Tajikistan 1998

International staff: 8 National staff: 45 Psychiatric care needs overhauling A major breach of the peace agreement occurred in March 1998 with a significant clash east of Dushanbe between government and opposition forces. In September 1997, MSF started an emergency programme for about 1,500 patients in mental health institutions after an August assessment revealed alarmingly high mortality rates (up to 30-40%) in the two largest psychiatric hospitals, one near Dushanbe and one in the north of the country. The mental health service is particularly in need of support because of the negative bias remaining from Soviet times, the lack of specialists and the less than minimal investment. Focusing mainly on these two hospitals, MSF began distributing drugs, setting up patient care programmes and training staff supervisors. Building renovations are underway and food, bedding and clothes are supplied. The first major goal was reached with a dramatic fall in mortality rates over the past winter. MSF is expanding this programme and preparing to hand it over to the local staff and authorities. In spring 1998, a programme began in the Karategin Valley providing drugs for rural health posts and preparing for an EPI by establishing a cold chain for vaccines and training for health staff, and by mobilising the community. It is hoped to reduce both the morbidity and mortality rates in this region.