Uzbekistan: Environmental disaster on a colossal scale

  • International staff: 18
  • National staff: 69 The Aral Sea, once the fourth largest inland body of water in the world, has shrunk by 50% since 1960. Massive cotton irrigation has diverted much of the water from the rivers that feed the Sea, exposing 38,000 square kilometers of the former seabed. Each year, wind whips 45 million metric tons of salty and contaminated dust into the air, contributing to health problems such as respiratory infections, tuberculosis, anemia, kidney diseases, diarrhea and cancer. This massive environmental disaster affects about five million people. MSF established a presence in the Aral Sea area in July 1997, and is still the only international medical aid organization in the region. The medical program, based in the Karakalpakstan region near the Aral Sea, is focused on tuberculosis (TB) control and treatment, and on the prevention of respiratory infections and diarrheal diseases. DOTS is used to fight ravages of TB To combat TB, MSF uses the DOTS protocol (Directly Observed Treatment Short Course), recommended by the World Health Organization (WHO). DOTS is a comprehensive public health strategy used around the world to detect and cure TB patients. Detection of infectious cases by laboratory microscopy, direct observation by health care professionals of patients taking their medicine, as well as an uninterrupted drug supply are key to the strategy. Begun with pilot projects in the districts of Muynak and Kungrad, DOTS treatment was expanded to the city of Nukus in February 2000, and to Khorezm, in the northwest, in August 2000 - all in close collaboration with the Ministry of Health. In July 2000, 780 patients were following the DOTS treatment in those three areas. The ultimate goal - known as the "DOTS for ALL" strategy - is to cover the entire region of Karakalpakstan. MSF trains Aral Sea-area health workers in TB diagnosis and the stages of DOTS treatment at a regional training center established in February 2000 in Nukus. MSF has another basic training program for health workers on acute respiratory infections and the control of diarrheal diseases, the leading causes of children's morbidity and mortality. In addition, MSF offers logistical support, fundamental to the success of DOTS. The organization also works closely with the Ministry of Health to gather and analyze epidemiological data on infectious diseases. Research program explores link between environment and health Besides delivering medical assistance, MSF has launched a research program that focuses on the relationship between environmental degradation and public health in the Aral Sea area. In 1999, a research agenda was developed based of interviews with 50 specialists and a survey of 1,000 people from Karakalpakstan about the impact of the environment on their health. In June 2000, a study was launched on the links between dust deposit and composition and respiratory diseases in children. Other current studies include one on the links between water salinity, hypertension and kidney diseases, as well as pesticide contamination of the food chain. The goal of the research program is to provide scientific evidence for MSF's advocacy campaign, provide policymakers with reliable environmental health data and, ultimately, improve the health of the local people. Following a health education needs assessment in the Ferghana Valley, MSF has begun a new project aimed at improving the health information capacity of the local communities through traditional social structures known as makhallas. In May 2000, MSF established an office in Ferghana city from which pilot makhallas within the Namangan, Andijan and Ferghana regions will be identified.