TURKMENABAT, Turkmenistan -- In provinces of Turkmenistan, like Lebap and Dashoguz, many villagers say they avoid hospitals when they become ill because public health facilities have almost nothing to offer.
In the Darganta district of Lebap Province, hospital patients are even expected to bring their own firewood and blankets to stay warm.
Residents say they also must provide their own food three times a day because local hospitals don't offer anything to eat.
In fact, the majority of rural hospitals in Turkmenistan lack modern equipment or adequate supplies of medicine.
The sick say they must supply their own medicine too, or pay bribes to doctors in order to receive the medication they need.
Many villagers say their response to inadequate hospital facilities is to simply get the prescriptions they need from doctors, buy the medicine themselves from pharmacies, and stay home.
Those who require medical injections often privately pay nurses for a home visit.
But not everyone can afford that in Turkmenistan, a former Soviet republic in Central Asia where a majority of residents face unemployment and crippling poverty.
Infections From Injections
Impoverished patients have told RFE/RL that it is common to ask relatives or neighbors to administer injections -- even though they lack the necessary medical expertise.
In several such cases, villagers say patients have become infected and ended up with serious complications because of improperly administered injections.
"People know that it's a dangerous practice, but they do it anyway because they don't have money to pay a [skilled professional]," RFE/RL's correspondent in Lebap Province reported on November 10.
No one, however, is openly complaining or criticizing public officials about the dire conditions of the country's hospitals. That's because Turkmenistan's authoritarian government is known for brutal crackdowns on critics and dissent.
In theory, health care is mostly free in Turkmenistan. State-funded health insurance covers treatment in public hospitals.
And during the past decade, Turkmenistan has spent millions of dollars to build modern hospitals and diagnostic centers.
State media often shows President Gurbanguly Berdymukhammedov, a former dentist, at ceremonies that mark the opening of marble-clad, state-of-the-art medical facilities.
But the reality is far from the gleaming public image presented by the state. The new facilities often remain empty or serve only a handful of elites who can afford to pay.
Lack Of Trust
In Turkmenistan, those who have the resources usually seek medical treatment abroad. Russia, India, and Turkey are among the popular destinations.
Many citizens speak about a lack of public trust in Turkmenistan's younger generation of health professionals -- particularly, those trained in Turkmenistan's own medical schools.
They say corruption is commonplace at Turkmen universities where ill-prepared medical students can pass their exams simply by paying bribes.
Several doctors at an Ashgabat hospital told RFE/RL that young specialists from Turkmenistan often lack basic skills because they didn't receive adequate training at university.
Separately, hospital sources in Ashgabat say medical malpractice is one of the major causes of deaths in the country's hospitals. RFE/RL could not independently verify that claim.
In recent months, the fear of catching COVID-19 during a visit to a medical facility has added to the wariness about Turkmenistan's health-care system.
Most Turkmen don't believe the government's claim that the country remains free of coronavirus cases.
'Out Of Control' Pandemic
Ashgabat hasn't reported any confirmed COVID-19 infections. But many hospital workers insist the pandemic is widespread and "out of control" in Turkmenistan.
RFE/RL's correspondent in Dashoguz Province says many people -- including those with coronavirus symptoms – are too afraid to go to a hospital until it's too late.
"The majority of them stay home and don't seek medical help until the very end when they become severely ill and can't breathe," RFE/RL's correspondent said on November 11. "Doctors register such cases as deaths caused by a heart attack, stroke, or blood clot."
Meanwhile, to avoid contradicting the government's claim that COVID-19 does not exist in Turkmenistan, sources tell RFE/RL that hospitals aren't allowed to diagnose anyone with the coronavirus.
At the same time, authorities have tightened preventive measures -- suspending most travel between regions and banning people from traveling within the country without an "extenuating" reason.