TURKMENISTAN: MEDICAL CARE WELL BELOW WESTERN STANDARDS

UNCLAS SECTION 01 OF 02 ASHGABAT 000055 SENSITIVE SIPDIS STATE FOR SCA/CEN E.O. 12958: N/A TAGS: TBIO AMED PGOV SOCI TX SUBJECT: TURKMENISTAN: MEDICAL CARE WELL BELOW WESTERN STANDARDS REFS: A) 09 ASHGABAT 1269; B) 09 ASHGABAT 211 ASHGABAT 00000055 001.2 OF 002 ¶1. (U) Sensitive but Unclassified. Not for Public Internet. ¶2. (SBU) SUMMARY: The system of medical care in Turkmenistan is unreliable, with the majority of hospitals being old, unsanitary, and lacking in basic diagnostic equipment and medical supplies. However, there are some well-educated doctors and a few new hospitals that come closer to Western standards. It will take time for Turkmenistan, with the help of international assistance, to rebuild a cadre of experienced doctors with training in using modern equipment, facilities, and WHO standards. END SUMMARY. ¶3. (SBU) Turkmenistan does have some knowledgeable, well-trained doctors that work in both the private hospitals and the government hospitals. Some of them have had training in the United States, or elsewhere outside of Turkmenistan, that has clearly improved their abilities. One doctor at the Central Hospital, a Turkish-run private hospital in Ashgabat, takes very thorough patient histories, which is rare in Turkmen medical practice. Although Turkmen doctors do not follow Western practices for assessing a patient's condition, they appear to usually correctly diagnose their patients. ¶4. (SBU) Turkmen doctors are hampered by their working environment and their limited training. The coordination of care between doctors is nonexistent. As the family member of an Embassy employee was getting ready to have surgery, she underwent a number of pre-operation tests. The day she checked into the hospital, she was told she needed to have all of those tests done again at the hospital, because they could not use the results from her previous tests. ¶5. (SBU) New hospitals in Turkmenistan reportedly have modern diagnostic equipment, but it is unclear how many doctors are trained to use it (Ref A). Experienced specialists that worked in old oncology and neurology departments have experience, but need retraining on analyzing the resqlts produced by the new equipment. In addition, the quantity of diagnostic equipment is lower than in the West. A patient's room in a Western hospital has more equipment for monitoring blood pressure, pulse, and breathing than an emergency room in Turkmenistan. Most Turkmen hospitals also lack a stock of even basic medicines. One Embassy employee had stitches without anesthesia, because the hospital did not have any. Another Embassy employee was told to bring with her all of the medicines, bandages, needles, and even plasma needed for a surgery. ¶6. (SBU) Lack of cleanliness is a significant shortcoming of Turkmen hospitals, particularly the older ones. An Embassy employee noticed that in one hospital that handled the donation and distribution of blood, there was dried blood splattered on the table and in the registration book. Embassy employees have also noticed that even at a new hospital there was no soap, nor toilet paper in the public bathrooms, although they appeared clean. Most doctors and nurses, even at Central Hospital, do not wear gloves. ¶7. (SBU) Locals' level of trust in their government health care system is very low. They have told us that if they had the money and ability, they would go to Moscow, or somewhere else outside the country, for medical care. Those who must stay here manage as best they can by getting recommendations for good doctors and paying the necessary "fees" to get medicine and treatment they need (Ref B). A hospital gave one local a list of plasma "donors" that she could call to get plasma for her husband's operation. Each of these so-called donors asked her for 200-500 manat ($70-175) for the plasma. ¶8. (SBU) COMMENT: Turkmenistan's overall level of medicine does not approach Western standards, but there are individual doctors and hospitals that come close. The biggest problem is that the system does not support those who are good. Good specialists without Turkmen language skills are generally deprived of the ability to work at modern facilities, as are older, more experienced doctors. ASHGABAT 00000055 002.2 OF 002 Medical education in Turkmenistan is conducted solely in Turkmen language, limiting doctors' ability to access medical journals from outside the country. Furthermore, doctors are underpaid, working with undereducated staff, and lacking a proper stock of medicines. Turkmenistan is receiving U.S. Government and other foreign assistance to implement WHO standards in its hospitals and medical schools, but it will take time to build up the system. And it is anyone's guess if they will continue to maintain it, even after training. Turkmenistan will only have a more modern health care system when the new training has been institutionalized and when most doctors in the country have the experience to perform evidence-based medicine, as opposed to rote prescription. END COMMENT. CURRAN