Health Services
As I have been sitting nursing a bout of the flu, my mind has turned, (naturally), to medical matters … I have, for example, looked up symptoms and treatments, but I have also been thinking about the medical provision here in Kyrgyzstan.
The travel advice for Kyrgyzstan from the British Foreign and Commonwealth Office states:
Medical facilities in Kyrgyzstan are not as developed as those in the UK …
Well, it’s difficult to argue with that, but it’s not all that helpful. .
Having grown up under the National Health Service of the Welfare State that had been established at the end of the Second World War and was, (so we were told), the envy of the world, I have to admit that the difference is very marked. However, I also have to say that the last two occasions that I had cause to consult the medical profession in the UK, I cannot say that I was that impressed. It was no longer the NHS of my childhood as represented by Doctors Brown, May and Elliott, of the Avenue Road Practice.
(Well, of course, at that point, as an ex-pat, I was no longer an NHS patient but a Private Patient … not that it seemed to make any difference).
Over ten years ago, for example, I only managed to get to see a doctor by pure chance … it turned out that he was my cousin and just happened to be walking through the surgery as I was talking to the receptionist trying to make an appointment and being told that I would have to make a temporary registration and then wait for something like a week before an appointment could be finally made. He recognized me, (or at least my name – we hadn’t seen each other for something like thirty years), and told her, “I’ll see this gentleman.” Once in the consulting room he identified himself and I thanked the sweet spirits of serendipity for my good fortune.
I learned from this and five years later, when I found myself needing to consult a doctor, I decided not to try a local surgery but presented myself to the hospital, (it was in a different city, so I couldn’t try try looking my cousin up). After the form filling, paying the fee and waiting in line, I finally got my consultation … but it was useless as the doctor simply told me to take Aspirin and refer to my doctor “back home in Kyrgyzstan”.
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Well, “back home in Kyrgyzstan”, there are some problems with the health services – mainly because they are underfunded, but then the provision of health care is a “black hole” and even in the West there are continuous cries about the insufficient funding to provide services for everyone.
The level of funding is an important issue, but it is also important how the funding that is available is used.
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Kyrgyzstan inherited the Soviet system of free universal health care, which generally provided sufficient numbers of doctors, nurses, and doctor’s assistants, as well as medical clinics and hospitals. Following the dissolution of the Soviet Union in 1991 and the deteriorating relations between Bishkek and Moscow – and the consequent withdrawal of financial support – the medical services of the country were left with an aging inventory of premises and equipment.
The number of medically trained personnel was adequate to meet the needs of the population – and medicine is still a popular profession and career choice. Medical students continue to receive adequate training – but with the collapse of the Soviet Union they lost the opportunity to travel further afield for specialist training and broadening their experience, (although some still manage to arrange further training, for example in Moscow). The various training institutions in Bishkek still train foreign students, (in Russian), especially from the South Asia, (the Indian sub-continent).
Also, with the dissolution of the Soviet Union, Kyrgyzstan’s residents lost the right to free treatment in the hospitals of other former republics, making unavailable many types of specialized treatment that the Soviet system had apportioned among adjacent republics.
Many of the services which would have been provided free in Soviet times, are now “paid services”. There is a system of Statutory Medical Insurance, operated by the Social Fund and funded by contributions from employers and employees based on salary levels – but the benefits are very small and only some basic services are covered.
The salaries of the medical staff are not very high. As a result many doctors have chosen to leave medicine for higher salaries in other professions. For those remaining, although it is illegal for employees of the state working in the health services to also work in “private practice”, many health workers were accepting payments for providing additional treatment, and it is sometimes said that medical staff may elect to perform operations – even exploratory operations – allegedly because they receive additional payments for them.
A few private health facilities have been established. In particular there are a number of doctors in the larger cities operating in private practice, and a number of private dental surgeries have opened. In the rural areas, however, the state run hospitals and medical services are still the only source of care and treatment available.
One of the biggest problems facing medical services in Kyrgyzstan is the lack of medicines. The country produces no vaccines of its own and almost no medicines or other pharmaceuticals. Although the supply of medicines substantially better at regional facilities than at smaller ones, items such as antihistamines, insulin, antiseptics, vaccines, and some narcotics are either extremely scarce or extremely expensive. It is thought that, because of the scarcity of vaccines, there is a greatly increased likelihood of epidemics of what would be easily controllable and containable diseases in other parts of the world. However, many proprietary brands of medicines are available “over the counter”, and even those which, technically, may require a prescription can be purchased. It is sometimes possible to purchase medicines in bazaars – but the quality of these is much in doubt. A number of scandals have erupted because of medicines which were supplied even though they were past their expiry date.
A wide variety of herbs grow in the mountains of Kyrgyzstan and herbal remedies are common used, especially amongst the Kyrgyz.
There are also trends for, what would be in the West, less orthodox forms of treatment. The salt mine of Chon Tus, near Kochkor, and the salt room at the Avrora Sanatoria are classic examples – thought to be good treating a number of ailments, including such things as asthma and muscular disorders. Avrora is just one example of the Sanatoria which were a major feature of Soviet Kyrgyzstan, and many still offer services in several places around the country – but primarily around Lake Issyk Kul.
There are plans for the reform of the service – supported by various donor organizations. For example: the capital, Bishkek, has a fleet of ambulances and other facilities provided by the Japanese International Cooperation Agency (JICA). A lot of attention is being directed by some projects at issues such as TB and AIDS, as these can be particularly debilitating to the population.
The main causes of adult deaths in Kyrgyzstan are: cardiovascular conditions, respiratory infections, and accidents. There is a low reported incidence of sexually transmitted diseases – but this may be due to the formalities involved – and many people infected may chose a less official approach to tackling their disease.
The quality of the water supply, especially in rural areas, is a matter of some concern … and is thought to be the source of several outbreaks of disease. Although adults traditionally consume most of their water in the form of boiled tea, children have greater access to untreated water and foods.
Additional stress is placed on the population by the rising cost of food, which has reduced the quality and quantity of most people’s diets. Also, there are sometimes reports of deaths or injuries caused by tainted or falsely labelled food and drink, particularly alcoholic beverages (“moonshine” vodka is known as “samagonka”) which are widely available.
The rising cost of energy has meant insufficient heat for many apartments and public buildings. In addition, the availability and range of ambulance services have been restricted severely by fuel shortages.
Bishkek