Qishloq Ovozi (Archive)

Lack of adequate medical facilities, misdiagnosis, and incompetence seem to be among the biggest health problems in Turkmenistan today.

The country's president -- Gurbanguly Berdymukhammedov -- came to power in late 2006 pledging to reverse many of the bad decisions of his predecessor, one of those decisions being the dismantling of the healthcare system.

But a promising start was short-lived and Berdymukhammedov, who was the country's health minister when former President Saparmurat Niyazov died, now seems to be paying almost no attention to the situation and authorities have actually taken measures to prevent people from seeking quality medical treatment outside the country.

RFE/RL's Turkmen Service, Radio Azatlyk, has been looking into the woes of Turkmenistan's healthcare system and what the service found out is shocking.

One Radio Azatlyk correspondent in the Birata district in eastern Turkmenistan's Lebap Province (Welayat) has reported that the closest, well-equipped medical facility takes several hours to reach.

But even when Turkmenistan's citizens arrive at the medical facilities that do exist there seems to be no guarantee that their medical problems will be over.

Quite the contrary, actually.

Tales Of Incompetence

One woman, calling herself Umyda, told Radio Azatlyk that doctors in Turkmenistan diagnosed her as having tuberculosis and recommended she avoid contact with her small child to prevent passing on the disease. The woman heeded the advice but managed to leave the country late last year for an examination in Turkey. Doctors there told her she did not have TB and was, in fact, completely healthy.

Another woman told Radio Azatlyk that doctors had said her now two-year-old child was handicapped at birth and would never walk properly. That woman made it to a medical facility in Moscow and her child is now walking without difficulty.

A third woman, calling herself Lale, told RFE/RL that her mother suffered from heart problems for some six years, being constantly in and out of the hospital. The doctors finally told the woman there was nothing more they could do for her and that she was going to die. The family went to Turkey where the mother had surgery and is now fine.

Despite the anxiety all of these people experienced at being led by Turkmen doctors to believe their situation was dire, one could say they all had a happy ending.

Not so for another woman, calling herself Aina, who told Radio Azatlyk that doctors in her area of Turkmenistan treated her for several years for what they said was a small tumor or cyst in her breast. Sometimes they gave her injections sometimes they used acupuncture. She later went to Turkey where doctors told her she had cancer.

Then there is the tale of a young man from eastern Turkmenistan who was diagnosed with a bone disease in his legs that caused his legs to swell up at times. According to his family, medications the doctors gave the man did not lead to any improvement in his condition so they took him to a hospital in the capital, Ashgabat. Doctors took X-rays of the man's legs and gave them to the family to take back and show doctors at their local hospital. Unfortunately, those local doctors could not read X-rays.

No Laughing Matter

It seems the only answer for those who are desperate about their health or that of their relatives is to get the patient to medical facilities outside Turkmenistan.

For the vast majority of people in Turkmenistan the financial burden of going for medical treatment abroad is crushing. But not even that matters. Few are allowed to leave even if they can get the money.

A 2012 report from the Norwegian Helsinki Committee noted that "Due to the poor level of medical care in Turkmenistan, many who suffer serious illnesses are forced to leave... [and go] abroad to seek professional medical treatment."

"However, since leaving Turkmenistan in search of foreign medical specialists can be considered an indirect form of criticism of the state of the country's national medical facilities, many are stopped at border crossings and airports when the purpose of their journey becomes clear," the report added.

Most reports about Turkmenistan in the Western media, and often in the media of other former Soviet countries, note that it is one of the most repressive countries in world.

But inevitably the figure of the president of Turkmenistan enters these reports and a topic that should be serious takes on a comical aspect.

President Berdymukhammedov and Niyazov before him have been eccentric leaders, to say the least, and outlandish might be a more appropriate word.

It is nearly impossible to talk about Turkmenistan's presidents and keep a straight face and I am one of many who have written tongue-in-cheek articles about the antics of "Turkmenbashi" and "Arkadag."

However, the tales of the incompetence in Turkmenistan's healthcare system are a reminder, to me anyway, that it is not always a laughing matter.

As some Turkmen friends said to me in the late 1990s, "it isn't funny for the people who live there."

-- Bruce Pannier with contributions from Muhammad Tahir of RFE/RL's Turkmen Service

In the battle of labor versus management, the labor force in Kazakhstan is on the brink of finding itself at a huge disadvantage.

Kazakhstan's parliament is currently reviewing a package of amendments to the country's criminal code that include stiff penalties for participating in an "illegal" strike. According to Article 400 of the draft legislation, it is up to courts to decide if a strike is "illegal" and, once such a verdict is reached, anyone who shows up at such an action could receive a fine in the region of $10,000 and/or be sentenced to correctional work, or receive a jail sentence of up to three years.

It would be difficult to say with 100-percent accuracy how often Kazakhstan's courts have found in favor of plaintiffs who raise cases against state enterprises, or even private businesses, but, generally, it hardly ever happens. It would be easy to say, however, that the proposed amendments restrict freedom of assembly.

The purpose of the new draft laws seems clear, at least to RFE/RL's Kazakh Service (Radio Azattyq) and Human Rights Watch, and it can be summed up in one word -- Zhanaozen.

Zhanaozen is a town in the sparsely populated western part of Kazakhstan, the region where most of the country's onshore oil sites are located. The town was built in the late 1960s specifically to house oil workers and was the scene of unrest in June 1989.

More recently, in 2011, it was the center of strikes by thousands of oil-industry workers (including company transport workers) around the region, sparked by working conditions but also, and perhaps primarily, because of the disparity in wages paid to Chinese workers (China being a major investor in Kazakhstan's oil industry) at the sites and local workers.

The strikes lasted some seven months and noticeably hurt Kazakhstan's oil production during that time. It ended in the worst violence in Kazakhstan's history as an independent nation in December 2011, when protesters, mainly striking oil-company employees, and police clashed. Seventeen people, including many petroleum workers, were killed in the unrest.

Protest leaders were jailed, as were many of those who lent them support during their demonstrations, including opposition figures that the government said had incited the striking workers.

Breaching 'Human Rights Standards'

This is a good time to note that, besides Article 400, there is also Article 403 in the package of amendments, which makes "leading, participating in the activities of an unregistered or banned public, religious association, as well as financing their activities" illegal. So, any one mingling with striking workers, giving money to support their cause, or perhaps simply bringing food or water to them could be arrested. Human Rights Watch said Article 403 and Article 400 "do not comply with international human rights standards."

Galym Ageleuov is a Kazakh rights defender who often visited areas where oil workers were on strike in 2011 -- the sort of visits that could see him jailed if the amendments are adopted.

Radio Azattyq asked his opinion on the proposed new rules. Ageleuov said a clear mechanism is needed and suggested that the announcement of a strike should immediately, and as a formal rule, initiate a negotiating process and the formation of a reconciliation committee comprised of management and workers. He advised that production should not be effected during the negotiations. Should an agreement prove elusive then the matter could be brought to court. But he warned that representatives from the striking workers must be invited to court proceedings, something he said was not the case during the strikes of 2011. "They [management] just brought the papers [with court decisions] to the striking workers and threw the papers at them saying: 'There's the court verdict, your strike is illegal.'"

There are some things worth keeping in mind.

The events of Zhanaozen did not mean an end to workers going on strike in Kazakhstan. There were at least five that I know of during 2013, all but one in western Kazakhstan and mostly involving oil workers (employees at the Kamkor Locomotive plant in Mangistau Province went on strike in October).

In the 1990s there were many strikes in Kazakhstan, many having to do with unpaid salaries, although some evolved into antigovernment rallies. Workers have been going on strike in Kazakhstan because often enough they have received at least some of what they want in the end.

Zhanaozen was a national tragedy. But since then officials have pledged to invest more money in the infrastructure of the long neglected western regions. Many of the oil workers who were fired during the 2011 strikes have been rehired and, the chairman of Kazakhstan's Trade Union Federation Abelgazi Kusainov said at the end of last November that wages for foreign and local workers were heading toward parity and within two years would be equal.

But the most vibrant industries in Kazakhstan -- those already employing tens of thousands and workers and likely to create the most jobs in the coming years -- are almost all in the energy sector. And the big energy companies -- KazMunaiGaz and Kazatomprom -- are owned by the state holding company Samruk-Kazyna. Should dissatisfied workers in the oil, gas, or uranium-mining sectors decide to hold a strike they would in effect be confronting the state.

Whom do you think the courts will rule in favor of?

-- Bruce Pannier with contributions from Yerzhan Karabek and Svetlana Glushkova of RFE/RL's Kazakh Service