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Best Of RFE/RL: Shadow of Tuberculosis Hangs Over Tajikistan's 'Valley of Death'

In Tajikistan, people suffering from tuberculosis rarely discuss their condition. That is because for them, TB is not only a disease but a profound social stigma. And no one knows this better than the residents of Ochqun, Ghilot, Kafterkhona, and other villages in the Wasse District of Khatlon Province. In this region, TB claims the life of one person every week. Sayfiddin Dostiev, a correspondent from RFE/RL's Tajik Service, is one of the few outsiders to travel to Khatlon Province and witness the devastation. (This story was a finalist for RFE/RL's Division of Broadcasting Innovation & Excellence Award for reporting on social issues, and was originally broadcast on 22 January.)

Khatlon Province, Tajikistan; 25 June 2004 (RFE/RL) --

"On the earth, flowers grow
Beneath the earth, my sister lies
I asked her to rise
But destiny has condemned her to die."

Sad and moving voices can be heard singing such mourning songs every day in the villages of Ochqun, Ghilot, and upper, lower, and middle Poshon and Kafterkhonna in the Wasse District.

This soft but grieving cry is a warning to neighboring villages that a shadow of death, sadness, and pain is hanging over the entire region. This part of Khatlon Province is known as the "valley of death."

No one from other parts of the province dare enter the area. Parents keep their children far away, and they themselves do not attend any wedding or funeral ceremonies in these condemned villages. If they must attend a gathering, they refrain from eating food or drinking water, and carefully wash their hands, faces, and clothes upon their return home. The villages of Wasse District are literally considered a death trap.

Residents of these villages say a person dies of tuberculosis every week. Elders who are in charge of funerals say there are days when more than one TB victim is buried. "Some weeks we come here twice, sometimes even three times a day," one elder said. "Once I was here [digging a grave] for the funeral of Jami Baba, [the brother of a man named Qurbanali.] People came to me and said Qurbanali was asking for me. I went there. Another member of his family had passed away. His entire family -- his wife, his daughters -- are all dead now."

The Ochqun village has more than 100 farms and about 3,000 residents, many of whom are suffering from TB. People in the village say over 200 people have died there over the past three years. One resident, Qiyomudin Muradov, said some families have vanished completely. In Ochqun alone, he said he knows of nine families that have been completely eradicated by TB. "In our village, there are 115 farms, but there may be only 10 or 12 of them which are not affected by TB," he said. "The rest are all suffering. If we take this into account, the average life expectancy would be only around 18 to 19 years old."

Other villagers have stories to tell as well: "My name is Muradov Sayed Jamol. In our home, in the past three years, 12 people have died. My wife, my children, my brother and others have all passed away."
Officials don't want to register deaths related to tuberculosis because it would reveal the low standard of living.

Officials in the region try to cover up the cause of death, usually claiming that people are victims of heart disease, diabetes, or other illnesses -- and never mentioning TB. This has caused concern among residents, who say they are trying to find an answer for the seeming official coverup. Mirali Koganov, a teacher at School No. 8 in the Ghilot region, said: "In our village, the number of the casualties are higher than in Ochqun. There are even houses where no one has been left alive -- the children and adults have all died."

Koganov goes to the village cemetery to point to the undeniable evidence. He said there have been so many deaths over the past few years there is no place left in the graveyard. "Three to four years ago, the cemetery was empty," he said. "Now it is full; it's is completely full."

In Ghilot, 168 people have died over the past three years -- most of tuberculosis. In the regional hospital for TB sufferers, some 20 students and schoolteachers are among the bedridden patients. Mirzirahim Saidov, a public-school teacher from Ochqun, said schoolchildren are especially vulnerable to the highly contagious disease.

"In this school, there are 110 students and only 30 plates and spoons available. Most of the time, these spoons and dishes are not even washed before they are used for other children. Many of the children are carrying the disease, and it infects others," Saidov said.

Medical centers have registered hundreds of TB cases. But few register TB-related deaths. Why? Atta Tabarov, the director of the medical department for the city of Kulab, told RFE/RL that TB is considered a social disease. The higher the number of infections, he said, the lower the standard of living in the region.

"This disease is not an illness related to doctors, because this is a social problem. This disease is 90 percent related to the conditions of society, and 10 percent related to doctors," Tabarov said.

Officials don't want to register deaths related to tuberculosis because it would reveal the low standard of living. It might also mean a change in the region's traditional work. Wasse is a long-standing cotton-producing region. If a tuberculosis epidemic was officially acknowledged, the cotton harvest would be forced to stop.

Mirali Koganov said that as early as the 1980s, a high-ranking Russian delegation suggested nearly 90 percent of the residents of this area were TB carriers. They ordered local residents to begin growing fruit instead, on new plots of land. But after independence, water-intensive cotton harvesting resumed. "In that period, our farms started producing other things than cotton," he said. "But now cotton is again the main product."

Now, with TB cases mounting, the government has few resources to deal with the problem. Atta Tabarov said the government has allocated a tiny sum -- one somoni, or 33 cents -- for the treatment of each TB patient. With that amount, he said, no one can dream of being saved from their illness. On average, it takes at least $500 to successfully treat a TB patient.

Tohir Moradov, a resident of Ochqun, said the situation is both complicated and sad. People try to marry their children at a young age, to allow them to taste the sweetness of marriage before they die. Moradov's daughter was among those married young. She has since died, as has her husband and their two children.

"I had a grownup daughter, Muradova Dil Afrooz. I married her off, but TB took her from us. We married our daughter to someone whose family members were all stricken by TB. We brought [our daughter] here to Kulab hospital for treatment. She was treated for eight years. We tried hard; we did everything we could. But we could not save her. She passed away. Later, her two children died for the same reason. Now there is nothing left to keep her memory alive," Moradov said.

One young girl, Gulpary, is a TB patient who is now preparing for her wedding. Gulpary knows her likely fate, and she is embroidering flowers on a waistband for her future husband, who is young but, like her, ill. In this region, all brides traditionally sew waistbands for their husbands. But after some time -- usually not very long -- the bands are used as ropes to carry their bodies to their graves.

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