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Focus on rural health promotion in Naryn

[Kyrgyzstan] A health worker in Osh.
David Swanson/IRIN
Since 1996, the number of hospital beds and medical staff in public hospitals has decreased
Head eastwards from the Kyrgyz capital Bishkek towards China and you will eventually reach Naryn Oblast - the least populated and the poorest region in the Central Asian state. Most of the 240,000 people in the province live in villages scattered in the high mountains, where temperatures can drop as low as minus 35 C in winter. Such harsh conditions can cause many health problems, which has made the provision of good health care in this region a national priority. The national health reform "Manas", launched in 1996, led to an attempt to reconstruct the decaying Soviet-era hospital infrastructure. In public hospitals the number of beds and medical staff was decreased with a view to rationalising the health system. The focus was shifted from medical treatment to the promotion of healthier life styles. However, in small villages such as Cholon Kayin in Naryn, the reforms have not led to significant improvements in the health profile of the population. It is hard to communicate basic health information to local people because roads are hardly passable, television and radio not available, and newspapers often delivered weeks after publication. Most information is communicated by word of mouth. PUBLIC HOSPITALS In Cholon Kayin village two family doctors serve 425 households. Gulnara Nurkemelova, 28, told IRIN that although she always wanted to be a doctor sometimes she hated her job. She described the difficult conditions in a rural hospital: "In winters we turn the heating in the hospital on only when we absolutely can't stand the cold, because we need to save the energy. The basic medical equipment is lacking, we used our own money to buy a sphygmomanometer. We don't even have enough thermometers." Gulnara came to work as a doctor in this public hospital after she graduated from the Medical Academy in Bishkek: "My salary is 700 som [US $ 17] per month. I would never have come back to work under these conditions. It's just that I got married to a local guy and did not have a choice but to stay". Even Gulnara's colleagues are surprised at her decision and say it is very rare for young medical graduates to return to rural areas. Zhanyl Musamambetova, a nurse who works in the regional hospital in nearby Baetovo village, told IRIN that most of the staff in rural hospitals are older than 50: "Really, we are fanatics of our job, that's why we are not giving it up. And I can understand young people, they do not have any motivation to come and work as doctors." HEALTH PROMOTION Since the state does not have resources to adequately treat diseases in rural areas, it attempts to mobilise villagers to be more active in organising preventive measures and break the old Soviet dependency mentality. "People have to start taking care of their own problems themselves and stop waiting for the state to do something. There is no other way to improve the situation," Nurkemelova said. "People used to get subsidies from Moscow, they got used to free medical services and cheap drugs. They were spoiled by the state and it is hard to change this attitude," she added. But some progress is being made. For the last two years the Swiss Red Cross in the Jumgal and Kochkor regions of Naryn province have been assisting the rural population in building a grassroots system of health promotion. The Swiss Agency for Cooperation and Development, which finances the project, contributes to the empowerment of the poorest and the least protected people in rural areas and helps them improve their health. Villagers get together informally to determine health priorities, to elect people to health committees and delegate them authority to organise preventive campaigns against common diseases. On the list of the priorities are diseases all too common among mountain populations, such as anaemia, high blood pressure, brucellosis, iodine deficiency and alcoholism. Health committee members receive training and become specialists in prevention of one of the diseases. Afterwards, they go house to house spreading their health knowledge. The committees are very short of resources, so they seek donors to fund the construction of water pumps and bath houses. They also hold events to promote a healthy lifestyle. SUCCESSFUL MODEL Temir Tologonov, the health promotion trainer for the Swiss Red Cross, told IRIN that although members of these health committees do not get paid, they are highly motivated. "It gives them a feeling of empowerment. For the first time in their lives they have a chance to play a socially important role, and they do not want to let their neighbours down". Melisbek Tuleberdiev, a health promotion specialist, endorses the "bottom-up" approach to health promotion. "For years I worked in health promotion. I would give lectures on this or that disease to people, but the next day they would not remember what I was taking about. In the old system we always thought that doctors know better what people needed." The Ministry of Health in Kyrgyzstan has endorsed the health promotion model developed by the Swiss Red Cross in selected parts of Naryn oblast. This year the rural population will start electing health committees all over the region, and they will also be established in neighbouring provinces, with a possible replication of the model to other parts in the country.

This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions

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