Providing health services on the Afghan border

The United Nations Population Fund (UNFPA), in conjunction with the Turkmen government and USAID, has been working to provide reproductive health facilities in the southeast of the desert nation in order to bring care to isolated communities and assist Afghans living on or near the border, an official of UNFPA has told IRIN. "With resources the way they are in neighbouring Afghanistan, UNFPA Turkmenistan has been trying to offer reproductive health facilities to thousands of Afghans who cross into the country looking for hospitals or clinics," UNFPA National Programme Officer Ezizgeldy Hellenov told IRIN in the second city of Turkmenabad. An agreement was signed between Ashgabat and Kabul in March 2002 for medical support to be provided to Afghans on the border. "Often the health situation of Afghans would be much worse once they had got to a big Turkmen town to seek medical help, so it was logical to try and take services to them," Hellenov said. He said some Afghans travel to the Turkmen border from as far away as Mazar-e Sharif, more than 150 km away, because word has spread about the health scheme. "Resources are very limited but we are doing what we can," he added. At a recent UNFPA-sponsored training workshop in Turkmenabad, doctors and nurses from the border towns of Serhetabat and Tagtabazar in Mary Velayat [region] said they were trying to implement safe delivery and pre- and post-natal care programmes in their communities. "Just some basic care and education goes a long way to helping mothers to have healthy children," Bayramgul Gamberdiyeva, a UNFPA project assistant, told IRIN. More than 50 Afghans received health care at Serhetabat this year, a nurse on the course told IRIN. However, it is not only needy Afghans who require improved medical facilities in southeastern Turkmenistan. A recent visit by IRIN to health institutions in the border regions of Lebap and Mary revealed a general lack of training and upgrading, resulting in reduced quality of care. Furthermore, there was a lack of medical equipment, basic laboratory equipment and drugs. Government information suggests the health situation has improved remarkably since the beginning of the transition from Soviet rule a decade ago. However, health indicators in recent statistical surveys suggest that the situation has hardly improved, and that real figures in key areas are up to three times higher than official figures. According to UNFPA Turkmenistan's Demographic Health Survey of 2000, infant and maternal mortality rates (74 per 1000 and 44 per 1000 respectively) are among the highest in the Central Asian republics, and are especially bad in the border districts. In Mary region, the infant mortality rate is an alarming 98.6 per 1000. In Turkmenistan, 22 percent of children under five are reportedly malnourished, and infectious diseases remain a major cause of death for all ages. Turkmenistan has the highest incidence of tuberculosis in the Central Asian republics, UNFPA says. In August 2002, UNFPA offices in Lebap and Mary were opened and supplied with the necessary technical equipment to implement the programme. But government health workers say more needs to be done in this isolated region. They say there is a real need for laboratory facilities at and near the Afghan border in order to rapidly identify diseases and deal with outbreaks of cholera and typhoid more effectively. A comprehensive vaccination programme is also required to keep preventable disease at bay until Afghan medical resources can be upgraded and take over.