Institute for War and Peace Reporting | Giving Voice, Driving Change

Kyrgyz Doctors Seek Better Life Abroad

Increasing numbers of medics are leaving for Russia and Kazakstan, reducing the quality of healthcare in their own country.
By Gulnara Mambetalieva
The Kyrgyz ministry of health is concerned that increasing numbers of medical staff are leaving the country in search of more lucrative work abroad, leaving people with inadequate access to healthcare.



Doctors and nurses say low salaries in Kyrgyzstan are forcing them to seek employment in other countries, most in Russia and Kazakstan, but increasingly also further afield.



The government’s statistical committee reports that about 1,000 doctors and other qualified medical personnel left the country last year, and at least 600 more in the first six months of 2007.



Kasymbek Mambetov, state secretary at the Ministry of Health, said that while emigration used to be commonest among healthcare staff in smaller towns and rural areas, where incomes are low and conditions arduous, the trend is increasingly affecting hospitals in the capital Bishkek.



Kadicha Omuralieva, 40, a paediatrician at a polyclinic in Bishkek, is leaving for Moscow to start a new job.



“I’ve been offered a job at a Moscow polyclinic, and I’ve accepted it,” she said.” Many doctors from Kyrgyzstan are now leaving for Moscow and other Russian cities because doctors get paid so little. If I had an adequate salary, I wouldn’t leave.”



In Kyrgyzstan doctors rarely get paid more than 100 US dollars a month, and many are forced to take a second job to make ends meet. By contrast, basic salaries for doctors working in Russia are about 6,000 to 8,000 US dollars a year. With allowances and regional weightings, that can reach 12,000 dollars.



Almaz Ryspekov, 37, now works at a polyclinic in the Siberian city of Krasnoyarsk, having left Kyrgyzstan three years ago. He used to have to moonlight to supplement his salary.



“When I was working in Talas regional hospital as an anaesthetist, my salary was about 1,000 soms [26 dollars a month at current rates]. At night, I would work as a self-employed taxi-driver so as to keep my family. I have two small children, and we didn’t have enough money,” he said.



That all changed when a group of Russian doctors visited the hospital on a recruitment drive. “They said we’d earn 1,000 dollars [a month] and would also get a package of social benefits. I and three other doctors agreed straight off. I’ve been working here for three years and I’m not sorry I left,” said Ryspekov.



In the three years since he has been in Krasnoyarsk, he has bought a flat and a car and can afford to make trips home to Kyrgyzstan every year.



Not everyone makes the transition so successfully. Zamirbek Sakimbaev, a traumatologist, left for Krasnoyarsk with Ryspekov, but subsequently returned home.



“Above all, we came back because of the climate - it’s very cold there. Besides, I couldn’t get along with my colleagues…. So I had to come back to Kyrgyzstan,” he said.



Recent graduates account for a high proportion of people leaving Kyrgyzstan to work abroad, and that applies to healthcare professionals as well. The three Kyrgyz universities that offer medical degrees produce about 1,000 graduates a year, who must complete two years of hospital internship after their five years of study.



Nurlan Rakhmanov, a recently-qualified dentist at a clinic in Bishkek, is already dreaming of leaving.



“I’ve been working for more than a year, but now I want to leave for Russia or Kazakstan and work there,” he said. “I wouldn’t have left the country at any price, but it’s humiliating to have such a low salary. I need to get married, and I need to support my parents. Our government doesn’t seem to care about doctors.”



He added, “I know that many medics have left for Russia and they are well looked after.”



Juma Abdullaev, the head of the Association of Kyrgyz Diasporas in Kazakstan and Russia, told IWPR that getting a job in Russia is fairly easy, with plenty of job advertisements and recruitment agencies.



“There are huge lists of vacancies in almost every Russian newspaper and magazine and on the internet. Qualified doctors know where they are going and what they’ll be doing there. They will be OK,” he said.



Abdullaev is concerned at the effect that the exodus of doctors will have on Kyrgyzstan, he understands their decision to go.



“I feel very sorry about it. Who’s going to treat us if the doctors leave the country?” he asked. “On the other hand, I do feel sorry for them too. What are they to do if they don’t have enough money to buy the bare essentials?”



Health ministry official Mambetov is especially concerned at the rising trend for doctors to leave the relative comfort of big cities like Bishkek. “It is largely because of low pay and inadequate welfare provision,” he said.



One Bishkek resident told IWPR that working conditions for healthcare professions were poor even in the capital. "My sister worked for the emergency ambulance service. But because of a shortage of petrol, they could not answer emergency calls - and this was happening in Bishkek, not a remote village,” he said. “I know that because of the meagre salaries, many doctors left their jobs. Two of them [from the ambulance crew] left for Russia.”



Outside the main urban centres, things are many times worse. Many local hospitals lack doctors with key specialisms. Even just outside Bishkek, the village of Oktyabrsk has just one doctor for its 8,000 residents.



According to Mambetov, “The most distant regions are the most vulnerable. Chatkal, Toguz-Torous, Aktala and Chon-Alay family [should] have medical centres and doctors’ practices – but there aren’t actually any family doctors there at all. Can you imagine that?”



A government programme to encourage young doctors to spend at least a few years working in rural areas has made little difference. Under the “Young Doctor’s Deposit” scheme launched in 2006, anyone who signs up for three years gets 80 dollars a month paid into a special account, which they can only touch when they have completed the agreed term.



The programme has proved less than popular and fewer than half the 100 places available in 2007 were taken up.



Mambetov said that to fill the gaps, hospital managers have to ask the doctors they have to work in specialist areas other than their own, paying them extra wages to provide cover.



“That’s how we cope with the situation,” he said.



Gulnara Mambetalieva is an IWPR contributor in Kyrgyzstan