Azerbaijan: A Matter of Life and Limb

When one of her students asked what gift she would like for Teacher's Day, Sakina Zeynalova did not hesitate. "A flask of insulin," she replied.

A diabetes sufferer, Sakina has endured long periods without this vital medicine, which resulted in the amputation of one of her legs. Now she fears she may lose the other.

The problems started when Sakina's son died. Until then he had helped her to buy insulin privately, but once on her own she was left dependent on state supplies of the drug.

"I simply do not have enough money to buy the dose I need," she said. "After Azerbaijan became independent, clinics cut the allocations in half, saying there was a shortage. I am convinced that medical workers are selling state supplies to private pharmacies, who then make a profit."

Chairwoman of the Azerbaijan Diabetes Association, Mominat Omarova, confirmed that the state endocrinological dispensary allocates only a single flask of insulin to each patient monthly. Those who require a higher dose must buy the remainder at a commercial pharmacy. She added that privately-purchased insulin is often of lower quality, because of faulty storage procedures at the pharmacies.

Azerbaijan has a law on diabetes, which obliges the government to fund the timely diagnosis, treatment and prevention of complications from the disease, as well as social provision for patients. Moreover, the annual allocation of insulin and other medical aid for diabetes sufferers should be based on actual need, not a predetermined quota. To this end, a national pancreatic diabetes programme was drawn up in February 2004, but has still not received state approval.

Estimates vary as to the true cost of controlling the disease. The Azerbaijan Diabetes Association estimates that the annual insulin bill alone should be around two million US dollars, a figure based on official statistics and the minimum price for insulin.

Chairwoman of the Diabetes League of Azerbaijan, Yegana Sultanova, suggested a preliminary estimate of 15 million dollars for 2005, to implement the existing programme for diabetes control. This would cover the purchase of all necessary insulin, the maintenance of dispensaries and the provision of instruments for self-monitoring.

Whatever the real cost, on the ground the resources for this year have already been slashed five times, leaving only the bare bones of the programme in place.

"The government is not allocating sufficient resources to carry out all the measures prescribed by law," said Mominat Omarova. "As a result, increasing numbers of patients are developing complications."

Head of the Baku endocrinological dispensary, Vurgun Akhundov, refused an interview with IWPR, commenting only that "all patients receive sufficient doses".

Much of Azerbaijan's insulin is imported by the pharmaceutical company Novonordix. Their representative, Rena Kuliyeva, insists that plentiful supplies of the drug enter the country.

"We import as much insulin as Azerbaijan can afford. The warehouses of the ministry of health’s pharmaceutical department always hold plentiful supplies. Problems arise because the state dispensary must wait for resources to be transferred from the budget before they can pay the pharmaceutical department, which causes delays," she said.

However, Abulfaz Abdulladzade, head of the ministry of health’s central monitoring laboratory, recently suggested to the Turan news agency that around 40 per cent of the drugs sold here have been smuggled into the republic and therefore not subject to quality control.

According to official statistics, Azerbaijan's pharmaceutical market is worth more than 28 million dollars. "Our investigations show that the ministry of health has failed to create a stable climate in the pharmaceuticals market. Patients are being poorly treated by doctors who lobby for firms which import medicines for commercial distribution," concluded the Turan news agency report.

A World Health Organisation, WHO, global report on the spread of diabetes, taking the figures for 2000 and 2003 as a baseline, estimates the incidence of diabetes in Azerbaijan at 300,000. Chief state endocrinologist Rafig Mamedgasanov refutes these figures.

"According to our statistics, we have just over 55 thousand registered patients, of whom 17,000 are totally insulin dependent," he told IWPR. "A few hundred wealthy patients may have neglected to register because they receive private treatment, but it is not realistic to suggest there are 300,000. Their figures are quite approximate."

However, independent commentators question the government statistics, because they are based on official registration at dispensaries. In fact, many patients face obstruction when they try to register. "We regularly receive complaints from patients, because the endocrinological dispensaries simply refuse to register them. We believe that up to 150,000 people in Azerbaijan are suffering from this disease," said Mominat Ominova.

Sultanova agrees. "Unofficial statistics based on the amounts of insulin and other anti-diabetes medicines imported to this country confirm that the true figure is much higher," she said, adding that a lack of awareness and self-monitoring has led to a particularly high incidence of chronic diabetes in the regions.

Saida Gurbanova, who has suffered from diabetes for five years, told IWPR she had already been receiving private treatment for 18 months when she discovered by chance that she could register with an endocrinological dispensary.

"None of my doctors advised me to register and there is no information widely available. Also, I am sure the dispensary has no interest in expanding the registration lists, because then they will be obliged to provide more free treatment to patients," she said.

Saida still spends around 20-25 dollars every month to make up her required dose. The commercial price of insulin varies between three and a half to six dollars per flask depending on the dose.

"Daily insulin injections enable patients to live a bit longer, but the treatment does not end there. You need up to 200 dollars per year for the most basic treatment, which includes a full examination and an annual visit to a special sanatorium to receive massage and other treatments," she said.

Gulnaz Guliyeva is a freelance journalist in Baku.