Tajik Village Decimated by TB

The home  where the Karimov family used to live in southern Tajikistan now stands deserted. After seven members of the household died of tuberculosis a few years ago, a little girl who was the sole survivor was taken away to a children’s home. 

This was no isolated case – TB-related fatalities are such a regular occurrence in the village of Karagach that its mountain location has become known as the “valley of death”.

Tajikistan’s government has a concerted nationwide programme in place to combat tuberculosis, but Karagach seems to have fallen off the radar.

Residents say they are not getting the medication they need for what seems to be a virulent strain of TB, and some believe local officials are underreporting the mortality rate to their superiors.

The rates of infection and death are staggering – 17 people have died so far this year, and there is hardly a family in this community of some 380 that does not have at least one member with TB.

The Nosirov extended family, for example, has lost 13 people, from children to grandparents, since 1999 – the year many villagers say marked the start of the epidemic.

A visit to the village quickly reveals the devastating effect that untreated TB can have when extended families live together in cramped conditions. Without treatment, the infection will spread rapidly.

“Every year between 11 and 18 people die,” Karagach resident Zafar Zardakov said. “Why isn’t anyone alarmed by that? We had a case where three people died in one day…. 57 of our fellow-villagers have died in the last three-and-a half years, most of them young. They should have lived long lives.”

The chief doctor for Hamadon district, Asror Isupov, said X-rays conducted on 318 Karagach residents had revealed 18 suspected cases. All school-age and pre-school children had been given TB vaccines.

Residents are concerned that adults are not receiving the same level of care.

Dr Isupov said most cases in the village involved a persistent strain of TB, and dealing with it would require expensive courses of treatment which Tajikistan could not afford.

The Tajik government is implementing a United Nations-funded programme that applies the World Health Organisation’s DOTS (“directly observed therapy, short-course”) methodology.

But current policy is to focus on certain regions, while others like southeast Tajikistan are left out – even though Karagach clearly looks like a priority case.

“Medicine has been allocated to treat 50 people across the country with the persistent strain of TB in the Machiton TB hospital. These 50 come from districts around the capital [Dushanbe], and patients from Hamadon and Vose districts [in the south] will wait in the queue,” Dr Isupov said.

Village nurse Zulfia Kholova is a member of the Nosirov family by marriage, and her husband Mirzo is among those with TB.

Kholova believes the local health authorities are reluctant to disclose the true extent of the problem, thus preventing sufferers in the early and advanced stages of TB from getting the different kinds of treatment they need.

“When I’ve submitted reports from the health centre, I’ve been told to put down causes of death other than tuberculosis for most of the cases,” she said.

Kholova believes a representative of Project Hope, a non-government health charity, was deliberately misled when he visited the Nosirov home and asked about the number of sufferers.

“When he asked – in Russian – how many had died, a district hospital representative who was accompanying him translated [from Tajik to Russian] with a completely different figure from what I had said,” she recalled. “I asked him in Tajik why he’d given a lower figure… and he replied ‘that’s how it should be’.”

Local resident Saidamir Nabotov is similarly suspicious of the way healthcare authorities are handling the TB epidemic.

After losing two teenage sons aged 18 and 22 to TB last year and a 26-year-old daughter this February, another son is now showing symptoms of the disease, although a recent X-ray showed up nothing.

“You can say that almost every family in the village has members with TB,” he said. “I don’t know why they are concealing the number of ill and dying people.”

Local healthcare staff approached by IWPR declined to comment on allegations that the epidemic was being downplayed.

The death and incapacitation of breadwinners from TB has had a devastating effect on villagers’ ability to sustain themselves. A lucky few have relatives working in countries like Russia and sending money back home.

Muborak Zabirova’s husband went off to Russia five years ago, but he stopped sending money back after hearing of illness in the family.

Zabirova’s 22-year-old daughter died of TB recently, and the family has had no income since the last breadwinner, her son Saifullo, 23, had to stop working six months ago and is now emaciated by the disease.

Although tuberculosis is airborne and transmitted from one person to another, many people in Karagach believe the very ground they stand on is infected.

Dr Isupov also believes the only solution is to resettle all the village’s inhabitants.

“They must be relocated somewhere else in their entirety,” he said. “The district administration has written specially to the government, but so far there’s been no response.”

Biloli Shams is an IWPR-trained journalist in southern Tajikistan.

This article was produced jointly under two IWPR projects: Building Central Asian Human Rights Protection & Education Through the Media, funded by the European Commission; and the Human Rights Reporting, Confidence Building and Conflict Information Programme, funded by the Foreign Ministry of Norway.

The contents of this article are the sole responsibility of IWPR and can in no way be taken to reflect the views of either the European Union or the Foreign Ministry of Norway.