http://news.bbc.co.uk/2/hi/asia-pacific/7474998.stmCentral Asia's child Aids tragedy
By Natalia Antelava
Central Asia correspondent, BBC News
Doctors who treated Bekhruzbek are now accused of infecting him with HIV
Dilfusa wept as she rocked her baby, Bekhruzbek, to sleep.
She had taken her son to hospital near their village in southern Kyrgyzstan because he had heat stroke.
Eight months later he was diagnosed with HIV. "I thought my life was over," she said.
The doctors who treated Bekhruzbek are now on trial, accused of infecting him.
There are 78 other babies who have contracted HIV inside hospitals in Kyrgyzstan. Three of them have died, and new cases continue to emerge.
Most of their parents do not want to talk - so great is the stigma.
"My husband left me, he is in Russia now. The night when we got the test results he slept on the other side of the bed. I accidentally touched him and he kicked me," said Dilfusa.
Dilfusa, in her early twenties, is now also HIV positive. Like 16 other mothers in Kyrgyzstan, she contracted the virus through breastfeeding.
It is rare, but it happens - yet no-one warned her, she says, that she should not have nursed.
Fourteen medical workers in Kyrgyzstan have been accused of negligence, malpractice and corruption.
The prosecution alleges that doctors charged parents for equipment which they had used again and again.
Crumbling system
But it is not just individual doctors, it is the entire medical system in Kyrgyzstan and across Central Asia that is on trial.
This system is part of the region's Soviet legacy.
Soviet healthcare - just like much in the USSR - was huge, centrally managed and inflexible.
The situation in hospitals is similar everywhere, it just happened that it was discovered in Shymkent
Bahit Tumeneva,
former Kazakh health official
Doctors followed the orders of the Communist Party, but they were well paid and had plenty of resources.
As the USSR fell apart, so did its health system. Hospitals lost funding, many doctors left for better paid jobs overseas, leaving the crumbling medical system unprepared for new challenges like HIV/Aids.
As the international community began to pour tens of millions of dollars into HIV/Aids prevention, very little was spent on reforming the health system itself.
Donors are beginning to realise that this was a mistake.
"I think trying to address the problem of HIV/Aids without investing in health systems is inefficient use of resources," says Gabit Islmailov of the World Health Organisation.
"I think this is a realisation that is coming to the mind of many donor agencies."
But it has come too late for the growing number of children already affected, and not only in Kyrgyzstan.
Drug users
Across the border lies Central Asia's richest nation, Kazakhstan.
It boasts one of the former Soviet Union's most successful economies. But away from the buzz of the capital, the country's health system is in ruins.
One year ago, an unprecedented trial took place in the southern city of Shymkent.
Twenty-one medical professionals were found guilty of infecting more than 70 babies with HIV. The number of infected children now stands at 149.
Most of the babies were infected through blood transfusions as doctors made money by prescribing unnecessary transfusions and selling blood to parents.
Court documents show one child received more than 50 transfusions during just one treatment.
It is not clear where the infected blood came from. But the prosecution suggested drug users could be one possible source.
They are the biggest HIV risk group in Central Asia. In Shymkent three drug users said it had been standard practice for them to give blood for money, and that when they did they were not checked for HIV.
The government says this is no longer the case and that all blood donors are now carefully screened, but the problem, some believe, is that the underlying cause of the outbreak still exists.
"Corruption is a particularly dangerous infection for society," says Bahit Tumeneva, a former senior Kazakh health official who left her job several years ago to protest against corruption in the medical sector.
"The doctors have to bribe in order to get jobs or to get a place for their children in school, and then they start taking bribes too. When the power of law is substituted by the power of money, all of us become hostages to situations like the one in Shymkent," she says.
Ms Tumeneva, like many, is convinced that the Shymkent and Osh outbreaks are part of a larger regional trend.
"The situation in hospitals is similar everywhere. It just happened that it was discovered in Shymkent," she says.
Wasted lessons
More than a year after he was first diagnosed with HIV, two-year-old Syatt now lives with his grandmother, Salima, in the outskirts of Shymkent.
Both Syatt and Ruslana face an uncertain future
The government provided accommodation for 10 of the 149 families. Their houses stand on the edge of a landfill. The air reeks of rotting rubbish, and their neighbours want them out.
"When the neighbours found out that Syatt was ill, there was a big scandal - there was even fighting. They wanted to evict us," she said.
When Syatt was seven months old, Salima took him to hospital to check a swelling on his knee. It was inside the hospital, she says, that he got sick with pneumonia and doctors administered several transfusions
"I'm heartbroken. None of our relatives want to know us. They told me to abandon him, to put him in an orphanage. But it's not his fault, it's the state's fault and the doctors' fault," she said.
As she speaks, Syatt is playing with his only friend, Ruslana.
She is another of the HIV babies. Salima hopes that maybe one day the two will get married. No healthy girl will ever marry my grandson, she tells me.
But Ruslana is already very sick and only one stage away from getting full-blown Aids.
Fifteen babies have died of Aids in Shymkent, killed in places that are built to cure.
Salima has heard of the new outbreak in Osh.
Syatt and Ruslana's tragedy, she says, is all the more pointless because elsewhere the painful lessons of Shymkent have already been wasted.
http://www.alertnet.org/thenews/newsdes ... dc8593.htmCENTRAL ASIA: Nutritional problems remain despite improvements
05 May 2008 05:34:19 GMT
Source: IRIN
OSH/ASHGABAT, 4 May 2008 (IRIN) - Islam, 13, does not differ much from his friends. But he is definitely short for his age and looks younger than most of the children in his age group in the southwestern Kyrgyz city of Osh. He is at least 10 cm shorter than most of his classmates.
"I feel a bit sorry, particularly when playing games because I am shorter and also I get tired very quickly," he said.
Islam's parents divorced about 10 years ago and his mother has been suffering from tuberculosis for a long time and is unable to work. With no income or job, she had to rely on support from her relatives.
"We have been living not just from hand to mouth. Sometimes we didn't have even a loaf of bread and I used to cry at my desperation when I couldn't find food for my children," Islam's mother said. "That's why my son is short and weak, he gets sick very easily, and he is not doing particularly well at school."
The problem of malnutrition is similar in many Central Asian countries, said an expert from the UN Children's Fund (UNICEF).
"There are definitely specific nutritional problems here, especially among children. There is still a high percentage of children with chronic malnutrition; you still find acute malnutrition," Arnold Timmer, a nutrition specialist with UNICEF's Regional Office for Central and Eastern Europe (CEE) and the Commonwealth of Independent States (CIS), told IRIN in the Turkmen capital, Ashgabat.
The prevalence of chronic malnutrition in Central Asian countries among children under five is highest in Tajikistan - 27 percent, according to UNICEF's Child Nutrition Situation in CEE and CIS Strategic Direction report.
"Chronic malnutrition is when children are too short for their age, but there are also hidden issues - what you call hidden hunger - a lack of minerals and vitamins in the food that leads to micronutrient deficiencies," Timmer explained.
Anaemia
A large proportion of the population in the region is affected by micronutrient deficiencies which are not easily seen, for example anaemia. "It [anaemia] presents itself as general fatigue, lower work output, but it is not something that you can see, it is not visible," Timmer said.
"That is also a serious problem for young children. It happens largely among children under two because of lack of exclusive breast feeding - in the first six months a child should receive only breast milk - and after six months up to two years the child's food is not exactly the family diet, yet it has to have enough energy and protein, and also enough vitamins and minerals," Timmer said.
"Those two components - breast feeding and complementary feeding - are insufficient not only in Central Asia, but in many countries around the world," Timmer said.
Anaemia is a major public health problem among children under five in CEE/CIS, according to UNICEF. According to the World Health Organization, Kyrgyzstan is in the severe category with regard to anaemia.
Iodine deficiency
"Iodine deficiency is a specific micronutrient issue for children in Central Asia because there is no iodine in the soil any more. There used to be but because of the formation of the mountains the iodine leaks out of the soil because of erosion and rainfall," Timmer said.
Iodine deficiency increased after the collapse of the Soviet Union as iodised salt was no longer produced. Since the 1990s efforts have been revitalised to implement universal salt iodisation (USI), which gained momentum after 2001 when UNICEF, with support from donors, started advocating USI.
Most Central Asian countries have tackled the problem of iodine deficiency. "We don't see iodine deficiency in Turkmenistan any more, also in Kazakhstan all salt is iodised," the UNICEF expert said.
The impact of the lack of iodine on brain development is quite severe, particularly during pregnancy when the brain cells of children are formed, according to Timmer. "We see the clinical effects in goitre - an extreme state of iodine deficiency and a visible one. But an invisible effect is reduced intelligence among the population. That's why we want the entire population to consume only iodised salt," he said.
Iodine deficiency is decreasing throughout the region, but work still needs to be done in Kyrgyzstan, Tajikistan and Uzbekistan. "They are getting there - about 70-80 of salt is iodised. The issue is to make it sustainable on the supply side, and make sure that producers self-maintain it. And also that there is a monitoring system that the population is aware of, and that it accepts iodised salt, and national leaders are committed, but also maintain oversight of the process," Timmer said.
Iron deficiency
Timmer said the best sources of iron are animal products, especially meat: "If that's not there, if people cannot afford it - which is often the case because meat is expensive - that leads to iron deficiency."
Echoing that view, Islam's mother said she could not afford to buy meat, as a kilo of beef cost about US$4.5, while lamb was more than $5. "I cannot buy it for my children. It is too expensive for us."
"Women and young children have a higher requirement for iron - women because of pregnancy and menstruation, higher loss of blood. As for young children, they are growing, so they need a lot of iron to build their body system," Timmer said.
In Central Asia iron deficiency can be detected in 50-60 percent of women and children, according to Timmer.
Vitamin A
Vitamin A deficiency is also related to poverty and the lack of animal-based food products. "This has serious implications as it is directly related to mortality and death. That's why we start providing vitamin A supplements to children under five and women after delivery - so that vitamin A comes in the breast milk," Timmer said.
Sources of Vitamin A include most vegetables and liver.
About 50-60 percent of women and children have Vitamin A deficiency in the region, while in some of the countries it is 40-50 percent, Timmer said. "In Turkmenistan they have not done a study on Vitamin A deficiency so we don't know what the situation is," he added.
at/ar/cb
Resumidamente, colapso y absoluta corrupción del sistema sanitario, deficiencias graves en la nutrición de la población, problemas económicos casi terminales...
Tras la retirada británica de La India, las grandes hambrunas desaparecieron, con todo y que el legado de miseria sigua ahí. Y esas hambrunas se producían mientras la metrópoli prosperaba (o precisamente, eran condición de la prosperidad de la metrópoli).
Con la URSS, los habitantes de estas repúblicas pasaron hambre cuando la situación general de todo el estado era grave (periodo de las colectivizaciones y Guerra Patriótica), no en los periodos de normalización. Pero, y esto es lo que marca la diferencia, lejos de suponer un alivio para sus economías y las condiciones de vida de sus habitantes, la implosión de la URSS y la retirada de muchos de los lazos que les vinculaban a Rusia ha sido un desastre.
Como siempre, las comparaciones son odiosas. ¡Qué racistas, los rusos!
ahora estoy mejor 
)
No me hace falta recurrir a los tristes hechos de 1945 en Alemania... Por cierto ¿y las violaciones en 1945 en la isla de Okinawa dónde se encuentran en esos textos?
