Tajik Health Scare

Failure by the Tajik government to quash rumours about an unidentified illness affecting parts of the country has led to fears of an epidemic of cholera or some similar disease.

The health ministry has diagnosed either dysentery or food poisoning but has said little else, except that people have no reason to be alarmed. Some doctors doubt that, and say the authorities could be covering up a more serious outbreak.

The lack of precise information about the number of people who’ve fallen ill, and the presence of police blocking hospital entrances, have only added to the sense of fear.

Around 40 children suffering from intestinal problems in Dushanbe were the first to be affected in mid-June. About 200 others in areas around the capital soon followed, with one fatality reported. The Jami region in the southern Hatlon province was next to succumb, with 27 cases and two deaths.

Up to four per cent of those infected have since died, a source with an international organisation told IWPR on condition of anonymity.

“There are a lot of sick people,” said Usmon, who came to the central hospital in Hissar, near Dushanbe, to visit his wife. “In one family, five people fell ill at once. All of them had vomiting and diarrhoea. And in the neighbouring village several people died.”

Another added, “There are dozens of sick people in every village.”

Though the situation now appears to be stabilising with new infections becoming less frequent and many of those admitted to hospital now discharged, fevered speculation that the victims were suffering from cholera continues.

“The main flow of sick people is sent to the central infectious diseases hospital. The police don’t let anyone in there,” said a man who gave his name as Umar.

Information about the scale of the outbreak appears to have been complicated by the fact that many of those who died were buried swiftly – in line with Muslim tradition - before autopsies could be performed.

Though patients with infectious diseases like cholera and dysentery are normally held in isolation wards, that has not been happening since Tajikistan introduced its new system of paid healthcare at the beginning of August. Just one day in hospital can cost up to 30 US dollars, unaffordable for most ordinary Tajiks.

One doctor who treats infectious diseases doubts the health ministry’s diagnosis of food poisoning or dysentery, saying the symptoms don’t match up. “Food poisoning and dysentery cause a temperature. Most of these patients don’t have one,” said this doctor, who asked to remain anonymous.

Another infectious diseases doctor says that if a government cover-up is taking place, testing patients for cholera will be impossible, as the laboratories where the analysis is done are state run.

“We do have not have any alternatives to the state laboratories, and every laboratory has probably received orders from above not to confirm any suspicions of cholera,” Dr Nigina Mirzoeva told IWPR. “So we will be kept in the dark anyway.”

Suspicions were further raised after the government initially said it didn’t have enough money to test for cholera, but is now insisting that anyone who was suspected of having the disease was tested and given the all clear.

Many Tajik doctors recently took special courses on preventing and treating cholera, useful in a country where outbreaks of infectious diseases have become a yearly occurance.

Polluted drinking water was blamed for a November 2003 typhoid epidemic in Dushanbe and regions bordering on Afghanistan. Last September, typhoid again broke out and more than 90 people fell ill when a pipe burst in the town of Penjikent, 180 kilometres northwest of Dushanbe.

Whatever the latest illness turns out to be, it is likely to be connected with the hot weather, consuming food under unsanitary conditions and drinking untreated water. Serious flooding in the south in June and July which destroyed canals and drains could also have contributed to the problems there.

A poster and newspaper campaign organised by the United Nations Development Programme, the World Health Organisation and the health ministry is advising Tajiks to drink only boiled water, peel the skin off fruits and eat only carefully prepared hot food.

But this advice may be falling on deaf ears.

“How can I boil water to wash fruit and vegetables when I don’t even have [running] water in the house,” said Dushanbe resident Oishamoh Sharipova. “For five years now water hasn’t reached us on the third floor during the summer.”

Sharipova’s neighbour Farida added, “We drank water from the tap all our lives without boiling it, Dushanbe water was considered the best-tasting in the world, and no one fell ill, let alone died from cholera or anything else. But what is happening now? There’s mud flowing out of the tap. There will be more than just cholera – a plague will break out.”

Observers say wealthy Tajiks are taking precautions, buying mineral water in shops, a luxury people like Hasan say they can’t afford.

“Everything is in God’s hands,” he said. “I can’t drink boiled water, it doesn’t taste good. It’s better to drink cold water out of the tap.”

Naturally, speculation is running rife as to why the Tajik government has been less than forthcoming on the recent outbreak.

Some believe it is connected to next year’s presidential elections.

“The Tajikistan government currently has absolutely no interest in sowing doubt that its chosen path of development is correct,” analyst Sobirjon Sharipov told IWPR. “To admit the fact would be tantamount to admitting a weakness in government, or that it is still unable to provide proper living conditions for the population and reduce the number of people living below the poverty line.

“After all, it is in poor developing countries that outbreaks of acute intestinal diseases occur.”

He concluded, “This move shows the weakness of the government, if 14 years since independence, and eight years after the end of the civil war, Tajikistan has not yet been able to cope with a problem that arises every year.”

Though the crisis appears to be waning with fewer illnesses reported in recent weeks, many Tajiks like Dushanbe resident Zuhro Davlatova remain on their guard against the mystery disease.

“To keep out of harm’s way, I don’t go out on the street at all. I don’t take public transport. I only buy goods at the supermarket. I don’t go to the market at all, and I only drink mineral water. I am even afraid of talking to my neighbours,” said Davlatova.