Tajikistan: Vast improvement in living conditions for mental health patients
- International staff: 16
- National staff: 140
The legacy of civil war and economic collapse in this poorest of the former Soviet Central Asian states has given MSF the challenge of rehabilitating the country's mental hospitals and sustaining critical health services in some of the most isolated areas.
A better life for psychiatric patients
The past year has seen MSF's relief program in Tajikistan's psychiatric institutions nearing completion. When it was started in 1997, mental patients were dying in large numbers from hypothermia, malnutrition and infections. MSF has put in heating, showers, toilets and new kitchens in 17 institutions scattered throughout the country.
Patients are supplied with food, clothing and medicine. Training programs for nursing staff and the encouragement of new professional standards have also been part of the work. When the last of the restored institutions was handed back to the Ministry of Health in March 2000, the survival prospects of the people living there had been transformed.
The need of the broader society for mental health support is being addressed in a community project now underway in the capital, Dushanbe. A team of counselors is being trained to work with people traumatized by the horrors of the civil war of the mid-nineties or suffering from stress brought on by the continued lawlessness and insecurity of everyday life.
When MSF did a mental health assessment in 1999, the symptoms of depression, hopelessness, anxiety and increased drug use were readily identifiable. The 15 counselors and five trainers in the capital will be the core of a service that will be extended by the Ministry of Health across the country. A companion public education effort attempts to break down fears and taboos about mental health.
Care in isolated regions
Another group of people that MSF has identified as being particularly at risk are those living in the central Karategin Valley. Since the civil war, the valley has been a stronghold of armed opposition forces - and as a consequence gets limited health resources from the state system. MSF distributes medicines, trains health workers in rational drug use and is now establishing a network of mother and child health workers among the valley communities.
Because the ongoing war in Afghanistan and political instability in other neighboring states threatens Tajikistan's own precarious semi-peace, MSF has been working on emergency preparedness and strengthening local health structures.
Similarly, the province of Pamir is geographically and politically isolated from the rest of the country and is largely dependent on humanitarian aid. Since 1999, MSF has given technical support to the infectious diseases department at the hospital in Khorog and has worked to improve the quality of the laboratory. MSF has also set up a system for the weekly supply of the pharmacy.
A key aim of work in Khorog is to strengthen the local capacity to treat infectious diseases. MSF will work with the authorities to put in place a surveillance system for epidemics and will help create a cold chain, provide medicine and equipment, and monitor nursing care.
Khorog also serves as a base for MSF programs in Badakhshan and the Panjshir Valley in Afghanistan.
MSF has been working in Tajikistan since 1991.