by Ata Garlyev
The article devoted to the situation in Turkmenistan’s pharmaceuticals market is available here.
Good-looking statistics and horrific reality
As claimed in official statistics, Turkmenistan’s residents seldom get sick, especially with virulent diseases.For instance, according to WHO (the statistical data is submitted by the country), the number of those diagnosed with tuberculosis is declining every year from 20 per 100 thousand residents in 2000 to 7,6 in 2016.
There are no HIV-positive people in Turkmenistan at all, despite the fact that in 2017 the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, according to the news outlet “Fergana” registered 136 cases of HIV-positive Turkmen nationals although the flow of migrants from Turkmenistan is quite low.
A similar situation is being observed in the case of other diseases.
Healthcare practitioners, however, testify to the opposite— the morbidity rate is constantly on the rise whereas the statistics, as is common, are embellished. What goes on “behind the scenes” is complicated but the scheme has been operating smoothly for many years.
For instance, neither in outpatient clinics or inpatient facilities are patients diagnosed with “serious” diseases such as HIV, measles, chicken pox, rubella, scarlet fever, diphtheria and some others. The symptoms of some of these are attributed to “allergic reactions”.
Medical staff refuse to diagnose TB until there are obvious symptoms when the disease moves to an advanced stage. Meanwhile patients are suffering and communicating the hazardous and easily-spread disease among people.
Constant stress caused by the economic crisis, a drop in income and a worsened quality of life are causing an increase in the number of cardio-vascular diseases and cancer.
The mortality rate is underreported in hospitals. Patients in a critical condition are not admitted into hospitals or, if the latter are already in the hospital, are sent home to die.
Consequently, the number of those who have died in medical facilities does not increase, which positively affects the statistics.
Medical tourism
Often patients choose to leave hospital as they cannot afford to pay for treatment or fear to be assigned to young doctors.If necessary, people try to be referred to doctors only on recommendation of family or friends. “Old guard” doctors are in a big demand and patients trust them much more than those who graduated from local universities under the new system.
Individuals who manage to obtain exit documents try to undergo medical treatment overseas. If residents have no opportunity they contact the privately-owned medical consulting centres. There are only two such centres left in Ashgabat. The Turkish clinic used to be popular but it was closed down in April 2017 without explanation.
Iran, India, Turkey and, to a lesser extent, Russia and the European countries are popular destinations for medical tourism. The qualifications and competence of the doctors there are incommensurably higher than in Turkmenistan.
Let me provide an example.An elderly male patient, an abstainer and non-smoker, had been suffering from kidney stone disease for 15 years.He had contacted numerous medical facilities and undergone courses of treatment in various outpatient hospitals, took numerous pills but pursuant to the verdict of Turkmen doctors he was prescribed to have nephrectomy of one kidney and breaking up of the stones in the other.
Doctors gave an unfavourable prognosis and warned that the patient should get ready for the worse-case scenario (fatal outcome) within a year and a half or two years.
After abandoning hope of recovery, wasting a lot of money and time and going through a nerve-wrecking experience, he decided to follow the advice of family members to try the last option and go to Iran.
Local specialists there cancelled nephrectomy and performed surgery to break up and remove stones from the other kidney to fully restore its function.Moreover, they prescribed medications preventing the formation of stones and gave recommendations which need to be adhered to throughout his entire life.
The patient was informed that if he followed these recommendations, he would not be fully recovered, needless to say, but the prognosis was favourable and it was possible to improve his quality of life.
This happened in 2014.The patient no longer considers himself to be sick, is celebrating his “new” birthday after his trip to Iran and enjoying life up to now.
However, the authorities of Turkmenistan try every possible way to prevent residents from departing overseas for medical treatment.The patients obtain a tourist visa or say that the purpose of the trip is visiting relatives.
Those who travel openly for medical treatment but have not had their trip pre-approved in the Healthcare Ministry are barred from boarding the plane in the majority of cases.
Nobody provides any clear explanations for the travel ban on passengers traveling overseas for treatment, but it appears that is how residents are urged to visit local new and state-of-the-art clinics and hospitals with advanced equipment.
State-of-the-art equipment and poorly qualified personnel
The equipment in these medical facilities is indeed good, but it cannot function on its own.A specialist is needed who has completed the relevant training, preferably overseas, in the training centre of a manufacturer.
This is a time-consuming procedure which requires money that is no longer allocated and, unlike equipment, this cannot be broadcast on television.Therefore the equipment mainly stands idle or is rarely used.
Another problem with equipment is a shortage of funds for maintenance and supplies.For the first few years (two years as a rule) the manufacturer provides free after-sales service.
In case some parts are broken, the hospital administration, which has to allocate funds for repair, is held responsible.Nobody is willing to allocate this money and, to be on the safe side, the equipment is taken away to be kept in operating condition in case inspectors come or new television footage on achievements of domestic medicine is made.
In order to keep abreast of modern methods of diagnostics and treatment, doctors need to visit international medical centres on a regular basis to have internships and learn about modern theoretical trends, attend advanced training courses, international conferences, exhibitions and other specialized events.
During Soviet times, this was common practice which brought about positive results.This is an undisputable fact.For instance, the Turkmen Research Institute of Eye Diseases led by professor N.N.
Nurmamedov, famous outside Central Asia, arranged professional exchange programs, shared methodology and best practices with the S.Fyodorov Eye Microsurgery Clinic (Russia) and the European Institutes.
Other examples are the Research Oncology Institute led by G.M.Nummaev and the Research Institute of Maternity and Child Welfare led by V.E.Radzinsky.
These times are long gone, but the tested models can be used even now.It should be mentioned that Iranian doctors go to Europe or the US to attend refresher courses for a month every year.
Regrettably, Turkmen healthcare practitioners can do this only upon their own initiative.There are some, but only a few.However, this individual initiative is not welcomed if a trip is not properly approved by higher-ranking authorities, doctors might face punishment and even termination.
Why?There is no comprehensible answer.According to medical doctors, the administration fears that subordinates might get exposed not only to medical practice but also to freedom; others fear that young professionals can become “too smart” and oust them, whereas the rest just want to avoid any problems and to be on the safe side.
Under such a degrading state of healthcare in Turkmenistan, it comes as no surprise that traditional medicine and witchcraft are thriving, and tabibs (healers) are more respected than doctors.
Under such conditions nothing remains except to wish Turkmen residents good health…