Eurasianet says there are no specialized pharmacies for post-organ replacement treatments in Tajikistan, so those who need such drugs are engaged in an endless treasure hunt.  Usually, the medicines can be ordered from Russia, although there are lucky times when they can be sourced inside the country. The same situation confronts people suffering from all kinds of ailments.

The coronavirus pandemic has reportedly thrown this delicate arrangement into disarray, however. Flights have been canceled for weeks. Prices for what is available locally have rocketed. Shortages prevail.

According to Eurasianet, Safarali Toshev, who donated a kidney to his sick daughter two years ago, sold property, borrowed money from the bank and got help from charities to cover the costs.

The operation went well, but 17-year-old Zarina will now be on a course of drugs for the rest of her life – namely, Myfortic and Prograf, both of which are designed to insure against her body rejecting the organ.

Toshev used to buy packs of Prograf for 250 somoni ($24).  More recently, the same has set him back 1,000 somoni.  Now, the drugs have become impossible to find even at that high cost, Eurasianet says.

“If my daughter does not take these medicines for three days, then the treatment, despite all our efforts, will be for nothing. As our doctor told us, without these medicines, the process of kidney rejection will begin,” Toshev said.

Along with 30 or so other parents needing post-kidney transplant drugs, Toshev traipses daily to the Health Ministry in the desperate hope of hearing good news about the arrival of new consignments of drugs.  Officials keep promising deliveries are imminent, but nobody can offer a date.

Diabetics are reportedly in the same boat. When 12-year old Umar was diagnosed, his mother, Zulfiya Akobirova, had to scout around for the right type of insulin.  The endocrinology clinic that served her now says there will be no medication available for another two months.

“Humulin R insulin is what is suitable for my son – the other ones raise sugar levels. The clinic has offered us substitutes, but we turned them down, there is no sense [in taking them],” Akobirova told Eurasianet.

According to official data, there are more than 4,000 people in Tajikistan who require insulin.

Akobirova said that 30 days is the cutoff period for surviving without insulin doses. After a few days of going without in times of need, a sufferer risks falling into a coma.

“In Tajikistan, coma means death,” she said. 

Her task now is to work out how she can get the Humulin R from abroad.

“I still have enough medicine for two weeks. In the meantime, I will have to get hold of this medicine by any means possible. There is no messing around or being irresponsible with childhood diabetes, never mind that COVID-19 has spread all around the world,” she said.

These challenges are testing Tajikistan’s health system to the breaking point – and the people who use it too, according to Eurasianet. 

Hundreds of healthcare professionals have left the country in recent years.  Russia offers doctors a streamlined citizenship application procedure, a major temptation.  Doctors say the prospect of higher salaries and improved career options are too much to resist.

Eurasianet notes that although healthcare provision is nominally free at the point of delivery, the reality is that informal payments are the norm.  Anybody who can afford the additional expense goes abroad, to places like Russia, India, Iran and Turkey, for specialized treatment.  Doctors there are better-resourced, and the private clinics are motivated to give value for money.

Much of the problem is in where the government sees its priorities.  In 2020, the state budget envisioned a 12 percent increase in healthcare expenditures.  But the levels are painfully meager, as the World Bank found in a March research note on emergency COVID-19 preparations.

“Government spending on health as a share of general government spending is low: at 6.6 percent, equating to $17 per capita,” the World Bank found. 

And while finances are tight, the reason things are this bad is that the authorities see other areas as more pressing.

“Fiscal space for health remains constrained due to slowing growth and priority given to infrastructure projects in the government budget,” the World Bank said.