Tajikistan: Aid to health system in shambles

The break-up of the Soviet Union and the civil war and economic collapse that followed have left Tajikistan in a fragile situation. Today the health care system is in shambles; the country depends heavily on foreign aid, and ethnic tensions still surface despite a 1997 peace agreement. MSF works in the Karategin valley, a region excluded from government support and health care service in part because it is a historical stronghold of Islamic opposition. MSF regularly distributes essential drugs to 174 basic health posts in six districts of the valley, and trains health care workers in managing prevalent diseases and collecting health data. MSF runs a reproductive health program in the valley to decrease morbidity during births and improve knowledge of sexually transmitted diseases. In collaboration with the Ministry of Health and a local mental health organization, MSF has been improving the living conditions and treatment of patients in 17 psychiatric institutions by distributing essential drugs, food and non-food items, rehabilitating health facilities, and training hospital personnel. In the capital, Dushanbe, MSF initiated a community-based mental health program. It involves training counselors to work with people traumatized by the horrors of civil war or suffering from stress brought on by continued lawlessness and everyday insecurity. In the southern city of Kholog, MSF refurbished the hospital's infectious diseases ward and water system, and worked to improve treatment of infectious diseases. Lab workers were trained to focus on four main diseases: malaria, typhoid, brucellosis and shigellosis. MSF continues to donate medicines to the hospital. The Kholog mission is also used as a base for programs in Afghanistan, where MSF stays on alert for emergency situations such as refugee influxes, epidemics and natural disasters. MSF has been working in Tajikistan since 1991.