Several international media have pounced with fascination on news that Turkmenistan has seemingly slapped a ban on the sale of cigarettes, but the facts are a little less straightforward.
The offensive against tobacco began earlier this month, when President Gurbanguly Berdymukhamedov demanded “an intensification in the measures being taken to root out smoking.”
To drive his point home, he publicly chastised the head of the state service for the protection of public health, Atadurdy Osmanov and demoted him by one military rank. (The name of Osamov’s agency is a little misleading — although it sounds like a branch of the health service, it is actually the renamed anti-narcotics agency, another strand of the law enforcement structures in effect).
After Osmanov’s dressing down, cigarettes began disappearing from the shops, even though no law had been passed or any official order issued to make their sale illegal. Hardened smokers could still get their fix under the table from shopkeepers, although prices per pack have reportedly shot up from $6 previously to around $12-14.
Dogmatic opposition to smoking among the authorities goes back a long way.
The late President Saparmurat Niyazov, who died of heart failure in late 2006, banned smoking in all public places in 2000. In doing so, he acted with the typical zeal of a former smoker. After being operated on for heart problems, he was told by doctors to give up cigarettes, which is when he decided to try and extend the prohibition to all his subjects.
Similarly, when Berdymukhamedov came to power, he was notably on the chunky side. Since then, he has embarked on an exercise drive that has visibly slimmed him down. Accordingly, he has become an energetic proponent for healthy living.
Except that there may be a little more to the fight against cigarettes than meets the eye.
Exiled Turkmen activists have noted a strange detour during President Gurbanguly Berdymukhamedov’s return from New York this week, prompting speculation that he might be unwell.
The Chronicles of Turkmenistan website said a keen-eyed reader scouring planespotter resource FlightRadar24 noted that Berdymukhamedov’s plane had stopped off in Munich, Germany, on September 26 instead of heading straight to Ashgabat.
That was enough to prompt opposition site Gundogar.org to speculate that the president had stopped off for medical consultations precipitated by a health scare.
According to his official schedule, Berdymukhamedov was due to travel on September 24-27 to take part in the 70th session of the United Nations General Assembly.
As it happens, Berdymukhamedov’s speech before the General Assembly included a passage on health and on the need to promote healthy lifestyles.
The plot thickened further when BBC Monitoring, a service that closely watches media output across Central Asia, noted that state television station Altyn Asyr failed to report on the president’s regular Monday government meeting this week.
“Instead, its flagship evening news bulletin carried a report recapping the main events of last week,” BBC Monitoring said in a report summing up news from September 28.
That Berdymukhamedov is in poor health is always possible, although state media tirelessly rams home the message that the president is a superior sporting specimen.
The Munich connection is an intriguing one, however.
The “sex school” in Kyrgyzstan’s capital that EurasiaNet.org profiled last year has moved to a bigger facility and opened a branch in neighboring Kazakhstan.
The Jade Gift School’s new location on Bishkek’s Bokonbaeva Street includes a larger gymnasium, where men and women learn to exercise muscles used during intercourse. There’s also now a separate room for theoretical instruction, such as courses on sexual fantasy and “playing the flue” – the school’s metaphor for oral sex. The school now also offers yoga, weight training, and customized workout trainings.
“I never expected this to become a full-time job,” confesses Jade Gift School founder and owner Rakhat Kenjebek kyzy, 31, describing how the school started out as a personal project rather than a business.
While working in China in the late-oughts, Kenjebek kyzy became acquainted with traditional treatments for women’s health. When she returned home, she started passing her knowledge around among friends. The circle of people seeking her advice grew wider and she eventually founded Jade Gift in 2011.
The school now employs three sales managers, a social media manager and five trainers. There are about 50 regular students; another 50 or so attend one-time events each month.
In this conservative country, many eschew talking openly about sex. But Kenjebek kyzy says some of her students are girls from religious families. Some confide that they attend classes because they are afraid their husbands will take second wives, she says. (Polygamy, though illegal, is increasingly common in Kyrgyzstan.)
The leader of Russia-backed South Ossetia worries that Georgian doctors are undermining the breakaway entity’s health.
During a cabinet session of the de-facto South Ossetian government held March 2, Leonid Tibilov, the president of the self-proclaimed republic, expressed concern about the number of South Ossetian residents traveling to Georgia to seek medical treatment.
South Ossetia, along with the autonomous region of Abkhazia, broke free of Tbilisi’s rule in the early 1990s. In the aftermath of its 2008 war with Georgia, Russia recognized the independence of both entities, which remain heavily dependent on Kremlin subsidies.
Despite decades of political enmity, many South Ossetians prefer Georgian health services to what they can obtain at home, and they find Georgian healthcare to be cheaper than what can be found in Russia. Many are attracted by Georgia’s universal insurance program, which covers residents of the separatist regions. Official policy in Tbilisi holds that South Ossetia and Abkhazia are still part of Georgia.
South Ossetian authorities permit residents to make trips across the breakaway lines only in cases of a healthcare emergency, but, as Tibilov observed a year ago, a growing number of South Ossetians are opting for regular treatment in Georgian clinics. Georgian officials said that the number reached 400 last year, reported Ekho Kavkaza news service. The fraternization makes South Ossetian leaders uncomfortable.
In Kyrgyzstan, calculated outrage over sexual-health education is a political pastime: In the late 1990's, a reactionary group organized a public burning of books printed by the government for youth on healthy lifestyles, claiming the section on sexual education was immoral. Now rhetoric is heating up over a series of sex-ed pamphlets printed by the Alliance for Reproductive Health (ARZ), funded by the German development agency, GIZ, and the UN.
In this Q&A, Gulnara Ibraeva, a prominent sociologist and expert on gender and sexuality, formerly of the American University in Central Asia, explains to EurasiaNet.org what Kyrgyzstan’s growing “generation of blank minds” means for the country. This interview has been edited for length and clarity.
EurasiaNet.org: The Alliance for Reproductive Health brochures have suddenly caused a stir. Why? And are they necessary?
Gulnara Ibraeva: In the school curriculum this kind of practical education is absent. More than one generation of sexually illiterate people, people who don't understand basic aspects of sex, have been raised. There are many examples of how the absence of this sort of education negatively impacts schoolchildren. People know nothing about their bodies. They don't even understand how they function! They have medieval perceptions about the body, even now in schools – a totally medieval understanding of real adult sexual life.
EN: Is this why there are perceptions about sexual education being shameful? Or somehow antagonistic to the idea of a Kyrgyz identity or Kyrgyzchylyk [sometimes loosely defined as “Kyrgyzness”]?
Alcoholism – a scourge across the former Soviet Union – is no joke. But Uzbekistan’s state-run television has turned it into one with a sexist, pseudoscientific report this week.
The message is, basically: It is unbecoming for women to drink.
"It is worth saying a lot of pleasant words about females, the owners of grace and charm. However, you now can face an unpleasant situation that does not suit an Uzbek woman. For instance, we can see women and girls drinking alcohol during weddings and parties in cafes and restaurants. We will focus on this topic today," said the announcer, in a BBC Monitoring translation of a program that appeared March 11 on O’zbekiston Channel Number One.
One narcologist told the program that women become addicted to alcohol twice as quickly as men do, and that women are ten times more difficult to treat for alcoholism than men are. The program warns that women who drink while pregnant are more likely to give birth to children with birth defects.
That last point is widely accepted. But while many studies have found women more vulnerable than men to the effects of alcohol, a Harvard-sponsored report, among others, says women are just as treatable as men for alcoholism.
Overall, the program seems more concerned about Uzbek women's image than their health.
Just south of the Ashgabat city gates, a security checkpoint marks the entrance to a tightly controlled, 10-mile-wide no man’s land before Turkmenistan’s border with Iran. The guards turn back many Turkmen headed to the Islamic Republic, including those traveling for religious pilgrimage, aspiring students, and anyone else the authorities feel like blocking.
According to several Turkmen in Ashgabat, a new group is being stopped lately: medical tourists.
Moscow remains a destination for many Turkmen seeking higher-quality medical care, but the cost and complications of flying to Russia have begun to exceed the trouble of making a short trip south. Turkmen traveling to Iran can arrange fixers – often ethnic Turkmen from Iran – to provide translation, transportation, and accommodation during their stay, usually in Meshed, Iran’s second city, a half day’s drive from Ashgabat.
Patients reportedly appreciate the quality and service culture afforded by Iranian private clinics. Turkmenistan has one private medical facility, the Turkish-run Ashgabat Central Hospital, which is not well regarded by Turkmen or expats in the city.
One woman seeking fertility treatment turned to a private clinic in Iran after Turkmen doctors at the best maternity ward in Ashgabat prescribed her a list of drugs, vitamins, and folk cures three pages long. Many doctors in Turkmenistan, like their counterparts across the region, embrace folk practices and outdated Soviet-era theory over evidence-based medical treatments.
The ban on exits for medical tourists has been in place since summer, say Ashgabat residents. Some continue to make the trip, claiming to be on “business,” though sources in Ashgabat report that authorities limit even these trips to once in three months.
Georgia and Armenia may not be the Caucasus' richest countries, but they do seem to be the healthiest.
Bloomberg L.P. on August 15 released its global health rankings of countries with a population of a million or more. At 71st, Georgia was the highest-ranked country in the Caucasus. Armenia was next, occupying 79th place.
Although it may be loaded with oil & gas, energy wealth has not encouraged healthy living in Azerbaijan. At 87th, the country lagged behind its Caucasus neighbors in the health rankings.
That Georgia did comparatively well is surprising, given that 57 percent of the adult male population smokes, according to World Health Organization data. That’s the highest percentage in the Caucasus. In Armenia, 51 percent of adult males are smokers, and in Azerbaijan the figure is 41 percent.
Bloomberg’s interest in healthy living is not surprising, given that its owner, Michael Bloomberg, the mayor of New York City, recently tried to launch a municipal program to preventing obesity by placing limitations on the size of sugary drinks sold in the city. Bloomberg is also credited with the 2003 ordinance that banned smoking in city bars and restaurants, spurring a movement toward restricting smoking in many of the world's major cities.
The New York Times has a fascinating story today about Yusuf Sonmez, a Turkish surgeon who is suspected of being part of an organ transplant ring that stretches from Turkey to the Balkans and which may even involve the Prime Minister of Kosovo. From the piece:
For a surgeon wanted by Interpol and suspected of harvesting human organs for an international black-market trafficking ring, Yusef Sonmez, was remarkably relaxed as he sipped Turkish red wine in a bustling kebab restaurant facing the wind-whipped Sea of Marmara.
Dr. Sonmez, refreshed from a ski trip to Austria, spoke last month while on a break from business trips to Israel and operations on cancer patients here.
He boasts about the satisfaction of his kidney transplant surgeries, more than 2,400 by his count. He keeps friends (and, incidentally, investigators) up to date on his life via a blog and his Web site listing contact details. And in his seaside villa on the Asian side of Istanbul, he treasures a framed copy of a signed letter in 2003 from the Ministry of Health in Israel commending him for his life-saving aid to “hundreds of Israeli patients who are suffering from kidney diseases and awaiting transplants.”
Yet Interpol is circulating an international red-alert notice for the Turkish surgeon’s arrest with a mug shot of him in a surgical scrub cap. The Turkish authorities have shut down his private hospital. The local press has labeled him “Dr. Frankenstein.” And an expert who monitors the lurid and lucrative global trade in human organs says Dr. Sonmez has been arrested at least six times in Turkey.
Privately owned Kazakhstan daily Express-K has reported on a tragic and all too common case of teenage suicide in the northern industrial city of Temirtau.
On the landing of a high-rise apartment block, neighbors discovered the hanging body of a 15-year old schoolboy. Police say they found fresh slash marks on the child’s wrists, suggesting he had tried to commit suicide by other means.
As the newspaper notes, this was the second case of adolescent suicide in the city this year, and police have also recorded another six unsuccessful suicide attempts among young people.
Another piece titled “Death is Growing Younger” cites Deputy Education Minister Makhmetgali Sarybekov as saying authorities had registered 340 suicide attempts so far this year among the nation’s youth. Of the 211 children that died, a dozen were below the age of 12, Sarybekov said.
The explanations offered by Sarybekov range from poor family and social settings to school bullying.
A Kazakhstan General Newswire report (unavailable online) from April this year reports that 202 teenagers committed suicide in 2009 and offers a slightly more nuanced and critical explanation. As senior General Prosecutor’s office expert Andrei Kravchenko points out, suicide accounts for 45 percent of the juvenile mortality rate: "If we take into account 170 failed suicide attempts, it becomes clear that the life of a Kazakh teenager is far from blissful, opposite to what we like to imagine."