Uzbekistan: Alarm at Rise in Cancer Cases

Doctors in Uzbekistan say cancer treatment facilities are failing, with poor provision for early diagnosis, inadequate hospital facilities, and medicines that are unobtainable in the state healthcare system and unaffordable on the open market.



The warnings come at a time when a leaked internal report says the incidence of cancer is rising dramatically in this Central Asian state.



The report, based on a study conducted last year, showed a leap in the number of people with cancer – in the first half of 2009, 17.9 per cent more than in the same period of 2008. Over the five years from 2003 to 2008, the incidence of cancer increased from around 14 cases to 25 per 100,000 of the population.



The study drew comparisons with other countries around the world, where it said the annual growth rate ranged between six and 8.5 per cent.



The Uzbek health ministry says that in 2009, there were 90,000 people with cancer, about a third of one per cent of the population.



The internal report was based on data collected by doctors from all over Uzbekistan. The highest rates of cancer were discovered in Fergana, Bukhara and Khorezm regions.



Khorezm lies close to the Aral Sea, which has dried up over several decades, causing harmful dust in the air and other environmental problems. The study made a link between the Aral disaster and cancer rates, although it did not place the sea’s location – Karakalpakstan – among the regions with the highest incidence, while Fergana, one of the top three, is a long way away from the sea.



A more general cause was, said the report, the use of harmful pesticides on cotton plantations, where much of the work is done by hand by adults and often children.



A number of experts expressed concern that almost nothing was being done to prevent cancer or detect the early signs among children, young women, and people who work with chemicals or other hazardous materials.



Uzbekistan’s state health system appears to be in no shape to cope with such a high, and rising, incidence of the disease



One cancer specialist in the capital Tashkent, who was involved in the study, summed up what he saw as the main problems, “a lack of highly-trained experts and inadequate state funding for cancer centres”.



Nationwide, this doctor said, “There are only 1,104 beds for cancer patients. People have to wait their turn for months on end.”



According to a haematologist also from Tashkent, “The majority of cancer sufferers are admitted in the final stages of the disease. They cannot be treated, and we’re simply forced to watch them die.”



A doctor involved in gathering data for the report said Uzbekistan should have at 30 large cancer clinics instead of the current 19, and also hospices where the terminally ill could receive qualified care.



In addition to the inadequate number of specialised medical centres, many forms of treatment are in short supply. A health ministry adviser said the lack of radiotherapy and other treatment was causing “a lot of deaths”.



The cost of medicines used to treat cancer or alleviate the symptoms is a focus of many complaints.



The Tashkent cancer specialist said the health ministry had refused a request to buy in 1,000 bottles of an advanced drug known as MabThera to be dispensed by state doctors.



At 6,000 US dollars a bottle on the open market, the drug was beyond the reach of people who might considering buying it themselves, since the average wage in Uzbekistan is between 70 and 80 dollars a month.



“Doctors say that the combined treatment including modern chemotherapy and new drugs helps one recover,” said a 39-year-old woman who has stomach cancer. “But such drugs aren’t available here and I don’t have money to buy them abroad.”



Officials say the problems are exaggerated. Bakhtior Niozmatov, first deputy prime minister of Uzbekistan and the country’s chief doctor insists that state funding is adequate and the system is getting better all the time, with drugs and treatment methods available.



“Every year, several million soms [upwards of one million US dollars] is allocated to purchase of drugs for those who need cancer treatment,” he said.



“A wide-ranging programme is under way to prevent serious diseases, including cancers. Last year a haematological stem cell transfer centre opened… now it’s become much easier to treat serious forms of leukaemia.”



That will be little consolation to one woman, who told how she had brought her son to Tashkent the hundreds of kilometres from Navoi to Tashkent in hope he would get better treatment.



“For the last six months, we haven’t been able to get the medicines we need even though we have an official prescription from the cancer centre,” she said. “They say there aren’t any drugs. But the drugs they do have get divided up among those who’re able to pay over the odds, and they don’t have to wait in the queue.



“Our 27-year-old son is simply melting away before our eyes, and there’s nothing we can do to save him.”



Bakhtior Rasulov is the pseudonym of a journalist in Uzbekistan.