Kyrgyz Diabetics Face Uncertain Future

Pharmaceuticals companies have cut supplies of insulin to Kyrgyzstan pending repayment of debts, a move that could prove disastrous for the country’s diabetics.

A government contingency plan, the purchase of cheap insulin from Ukraine, has meanwhile come under criticism, with some suggesting that it poses a serious health hazard.

Bishkek owes more than 758,000 US dollars to the western pharmaceuticals companies who supply Kyrgyzstan with insulin. With supplies cut, it is thought that the country’s stocks will only last for around six weeks - a terrifying prospect for the many diabetics who rely on the drug for their survival.

This is not the first time the region has been hit by insulin shortages. Five years ago in neighbouring Kazakstan, the authorities reportedly failed to order sufficient quantities, resulting in the deaths of at least six diabetics.

According to the ministry of health, there are more than 16,000 sufferers in Kyrgyzstan, of whom around 4,000 - 154 of them children - are insulin-dependent.

The government currently provides the drug free of charge. Should supplies run out, sufferers would have to buy it themselves. But the average cost of a month’s supply, around 20 US dollars, is beyond the means of most Kyrgyz and private supplies are scarce.

Under the Soviet system, the government depended on domestic insulin providers, turning to western sources after independence in 1992.

However, the available funds have not been enough to pay for the quantities needed and the authorities have had to buy the drug on credit - arrears for 2001 were only paid off in May this year.

Both the ministry of health and diabetic associations have repeatedly issued warnings about the shortfalls. On September 17, Prime Minister Nikolai Tanaev demanded the problem be resolved as a matter of urgency. As a result, one sixth of arrears were paid off last week.

But even if the pharmaceutical companies agreed to resume supplies, the ministry of health has said that high levels of bureaucracy could mean that deliveries could take up to three months to arrive.

Some Kyrgyz diabetics have tried traveling to Kazakstan to acquire insulin but they have been largely unsuccessful. Since Astana provides the drug free of charge, there are no private suppliers.

But even if it was possible to buy the drug on the open market, most of the families of Kyrgyz diabetics could not afford to.

The Popovs, whose son Alexei is a diabetic, make a reasonable amount of money by Kyrgyz standards, around 160 dollars a month. They could just about pay for some treatment, but not over an extended period of time. This is not even an option for Kubat kyzy Adel, another sufferer; her mother, a nurse, makes 20 dollars a month.

In an effort to deal with the impending crisis, Bishkek intends to buy in cheap Ukranian insulin - but this plan worries physicians and patients alike.

The drugs supplied by US and European companies are produced using genetic engineering techniques and are very close to human insulin. There are concerns that the low cost alternative, which is animal in origin, could result in blindness, kidney failure, gangrene and even premature death.

A working party set up by the Association of Diabetics of Kyrgyzstan, which has been looking into the use of Ukranian insulin, expressed serious reservations about its quality in June. Its conclusions are due to be reviewed by the inter-parliamentary assembly of CIS countries in St Petersburg in October.

In an appeal published on September 19 in the Kyrgyz media, Diabetics of Kyrgyzstan, an organisation of mothers whose children suffer from the condition, said, “We will go to extreme measures to protect ourselves. We will not allow ourselves and our children to be used as guinea pigs.”

Natalya Domagalskaya is an independent journalist from Bishkek.