Urgent need for health education

The vast majority of Tajikistan's adults suffer from some kind of infectious disease, and there is a desperate need for basic health education, especially in rural areas, aid workers say. "We estimate that around 80 percent of the adult population is affected by infectious diseases," a public health nurse for the UK-based NGO, Merlin, Doris Manasseh, told IRIN in the village of Kofarnihon, some 20 km from the Tajik capital, Dushanbe. Tajikistan's crumbling health system has a budget which only stretches to US $1 per person per year in a population of six million. Severely under funded, it has scarce resources to deal with growing problems such as malnutrition in children, infectious diseases and HIV/AIDS. Although some assistance is being provided by the international community in the area of training health professionals and upgrading laboratory skills to better diagnose, treat and prevent illness, much more is needed. Health experts say improving the skills of nurses is of particular importance in the impoverished Central Asian nation, where 70 percent of the population is rural-based. In most cases, nurses and midwives are the first and only health care providers available to this section of the population. Merlin is one of a handful of international aid agencies working on improving the health sector in such areas. The NGO started a health education programme in local languages last year, warning people of simple diseases that can be easily avoided. Reaching out to 110 villages in the southern province of Khatlon Oblast, the sessions are conducted by trained medical staff once a week for a period of six weeks, covering various health topics. Highlighting the scale of the problem, Manasseh said collecting morbidity and mortality rates had been a big problem and that they were now encouraging local doctors to collect data. One problem exacerbating health challenges was low morale in the medical profession, fuelled by low pay. The average wage for a doctor in Tajikistan is US $40. "Medical staff do not receive support or supervision," she stressed. In Kofarnihon there was a chronic problem of malaria, diarrhoea and dysentery, caused primarily by drinking dirty water. Aminov Jaylo, a mother of three, told IRIN that her seven-year-old son had been ill for the past seven months, suffering from aches and pains. "This is most probably Malaria. There is an extremely high number of cases of this disease in the village," Manasseh said. The mosquito-borne disease was virtually eliminated when Tajikistan was part of the former Soviet Union and anti-malarial spraying extended even into parts of northern Afghanistan. Such mass sprayings stopped with independence and some 30 districts in Tajikistan are known to have mosquitoes carrying the potentially fatal plasmodium falciparum strain of malaria, according to experts. Compared to the more common type of malaria, which produces fever and chills but is rarely fatal, plasmodium falciparum produces a fever that rises steadily till the victim loses consciousness, suffers brain damage and dies. Jaylo had been attending the health sessions for several weeks and said they proved useful to her. "We know how to detect symptoms and if my children say they are not feeling well, I seek medical advice right away rather than waiting to see if they get better in a few days," she said. At the session in Kofarnihon, all 20 villagers present said they had not boiled water until they were told to do so during a class. "While working in the cotton fields we would drink water from streams and now know that we shouldn't do this," one woman told IRIN. During the session, the villagers were shown how to make dehydration salts in times of emergencies. However, one woman pointed out that some households would not have enough salt or sugar to enable them to make the mixture, as the average daily wage for labourers in this village was 25 cents. Local people do have access to a medical clinic, which is stocked with basic supplies, but many said they simply could not afford to buy medicines and would rather spend the money on food. "This is just one village in Tajikistan, there are many others in this situation," Manasseh added.