Image by Flicker user Howzey (CC-usage).

Editor’s note: Turkmenistan’s healthcare system is decrepit but veiled in totalitarian secrecy, says a report by humanitarian organization MSF.  “Trying to scare off criticism by baring its teeth will not save our government from decline,” writes neweurasia’s Annasoltan.  Read her ongoing coverage of Turkmenistan’s crumbling healthcare here.

Médecins Sans Frontières (MSF), which was kicked out of the country last year, have now gotten “the bill” this week from Turkmenistan.  In a rare spectacular showdown with an international and prestigious humanitarian organization, a Turkmen Foreign Ministry statement attacked with harsh words a report issued on 12 April by MSF as,

“a provacation, containing false information with the deliberate aim of discrediting the reputation of the country.”

The report provides valuable insight to Turkmenistan’s public health care system, the realities of which are usually “hidden with care” from the public. It says

The people of Turkmenistan are being failed by their health care system, by their government, and by the international community. The system that supposed to ensure their health is instead designed to conceal problems. This is not the case of individual practices failing to do their jobs but one that is far more systemic.

The report goes onto say that public health risks are not being effectively addressed, prevention mechanisms are not in place, misinformation about how to avoid contracting and spreading disease is rampant, and serious health care issues are driven underground.

Dying from an illusion

The report disputes the official figures about communicable diseases like HIV/AIDS and tuberculosis, saying that these illnesses are more prevalent than the government of Turkmenistan wants to admit.  Keep in mind that MSF worked in Turkmenistan for more than ten years and remained, until its departure in 2009, the sole accredited international NGO with a permanent presence outside the capital.  Their report is based on observations and information collected from within the country during this time:

“[We] had the unique opportunity to witness the challenges facing the health care system.”

The Turkmen Foreign Ministry retorted with this self-assessment of Turkmenistan’s healthcare capabilities:

“Turkmenistan is one of the few countries in the world that haven’t experienced HIV/AIDS spreading on its soil, thanks to international cooperation, prophylactics, and prevention against [their spread] and the steady steps Turkmenistan is taking.”

Why such a response? On the one hand, it’s about public relations.  The fact that the Turkmen authorities  wanted to hinder MSF specialists from getting directly involved with Turkmen patients, and that they were not ready to give up their role as the sole provider of medical services to the population, speaks volumes.  They were probably worried about how it would look if they seemed dependent upon a foreign organization to provide such basic services.

On the other hand, I think it’s also about self-image.  I think we should take the Foreign Ministry a bit seriously: false pride seems to be a critical factor in the crumbling healthcare system.  That little slipped-in reference to “international cooperation” and the reference to “steady steps” are just a way to protect the president’s carefully constructed image as a modernizer and reformer, an image that the MSF report undermines.

A Turkmen post-graduate student remarked to me,

“Apparently our president is doing an effort to improve the health care system and rightly, they want the whole world to see the efforts of our government. But it cannot be a reason of course to conceal or deny the grave deficiencies that still exist. It only would make things worse. We’re all judged by what we do.”

I agree.  But most of all, I think the picture that emerges from the report about the government’s attitude toward healthcare also reveals the authorities’ attitude toward the populace.  “Paternalism” doesn’t begin to describe the loathing and disdain our government feels for us.  Trying to scare off criticism by baring its teeth will not save our government from decline — a decline made all the more inevitable by the decay of healthcare and its total lack of transparency in every sector of society.