Kazakhstan has extended its smoking ban by prohibiting the use of the shisha pipe in enclosed public spaces including bars, nightclubs and restaurants.
The ban came into force on March 14, sparking an outcry among entrepreneurs warning of widespread job losses.
According to the calculations of the Association of Shisha Pipe Industry Entrepreneurs of Kazakhstan, reported by Bnews.kz on April 1, up to 20,000 jobs stand to be lost since each of the 5,000 premises where the shisha is smoked employs three or four people to clean and light the pipes.
The pipes are hugely popular in bars and restaurants in Astana, Almaty and other cities. One pipe, which is shared by groups of friends out socializing, costs around $30-$50. Establishments breaking the new rules face fines of just over $1,100.
Shisha – also known as kalyan or hooka – pipes had been exempt from a smoking ban in enclosed spaces introduced in 2009, when officials said some 30,000 people per year were dying from tobacco-related diseases. Implementation is patchy, with most establishments respecting the ban but some openly flouting it.
According to a World Bank report published in 2010, 40 percent of male adults in Kazakhstan smoke – fewer than Russia’s 59 percent, but almost double the 22 percent smoking in neighboring Uzbekistan.
Remarking on a topic not often discussed openly in Kyrgyzstan, a deputy health minister said last week that abortion is the number one form of birth control in the country and the numbers are rising.
Back in the Soviet Union, after 1955, abortions were legal and free, while access to birth control was difficult and highly unreliable. (One study estimates there were almost 6 million abortions in the Soviet Union in 1988 alone.) These days, borders are open and pharmacies are well-stocked. Yet a lack of education and youth-friendly medical services means abortions -- still legal in Kyrgyzstan if performed in a clinic – are a highly popular method of family planning.
While good statistics are hard to come by, experts have no doubt the numbers are staggering. According to some estimates, “on average, by the age of 22, a woman in Kyrgyzstan has had one abortion. By the time she is 30.7 she has had two. By the time she is 36, she has had three,” says the United Nations Development Program (UNDP) in its 2009/2010 National Human Development Report.
“I would say the real number of abortions in the country is much higher. There are many abortions that are performed in private clinics and are not registered,” Dr. Meder Omurzakov, the assistant representative of the United Nations Population Fund (UNFPA) in Bishkek, told EurasiaNet.org.
The UNDP study cites a local professor claiming that 70 percent of pregnancies end in abortion.
As the quality of medical services in the post-Soviet era declines, the procedure is also getting more dangerous.
The study finds that Uzbekistan, Turkmenistan and Kyrgyzstan have made huge strides in reducing child malnutrition. It singles out Uzbekistan (alongside Angola) as one of “two priority countries that have made the fastest progress in reducing child malnutrition – both cut stunting rates in half in about 10 years.”
Uzbekistan topped the list of states that have made the greatest strides. Kyrgyzstan and Turkmenistan came fifth and sixth respectively.
As The Economist pointed out, half of the top six success stories identified by Save the Children are in Central Asia (while number six is North Korea). “This finding is – how can one put it politely? – counter-intuitive,” The Economist commented.
“Number one on the list is Uzbekistan, a vicious dictatorship which imprisons political opponents and has been the site of mass killings,” it continued, while Turkmenistan “had for many years one of the world’s stranger dictators [Saparmurat Niyazov] who renamed the days of the week after himself and his family.” (Turkmenistan is still run by a dictator who is fostering his own personality cult.)
Being a doctor in Turkey carries with it a certain amount of prestige. But, increasingly, the job is also proving to be one that comes with a high level of danger. The last month has seen a string of violent attacks against doctors and health professionals in Turkey, from the murder of a doctor by the 17-year-old relative of a patient of his who died to attacks against ambulance crews that were accused of arriving late. Things have gotten so bad that Turkish doctors went on a nationwide strike earlier this month to protest the violence they are facing, while the Health and Justice ministries have been forced to step into action and come up with a plan to protect the country's medical workers.So what's behind this upsurge in violence against doctors? Some suggest that because of a recent expansion of universal health coverage in Turkey, the country is now facing a severe shortage of doctors, resulting in poorer care and more angry patients and relatives. Some doctors, on the other hand, believe that they are the victims of government rhetoric that they say portrays them as lazy elitists. Reports the Financial Times:
Everything is fine, no need to look here, we don’t secretly cut out our women’s wombs.
That’s the message from Uzbekistan’s state-run Uzdaily.uz, which has decried as the work of the “yellow press” a recent BBC report on how Uzbek doctors are secretly sterilizing tens of thousands of women.
Only women who wish to be sterilized are having the procedure, says Uzdaily. The BBC, however, reported that doctors are convincing women to give birth by Caesarean section in order to gain access to their internal reproductive organs: "Rules on Caesareans used to be very strict, but now I believe 80 percent of women give birth through C-sections. This makes it very easy to perform a sterilization and tie the fallopian tubes," a senior surgeon at a Tashkent hospital told the BBC. Uzdaily reiterated the government claim, which doctors ridicule, that only 6.8 percent of Uzbek women have C-sections.
The controversial sterilizations are not new, but the BBC report – which suggested officials are concerned with Uzbekistan’s ranking on international maternal mortality indices – appears to have gotten Tashkent’s attention. The Associated Press reported in 2010 on the “Uzbek women who have been surgically sterilized without their knowledge or consent in a program designed to prevent overpopulation from fueling unrest.”
The doctor “never asked for my approval, never ran any checks, just mutilated me as if I were a mute animal," one mother, who had part of her uterus removed during a C-section, told the AP, shortly after the death of her first, and last, baby.
Stories have been leaking out for years about doctors secretly performing hysterectomies on women who have given birth in hospitals. The surgeries are described as “voluntary,” but EurasiaNet.org has reported how increasing numbers of women are choosing to give birth at home, fearing doctors will tie up their fallopian tubes or cut out their uteri without their consent.
The UN Committee Against Torture and the US State Department have both expressed concern. Nevertheless, it appears Tashkent is issuing doctors quotas for the procedures.
"Every year we are presented with a plan. Every doctor is told how many women we are expected to give contraception to; how many women are to be sterilized,” a gynecologist from Tashkent told the BBC’s Natalia Antelava.
Several doctors I spoke to say that in the last two years there has been a dramatic increase in Caesarean sections, which provide surgeons with an easy opportunity to sterilize the mother. These doctors dispute official statements that only 6.8% of women give birth through C-sections.
"Rules on Caesareans used to be very strict, but now I believe 80% of women give birth through C-sections. This makes it very easy to perform a sterilization and tie the fallopian tubes," says a chief surgeon at a hospital near the capital, Tashkent.
One local expert estimated tens of thousands of forced sterilizations have happened in the past few years across Central Asia's most populous nation, a vast country of, officially, 28 million.
Researchers are warning that Central Asia’s post-Soviet decay has provided a fertile breeding ground for a group of dangerous tropical diseases. The region’s economic breakdown and falling healthcare standards have contributed to the reemergence of diseases that had been eradicated or were controlled when the countries were part of the Soviet Union. The diseases, such as malaria, hurt the region’s economy, the authors warn in “Central Asia's Hidden Burden of Neglected Tropical Diseases.”
NTDs “are a group of 17 parasitic and bacterial infections that are the most common afflictions of the world's poorest people. They blind, disable and disfigure their victims, trapping them in a cycle of poverty and disease,” says a press release from the Public Library of Science, which published the study.
Authors Peter Hotez, president of the Sabin Vaccine Institute in Washington, DC, and Ken Alibek of Nazarbayev University in Astana, who published their report September 27, write that “among their common features, the NTDs result in prolonged periods of disability and actually help to promote poverty through their long-standing effects on child development and worker productivity. It is not commonly appreciated that the NTDs are widespread throughout Central Asia where they are also a major determinant of poverty.”
The diseases include “soil-transmitted helminth infections, food-borne and zoonotic parasitic infections, and vector-borne protozoan infections.” Some of the infections spread through meat, which is no longer regulated by mechanized slaughterhouses, since the demise of the Soviet state left “livestock production in the hands of small farms and unsupervised homes, and largely without veterinary inspection.”
In the run-up to World Aids Day on December 1, Almaty's Central Museum is hosting a photo exhibition to draw attention to the spread of HIV and TB in Central Asia. The images on display give an insight into the daily lives of people affected by the HIV epidemic, which is quickly spreading throughout Kazakhstan and Central Asia. According to official statistics there are around 50,000 infected people in the region, though the real figure may be much higher.
The exhibition, entitled “We are Near! We are Together!,” brings the work of Ukrainian freelance photographer Alexander Glyadyelov to Kazakhstan for the first time. Glyadyelov has been working on documentary photography projects involving socially deprived children and the HIV/AIDS epidemic since the mid-1990s.
His striking black and white photos are being exhibited alongside images taken by young photographers from Kazakhstan, Kyrgyzstan and Tajikistan who are working in the NGO sector, living with HIV, or are from groups at high risk of contracting the virus.
Juxtaposed with everyday scenes of people living with HIV are some harrowing pictures from prison camps in Karaganda, Kazakhstan. HIV and TB are chronic in Kazakhstan's prisons.
It's not only the prison population that is suffering from these infections, however. According to the UNAIDS/WHO 2009 report “AIDS Epidemic Update,” Central Asia and Eastern Europe are the only areas of the world where HIV infection rates among all sectors of the population remain on the rise. The problem is most acute among people injecting drugs and those having unprotected sex.