Health problems by the Aral Sea

The people of Muynak, Karakalpakstan, Northern Uzbekistan on the shores of the Aral Sea remember the good old days of the 1970s. Then their home was the pride of the Soviet Union, a spa town known for its clean air, thriving port and fresh fish. Today, Muynak is a desolate place.

The Aral Sea has shrunk to half its original size and the shore-line is over 100 km away. Toxic salt storms blow salt and dust into the communities and the economy has been devastated. The region has witnessed a drastic increase in cancer and kidney disease and holds the dubious honour of having one of the highest levels of anaemia in the world and one of the highest levels of tuberculosis in the former Soviet Union. Life expectancy is falling fast, infant mortality is on the rise and infectious diseases are becoming more widespread.

Médecins Sans Frontières is the only international medical organisation working in the region. The urgency of the programme is clear, as Ian Small, Head of Mission in Uzbekistan explained: “The people of the Aral Sea area are getting sicker by the day, with fewer means of survival.”

This human, medical and environmental disaster is the direct result of a canal system, built in the 1960s to irrigate the cotton fields of Central Asia, which now diverts as much as three-quarters of the water destined for the Aral Sea.

The old Soviet health care system, which relied heavily on referrals to specialists, funded mass school vaccination campaigns and provided free drugs and yearly chest x-rays, has collapsed. According to Liz Frost, MSF’s British-born epidemiologist: “We are working with some of the most marginalised people in the world. The hospitals are absolutely empty with no supplies, no drugs, no syringes, no bandages, unbearable heat in the summer and no heat in the winter.”

The MSF team has an agreement with the World Health Organisation and the Ministry of Health to run one of three tuberculosis pilot programmes in Uzbekistan. The Muynak programme, the first to be up and running, expects to treat 200 patients within a year.

“There is a huge problem of acquired resistance here,” said Dr Darin Portnoy. “And many of those with early signs of TB, often in their 20s, don’t go to the dispensary any more as they know they will have to pay for drugs which may not work. By the time they turn up, they often have only a few days to live and have probably infected other members of their family. We are trying to develop a programme so that every TB drug a patient takes is directly monitored by medical personnel.”

Whereas patients used to be hospitalised for their entire TB treatment, this has now been cut down to two months, after which they will be treated as out-patients relying more on nurses than doctors for follow up.

Officially TB incidence is estimated at 150 cases per 100, 000, although this figure could be as high as 400.

70% of patient deaths in Karakalpakstan are in people aged between 20 and 49 years.

“I feel so strongly about how useful our work is,” adds Dr Portnoy. “It is a chance to show how well a simpler, more cost-effective treatment can work and therefore how many more lives can be saved.”

Reproduced from and with acknowledgement to Médecins San Frontières, UK issue: no13, Spring 1998