Kyrgyzstan: Doctors Deny Treatment to Undesirables

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Photos: Aman-Plus Serves a Beacon of Hope

Lev Babenko broke his collarbone five years ago. At the time, he was an intravenous heroin user, and he told the doctor that, due to his habit, he needed a higher dose of anesthesia to be administered and monitored. He had already had bad experiences at the dentist, he explained. The doctors agreed, accepted an additional payment, and began the procedure. The only problem was that the doctors did not bother to anesthetize Babenko.

"They tied me down. One doctor held me down, pushed me to the table, and the second doctor gave the operation. I was screaming, awake, feeling all the pain, screaming and screaming as they hammered the nails into my bones," Babenko, 28, recalled.

"After the operation, I asked him, "Why didn't you give me anesthesia"? He said, 'Because you are a drug user. If I give you anesthesia, you will remember your drugs and tomorrow go buy more,'" he said.

Such practices are not uncommon in Kyrgyzstan, according to a recent report that Babenko helped to write. In a nation where the healthcare system is crumbling and resources are scarce, drug users, former users, and HIV patients are so stigmatized that many are denied adequate treatment. It reached a point years ago that many Kyrgyz citizens living on the margins of society became afraid of seeking medical attention for their ills.

Lev stopped using heroin four years ago. After rehabilitation and subsequent training in psychology, he co-founded Aman-Plus, a support center where those with substance abuse problems can obtain clean needles, a bed and help readjusting to a mainstream existence.

"Many of our clients are former prisoners" who used drugs in prison, Babenko said. After they get out of prison, many do not have documents for living in Bishkek, or anywhere. Aman-Plus helps them get back on their feet.

Published with assistance from the Soros Foundation Kyrgyzstan, the report detailed the mistreatment of drug users in hospitals around the country. It documented numerous cases in which medical workers refused drug users life-saving treatment and violated patients' rights to anonymity. [For background see the Eurasia Insight archive]. [Editor's Note: The Soros Foundation-Kyrgyzstan, via the Soros Foundations Network, is affiliated with the New York-based Open Society Institute (OSI). EurasiaNet operates under OSI's auspices].

One doctor interviewed for the study said a drug user should not receive medical care in life-threatening situations, "because the person made a personal decision to choose such a lifestyle; to each his own."

A drug user, who wished to be known as Nikita, reported visiting a hospital in Bishkek in the company of a social worker known to help users: "When the doctor noticed me and the person who brought me there, he started saying loudly that I was HIV infected, although that was not true. The employees from the registration desk joined in with him and didn't want to serve me."

This attitude will only exacerbate public health problems, says Aibek Mukambetov, Director of the Public Health Program at the Soros Foundation-Kyrgyzstan. Drug users are at a higher risk of HIV infection, he says, adding that treating those infected, instead of shunning them, is in everyone's public health interest. "It is for the benefit of society that harm reduction philosophy should be integrated in the public health system, penitentiary system and accepted by the broader communities so that the spread of HIV/AIDS is not that drastic."

A visit to the drop-in center at Aman-Plus seemed to confirm the report's accuracy.
Vladimir, 51, recounted that he had spent approximately half his life in prison, gaining release in 2007. A year before release, doctors failed to treat his gangrene until finally they were forced to amputate his leg above the knee. "There is no attention to drug users in prison, doctors think [an illness] will pass, that it will be okay," he said. He now lives at the drop-in center and hobbles around on one crutch and an old cane.

Other clients at Aman-Plus say they fell through the cracks in different ways. Lev Dunaev, 50, spent over 28 years in prison for various crimes, including murder. In prison he injected heroin. Freed one year ago, Dunaev pronounced himself to be a "non-citizen." The only passport he ever had was issued during the Soviet era. He says he was born in Russia, but he has no way to prove it. Now, he has no passport, no citizenship, and cannot leave the country to search for his sister. He believes she is somewhere in Russia.

Aman-Plus helped Dunaev with documents, issuing him papers he can show the police when he is stopped, and that helped him get a job in a shoe factory. He has managed to stay away from drugs and alcohol, but every day is a challenge, he says. Former prisoners are especially vulnerable as police often pick them up and charge them with random misdemeanors, often unjustly.

"I just want people to understand us; I am a normal person," Dunaev said. "If [Aman-Plus] didn't exist, I'd be somewhere out at night, would drink, fight and again go back to prison . . . It is very difficult to start life over."

Babenko is positive about the potential for change. "After independence, we had no rights; we had no laws. One year ago we had only laws, but no rights. But now we have some rights," he said. The problem is that doctors are slow to recognize them. "The doctors have the opinion that drug users are the garbage of society." It is a product of their Soviet education, he believes.