By News Briefing Central Asia - News Briefing Central Asia 5 Aug 10

While Turkmenistan has made significant improvements to its healthcare system by building modern hospital facilities, patients and doctors say overall care levels still leave a lot to be desired. In an articled timed to coincide with a conference on health reform in late July, the government news agency TDH said dozens of new medical institutions had been built or refurbished, and fitted with state-of-art equipment.

“This has had the most positive of effects on lowering the incidence of disease and increasing life expectancy,” iit said. The creaking health system was allowed, even helped to disintegrate under the late president Saparmurat Niazov. On his death in late 2006, his successor Gurbanguly Berdymuhammedov pledged to reform and improve care provision. He was well qualified to do so, as a qualified dentist and lecturer in health-sector management. Some of the results are already in evidence. The last few years have seen new general hospitals, cancer clinics and ear, nose and throat centres appear. Berdymuhammedov has allocated hundreds of millions of US dollars to build large mother-and-child clinics in every province of Turkmenistan, and approved plans for a major ophthalmological centre in the capital Ashgabat.

Observers say that after the international health group Medecins Sans Frontieres was forced to leave Turkmenistan last year, the authorities closed down a tuberculosis prevention centre in Ashgabat, a venereal disease clinic, a blood bank, and the infectious diseases hospital in the capital. Despite improvements to infrastructure, residents say health service provision remains poor. A mother-of-two in northern Turkmenistan described her experience at a hospital that had been provided with a scanning machine. “It’s either out of order or else there’s no one who can operate it, so I had to take my daughter to the capital to get a brain scan done on her,” she said. A 50-year-old man said that after he had a scan done, he sent the results to Russia to obtain a diagnosis from doctors there. “The doctors here told me that the people here couldn’t read or interpret the results,” he said. A doctor in Ashgabat expressed concern at the lack of efforts to curb disease, infant and maternal mortality, and suicide. Bakhty, an experienced medic in the same city, says people are put off by surgeons who use obsolete treatment methods. Businessmen with the means to do so have been travelling to Europe for knee cartilage operations, as they will be able to stand up soon afterwards rather than spend a week in bed as they would have to in Turkmenistan. Education experts say training for medical personnel remains poor, and there is no career development for qualified staff, or opportunities to go abroad on exchange programmes. “Medical schools, like other institutes of higher education, admit students on the basis of ‘protection’ money,” a retired educational official in the southeastern Mary province said. “The bribe they have to pay to get in is several times higher than for other disciplines. And students continue paying bribes throughout their studies. “How are we to get good professionals in a situation like that?” Tajigul Begmedova, who heads the Turkmen Helsinki Fund for Human Rights based in Bulgaria, hopes that medical training will improve so that the profession becomes a real vocation. “This year, there’s some hope that fewer children of senior officials will apply for university,” Begmedova said. “There’s an unwritten instruction that the children of officials should go abroad to study, rather than to local universities.” Even before Berdymuhammedov, the healthcare strategy was to shift from free provision to paid services. At the moment, the system is in transition, and critics say that chargable services are far too expensive, while the old practice where patients pay informal “fees” to doctors for free healthcare persists. If a patient has no medical insurance, admission to hospital costs 75 dollars, and a day’s care at cancer clinic 25 dollars. With insurance, these fees are subject to a ten per cent discount. Medicines have to be paid for separately. “I had to pay nearly four dollars just for urine and blood tests at a test,” a villager from the eastern Lebap province said. “My neighbour is a ‘tabib’ [traditional healer] and for 20 cents she’ll tell me everything about my illness and give me all sorts of potions.” A pension said he did not like visiting hospitals as he could not afford to slip the doctors some money so that they would attend to him. “A doctor will come into the ward and deliberately ignore any patients who aren’t paying [informal] fees. He will be attentive to those who do pay,” he said. “One night, I was feeling bad so the doctor told to go to the pharmacy and buy the medicine myself, as he didn’t have any.”

This article was produced as part of IWPR’s News Briefing Central Asia output, funded by the National Endowment for Democracy.