Kazakstan: Disabled and Angry

Thirteen year old Nurlan, an epilepsy sufferer, waited patiently for two hours at a surgery in Almaty - not for medical help, but to prove that he was ill.

Nurlan's mother had brought him for his annual check-up so that he could qualify for another year's worth of government benefits - roughly 30 US dollars a month in his case.

However, the doctors wanted to be sure that Nurlan had not been cured since the last time they saw him.

After two hours wait, they got what they were waiting for - the boy suffered an epileptic attack.

As his mother rushed to give her son his medicine, she was held back by the doctors. It was not until Nurlan had fallen to the floor that they attended to him - satisfied at last that he was still epileptic.

Reports of corruption and humiliation are commonplace in the Kazakstan's smaller surgeries, where disabled people go to register in one of the three categories the government has created for them.

And clinics are putting their patients through increasingly surreal tests to judge whether they qualify for another year of state benefits.

The most severely disabled qualify for an allowance of around 45 dollars a month from the state. Those designated as category two receive around 30 dollars, while category three cases get just over 13 dollars.

The sizeable difference between the allowances for people in the second and third categories is due to the fact that the latter are considered capable of working and earning a wage.

In practice severe disabilities are no guarantee of exemption from having to work. A bribe paid to clinic staff, however, may be able to guarantee that.

IWPR recently witnessed the case of Evgenia Averintseva, when she went to the clinic for her annual registration as a category two invalid. She had lost the use of one of her hands four years ago.

A medical expert at the clinic told Averintseva she would be downgraded to the third category and forced to earn a living, unless she handed over a bribe of 100 dollars.

"But when I asked how I would work without a hand, she answered, 'Go and work as a janitor, you don't need two hands to do that.' It's a nightmare," said Averintseva tearfully.

The expert promised her that the bribe would buy her a place in category two for the rest of her life.

But not having worked for the last four years, Averintseva was in no position to pay the 100 dollars.

The expert then carried out her threat and transferred Averintseva to category three.

Only after complaining to the expert's superiors in Almaty was Averintseva reinstated in the second category.

IWPR contacted the expert, who dismissed Averintseva's complaint as "a complete invention". She refused to comment on why her superiors had contradicted her ruling that Averintseva should be able to earn a wage.

IWPR heard more tales of woe from the queues of disabled people lining up to register outside district clinics.

Some criticised a system that forces the weak and infirm to wait for hours on end every year to be registered. "Why can dentists arrange a consultation time and avoid queues, but no one thinks about the invalids?" wondered one category two invalid.

Others spoke of the neglect and indifference of medical staff. Evdokiya Matveeva witnessed a man have an epileptic fit while waiting to be seen. "A doctor came out to see what the noise was and simply said 'Oh, that's our patient', and went back to the consulting room."

"The man fell down unconscious and no one helped him," said Matveeva.

Irina Razina also complained of the neglectful attitude of the medical staff, but added - "as soon as you show them money or presents, the treatment changes immediately".

Aibek Dumbaev, a lawyer who campaigns for disabled rights, spoke of a rising tide of complaints against staff in district clinics.

In the first three months of this year, Almaty's medical watchdog has received over 100 complaints concerning district clinics.

Disabled people invalids say that although the authorities usually do act on individual reports of abuse, they have not been able to change working practices at many smaller clinics.

Lyazat Kaltaeva, who heads an association of disabled women, says the mistreatment of disabled people has its roots in the Soviet era. "Only a person who is obviously dying doesn't have any problems. If a person is in the second or third category, that's when the trouble begins."

Despite a presidential declaration that last year, 2002, was Kazakstan's "year of health", life is harder than ever for the disabled - and their anger is increasing.

Waiting to register outside a clinic, a woman who gave her name as Ainur told IWPR of a Kazak veteran from the Afghan war who had only one foot. The doctors took him inside and measured his leg with a ruler - to make sure his stump hadn't grown in the last year.

Erbol Jumagulov is an independent journalist in Almaty