This article is taken from the Institute of War and Peace Reporting 
(iwpr.org).  The leader of Turkmenistan has decided to close all hospitals 
outside the capital.  A pretty shocking example of regionally relocating 
resources, that is bound to have a major impact on regional access to 
health care that will disproportionately hit the poor.

Nick MEgoran.



Reporting Central Asia


Turkmenbashi Wields the Axe

Third wave of medical cuts closes hospitals everywhere except the capital.

By the IWPR team in London (RCA No. 356, 11-Mar-05)

The Turkmen president’s decision to close down all hospitals in the 
republic and concentrate treatment in the capital Ashgabat has caused 
dismay at home and abroad.

“Why should we waste good medical specialists on the villages when they 
should be working in the capital?” asked President Saparmurat Niazov, who 
styles himself Turkmenbashi or “Leader of the Turkmen”, as he announced the 
reforms on February 28.

“Why do we need hospitals and doctors all over the country? Let citizens 
come to the capital and be treated there. Needy people can visit state 
clinics for advice and the better-off can go to private hospitals. Nobody 
will be without medical help!”

The move is the third in a series of blows for the medical sector. Two 
years ago, some 12,000 medical personnel were laid off, and 15,000 more 
were made redundant last year and replaced with conscript soldiers. It is 
estimated that thousands more will lose their jobs through these new cuts.

The news has been greeted with anger in Turkmenistan, not least because it 
came only a week after the president flew a group of senior German surgeons 
to Ashgabat so that he could undergo an eye operation.

As the majority of the population live in abject poverty, analysts fear 
that many will go without vital medical attention, no matter what 
Turkmenbashi says.

Only polyclinics, offering a range of basic health services, will remain in 
the regional centres, with non-emergency patients being sent to the capital 
for treatment - but at their own expense.

And with many towns in this vast but sparsely populated country located 
hundreds of kilometres away from the capital, just getting to hospital will 
be no easy matter. The travel costs from remote rural regions will be too 
high for many.

However, most observers fear the real cost will be counted in lives, not 
money. As travel to the capital can take many hours, anyone seeking urgent 
medical help could die without prompt treatment.

Taxi driver Merdan, whose elderly parents live in village of Gumdag some 
390 kilometres from Ashgabat, told IWPR he was deeply concerned by the 
news.

“My father is a heart patient, and he goes to the district hospital twice a 
year for a check-up and treatment,” he said. “But after these new rules are 
introduced, he will have to go to Ashgabat - and with his small pension it 
will be very hard for him to do this even once a year.”

Turkmenbashi insists the latest reforms will not put lives at risk and 
points to the existence of an air ambulance service as an important 
failsafe in emergency situations. However, medical analysts say that only 
one helicopter has been available for the whole country since 2001.

“I live in the eastern village of Gaz-Achak, and to get to Asghabat today I 
had a two-hour drive to Kerka, where I caught a plane that flies on that 
route only twice a week,” said entrepreneur Gulshira.

“So if I have a serious attack of appendicitis, or, God forbid, a heart 
attack, I can only reach a surgeon in the capital in ten hours - and only 
on certain days.”

Ashgabat residents are worried that the new rules will lead to an influx of 
desperately poor people from the regions.

Natalya Davydovna, who lives near one children’s hospital in the capital, 
said, “People often knock on our door asking for money or to be allowed to 
stay the night. They are parents whose children are in hospital, and they 
do not have the money to stay in the capital. The numbers are certain to 
increase.”

One hospital orderly told IWPR that this situation was commonplace. “Entire 
families from out of town sleep under the windows of the hospital while 
their children are being treated inside,” he said. “In the cold or in the 
heat, they lay out blankets and sleep on the ground, adults and children 
alike.”

“The hospital administration used to try to do something about this, but 
now they no longer drive these people away.”

The situation is often little better inside the hospitals.

Many who have attended Ashgabat’s expensive medical centres are 
disappointed with the quality of service and lack of specialists and modern 
equipment available.

Frequently, the young specialists who work at the centres graduated from 
the state medical institute after the republic gained its independence in 
1991, and many do not understand the Latin terms use in international 
medicine.

Qualified personnel of the old school have either been laid off, or have 
resigned voluntarily.

Former paediatrician Svetlana Ivanovna told IWPR that she had left her 
clinic in 2002 because she did not want to follow “the enlightened health 
policies of president-for-life Turkmenbashi” and treat people with 
improvised remedies and folk medicine, such as wood ash instead of 
antiseptic to sterilise wounds.

“It’s strange that the president made the decision to close the hospitals a 
week after he had an eye operation conducted under general anaesthetic by 
German doctors who were flown in specially,” she noted.

“But the Turkmen people are silent about all these terrible new rules, and 
only express their dissatisfaction in their own kitchens, as it is 
dangerous and improper to criticise the president out loud.”