The TB bacteria. Image from Wikipedia (CC-usage).

Tuberculosis, especially the drug resistant kind, is a serious problem in Turkmenistan.  Yet, the government is doing little to treat the disease.  In fact, they seem to be doing just the opposite — doing everything they can to make it more of a problem.

In my last post I talked with Christoph Hippchen, the country manager for Turkmenistan of Médecins Sans Frontières (MSF), who left the country last week.  Today I explore the baffling behavior of Turkmen health policy.

Hippchen offers the following explanation for the Turkmen government’s strange handling of the situation:

In general it is very difficult to negotiate these kind of programs. I feel that there is not much interest in having international organizations in the country and also there is the ambition by the Turkmen Ministry of Health to manage everything themselves.

The rates of drug resistant forms of TB indicate a deeply alarming situation. More than 20 percent or every fifth of newly diagnosed Turkmen patients have multi-drug resistant (MDR) TB.

We felt that because of the many tuberculosis cases we could have helped with our expertise, we could have helped them increase the capacity, we could have helped to accelerate the program to start treating the patients especially with medical health workers. But it’s difficult to get acknowledgement from the Turkmen side.

Turkmenistan currently has no program to treat drug resistant TBC. The Turkmen Health Minister’s proposal for a new program has got preliminary approval from the Global Fund.
However, Hippchen says that a program to treat drug-resistant TBC patients is highly technical and very complex.  Patients have to be treated between 18-24 months. According to the national strategy the first patients would be treated in 2013 but people have already died.

A drug resistant TBC develops when patients weren’t continuing the drugs, if the drugs weren’t efficient or the treatment inappropriate or too short and the patient’s situation can get worse. A patient with a resistant strain cannot be treated with standard drugs and has to be monitored.

One certain breeding ground for tuberculosis are the prisons in the country, in which the conditions are severe, according to international human rights organizations. Prisoners infect each other and when they mix among the population after they are released.  Hippchen remarks,

Prisoners are a concern all over Central Asia. Before you can work in the prison to cure tuberculosis you need to have an agreement with the Ministry of Health which we did not have.  The situation is not getting better for the drug-resistant TB at the moment.

Experts have long deplored the impact of Turkmenistan’s secretive and authoritarian rule upon the health of the country’s population has so far attracted little international attention.  Hippchen remarks,

We feel that the statistics that can be found on the WHO website are often too few, sometimes old and sometimes don’t make sense. It would be good if WHO ensures that the statistics are of good quality and current. They are important international actors who could influence Turkmenistan to supply those statistics to the benefit of the people of Turkmenistan.

To repair some of the worst damage done by the country’s former eccentric ruler, Berdimuhammedov promised extensive reforms in a number of areas, including healthcare, shortly after assuming power in 2007.   But Hippchen says that the situation hasn’t much changed in the last three years:

There is great need in primary health care and there is a great need to tackle TB and especially drug-resistant TB/ If immediate measures are not taken, the situation is to get worse.

It is thus a supreme irony that Berdimuhammedov is a dentist by profession and a former Health Minister.