described a hospital without running water above ground level, where patients have to go home to wash.

Turkmenistan has been ignored by the West since the collapse of the Soviet Union

Many Turkmen agree with the international medical community that there could be horrific global consequences of this non-reporting of infectious diseases should a serious epidemic arise in Turkmenistan.

Turkmenistan has been ignored by the West since the collapse of the Soviet Union.

It was perceived as an oasis of stability in a volatile region that has seen its fair share of civil war, failed states and Islamic extremism.

Internationally, a blind eye was turned to the eccentricities of President Niyazov while, on the whole, the world's press played it for laughs each time a new absurd decree emerged.

Personality cult

Today's Turkmenistan is no joke.

It is, said David Lewis, author and expert on the region, on the verge of becoming a very nasty failed state.

Participants of a parade celebrate the Turkmenistan Independence Day
The president's portrait hangs everywhere in Turkmenistan

We were there during Independence Day celebrations, when Ashgabat was cleaned up and kitted out in colourful flags.

There was a day of parades, concerts, and an extravagant firework display.

Soldiers marched and shouted oaths of allegiance to Turkmenbashi, or the "Father of all Turkmen", as the president is known.

Music and mass dancing followed and then, quite suddenly, all was silent.

Birdsong filtered through the massive PA system and children rushed into the arena. They sang upbeat hymns to Turkmenbashi and his great work, the Ruhnama.

This is a feverish personality cult, which has few modern parallels.

Since our visit, doctors in Turkmenistan have been told they must pledge allegiance to the president, instead of taking the traditional Hippocratic Oath.

The Neitralniy Turkmenistan newspaper reported on 15 November that doctors must kneel solemnly and take the pledge to Niyazov and his book of moral guidance, the Ruhnama.

That lost generation is what people fear could provide the next generation of recruits for radical Islam
The population is kept in near isolation from the international community. That is the reality of the president's obsession with "sacred neutrality".

One Ashgabat intellectual said that generations of school children are growing up knowing practically nothing apart from the president's holy Ruhnama.

That lost generation is what people fear could provide the next generation of recruits for radical Islam.

"Soon," said the Ashgabat intellectual with an air of sad resignation, "there will be no-one left to talk to. It'll be the Taleban, it'll be like that. The world will see a new catastrophe, and it will be Turkmenistan."

BBC Radio 4's Crossing Continents was broadcast on Thursday, 17 November, 2005, at 1102 GMT.

The programme was repeated on Monday, 21 November, 2005, at 2030 GMT.

Assignment: Inside Turkmenistan was also broadcast on the BBC World Service.

Drugs in Turkmenistan
Lucy Ash speaks to a drug addict in a run down part of Ashgabat

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