At the start of the pandemic, volunteers worked 12-hour shifts. Following the relaxation of strict quarantine measures in June, Kyrgyzstan experienced a sharp increase in Covid-19 cases, catching health services off guard. Many complained that they were unable to receive timely medical care, and stories of people dying outside hospitals went viral on social media. Volunteers came to help, effectively taking over some of the government’s functions. For the authorities, this led to calls for impeachment.
On the night of July 14, Adinai Murzabekova, a 21-year-old fifth-year student at the Kyrgyz State Medical Academy, died in Bishkek. Like many other senior students at the KGMA, she assisted doctors during the height of the pandemic. Adinay worked as a volunteer nurse in one of the capital’s day clinics, which were opened by the mayor’s office for people who needed injections and intravenous fluids to relieve the regular hospitals. It was expected to treat mild and moderate patients, but within the first week, seven seriously ill patients died there for whom there were no hospital beds available. After another 12-hour shift, Adinai began to feel unwell, and local media, citing friends, reported that she began to have seizures. The girl needed intensive care, but the hospital did not have the necessary equipment and the ambulance did not arrive. After the autopsy at the Ministry of Health, they announced that Adina had bilateral pneumonia – although relatives said the girl was healthy.
“We were asked to help because there is a shortage of people, and we agreed to come as volunteers,” says Adinai Bekzat Abdrakhmanov, a colleague. “But we did not undergo any diagnostics, and no one warned us about the enormous workload here – patients come with 70% lung damage, and we work in sweaty suits for 12-18 hours. If you have health problems, you can’t handle it. In early July, it became clear that Kyrgyzstan’s health system was unable to cope with the new outbreak. Pre-arranged inpatient units quickly became overcrowded, the x-ray schedule was booked two weeks in advance, and the ambulance could not respond to all calls.”
Medical students became volunteers. “What is happening now is a catastrophe. The workload is increasing every day,” Yegor Borisov, head of the resuscitation department at the Bishkek Emergency Medical Station, wrote on Twitter on June 26. “We are practically setting new records for the number of calls in the queue every hour. This has never happened before. It’s a disaster.” We explain quickly, simply, and clearly what happened, why it matters, and what happens next. The number of offers should remain the same: episodes. The end of the story. Advertising Podcasts.
The epidemiological situation in Kyrgyzstan has worsened since the strict quarantine was lifted in June. The first cases of infection were reported in mid-March, and shortly thereafter the authorities declared a state of emergency in the country’s three largest cities, restricting the movement of people and shutting down virtually all businesses. The quarantine was fairly successful – by the time the state of emergency was lifted in May, only 12 people in the country had died from the coronavirus – but it led to a complete paralysis of the economy and a budget deficit of one-fifth. Until July, the Ministry of Health published two daily statistics – one for Covid-19 and the other for out-of-hospital pneumonia. However, the World Health Organization (WHO) has warned that the coronavirus may be misdiagnosed in many cases. As a result, when the number of pneumonia deaths in the country was already four times higher than the number of Covid-19 victims, the Ministry of Health decided to combine the data. The next day, after the statistics were merged, the number of infected people almost doubled, and the number of deaths increased four and a half times.
“The strict quarantine, which halted the operation of shops and businesses, was lifted in June”. Meanwhile, as Egor Borisov wrote, in the millionth Bishkek there are less than 40 ambulance teams – four times less than necessary. Sick people called ambulances and the Ministry of Health’s hotline, but often did not get through for several days. Then the first volunteer mobile brigades appeared in the city, using oxygen concentrators (devices for extracting oxygen from the air, used both in hospitals and at home) to maintain the breathing of seriously ill patients until the arrival of an ambulance. Sofia-Aidana Murzaeva, 24, is a member of such a team. She has been volunteering at various charitable foundations for five years, but she has no medical training. “Before the pandemic, I worked in a restaurant, but I quit when the quarantine began and joined the team of volunteers,” says Murzaeva. “We were instructed on how to use personal protective equipment (PPE), how to provide first aid, and how to use medical equipment. It turned out to be more difficult than I expected.”
At the height of the pandemic, I was out on calls up to 11 times a day, and I saw people die several times. Sometimes we would arrive and be told that the person had already died and we couldn’t get there in time. Now there are two thousand volunteers in the mobile teams, they have 12 cars and 30 oxygen concentrators. Kyrgyz celebrities, businessmen and ordinary citizens all contributed to the collection of concentrators. In July, social networks turned into bulletin boards where oxygen concentrators, masks, and pneumonia drugs were bought and sold. These drugs were often unavailable in pharmacies. The situation is no better in regions where equipment and specialists are even more scarce. “When we started helping, there were hospitals in Issyk-Kul that had no beds or [respirators]. The head doctor just retired, and the patients kept coming,” says entrepreneur Edil Azhibayev, who heads the Help Issyk-Kul volunteer movement, which is involved in fundraising and purchasing humanitarian aid for hospitals.
“In another hospital, the head doctor himself ended up in intensive care, another doctor died, and several staff members fell ill – there was literally no one to treat people. We managed to contact the Ministry of Health and doctors were sent here. Kyrgyz doctors have been particularly hard hit by the coronavirus: according to official data, nearly 3,000 health workers (about 21% of the country’s doctors) have fallen ill since the start of the pandemic, and more than 70 have died. In March, the Ministry of Health opened a special account for the fight against the coronavirus, into which funds were transferred by donors and charitable organizations, as well as ordinary citizens. They managed to collect more than $300 million, but the government used much of it to pay salaries and pensions, including for doctors and teachers, because of a budget deficit. Some of it was spent to support small and medium businesses, and only 44 million went to health care.
Day care centers have begun to open in Kyrgyzstan to relieve the burden on hospitals. During the quarantine period, Kyrgyzstan, unlike many other countries, did not build a single specialized hospital. The country’s authorities did not begin building an infectious disease hospital until July, after the peak of the outbreak. The government promised to compensate the sick and the families of the deceased doctors, but it was later determined that each case should be reviewed by a special commission: at the beginning of the pandemic, according to the authorities, many medical professionals themselves did not follow safety regulations and improperly used personal protective equipment. Doctors have repeatedly expressed outrage at what they see as unfair accusations, and have said that protective suits are far from adequate for everyone. Following the deaths of two patients at the doorstep of a Bishkek hospital in June, the ministry reiterated that there were enough beds for all patients in the hospitals and that the cause of death was the patients’ delay in seeking help. A week later, however, the Ministry of Health admitted that there was a shortage of ventilators and oxygen concentrators in the country. However, the ministry did not provide specific data on what equipment and specialists were lacking in individual hospitals.
Many hospitals did not have enough oxygen concentrators. “During the pandemic, many people wanted to help health workers but didn’t know how, so they did everything: they bought personal protective equipment, prepared food, bought and distributed medicine, and often doubled up on each other,” says Nargiza Sydykova, former coordinator of a food network for health workers in one of the volunteer movements. “For example, one of the local news agencies wrote a story about how in Vorontsovka (a sanatorium near Bishkek that was converted into a hospital for COVID-19 patients – BBC) doctors were not being provided with food, but later this issue was resolved. When Vorontsovka was contacted, the head doctor reported that there was enough food for both medical staff and patients, and asked for help with personal protective equipment instead of food. However, the article continued to circulate on social media for a long time, and people continued to bring them food.”
“These problems could be solved with a unified database,” says Sydykova. Currently, the distribution of humanitarian aid is chaotic and depends largely on the chief physicians – some show initiative, while others are afraid of management criticism. “In some villages, representatives of the local authorities approached volunteers and asked them to give them equipment because they did not trust doctors. Sometimes the doctors we have been working with since the beginning of the pandemic refused to take the drugs because they had been warned by the [authorities],” the volunteer said. “I think this is only appropriate if the state fulfills its obligations and provides the hospitals with everything they need.” On July 24, an order signed by the regional leadership of the Mandatory Health Insurance Fund under the Government of the Kyrgyz Republic (FOMS) was published online, prohibiting hospitals in the Jalal-Abad region of southern Kyrgyzstan from receiving assistance from volunteers. Activist Aizhan Chynybaeva wrote that doctors from other regions had anonymously contacted her with similar complaints.
The order threatens medical personnel with “personal responsibility” for seeking help. The Ministry of Health later said that no such orders had been given by the government. In response to a request for an interview with the BBC, the department declined, citing official briefings on the coronavirus situation. On August 18, the FOMS reported that it had allocated 1 billion 105 million soms (about $14.5 million) for the purchase of medicines, personal protective equipment and disinfectants for hospitals throughout the country. Also, during one of the government briefings, Deputy Prime Minister Aida Ismailova said that the authorities have tools that “collectively reflect all the current needs in the healthcare sector”. She noted that two government-sponsored databases had been launched: one with information on the availability of hospital beds and the other on the needs of various medical institutions. For a long time, volunteers had to collect this information themselves. To find out what hospitals needed, volunteers from the “Help Issyk-Kul” movement called hospitals and posted the information they received on the Internet. According to Edil Ajibaev, some doctors were afraid to accept humanitarian aid because of pressure from management.
Following allegations against the doctors for reselling donated equipment, Ajaibaev and his team insist on signing an invoice when transferring humanitarian aid. Their team consists of about 20 people, including directors, auditors, and accountants. Adzhibaev admits that such a team can only work temporarily on a voluntary basis to help “put out the fire.
Jeenbekova is criticized for the country’s unpreparedness for the pandemic. On July 15, President Sooronbay Jeenbekov signed a decree posthumously awarding the Medal of Courage to the late volunteer Adinai Murzabekova. A week earlier, when the Ministry of Health admitted that the spread of Covid-19 in Kyrgyzstan was following the worst-case scenario, Jeenbekov addressed the people, urging them “not to blame anyone, but to unite efforts. Within an hour of the speech being posted on YouTube, approximately 2000 users disliked it. Later, the video was republished with the ability to comment and rate removed.
On July 21, Jeenbekov met with volunteers, thanking them for their contribution to the fight against the pandemic and assuring them that problems would be solved. Some volunteers openly refused to meet with the president. One of them, 25-year-old soccer player and founder of the youth movement “Soobsha”, Aydana Otorbaeva, accused the authorities of inaction and called the meeting pointless. After Adinai’s death, the Ministry of Health changed the work schedule for doctors, limiting medical teams in day hospitals to six hours per shift. The number of people has remained the same, notes Nazikbek Kydyrmyshov, a volunteer at a day hospital in the city of Karakol in northern Kyrgyzstan. “There were 12 of us in the hospital, and there still are, it’s just that now we’re divided into two teams and we work six hours instead of 8-12. So it could have been done from the beginning,” says Nazikbek. “Sanitary and epidemiological violations were widespread, doctors did not have time to ask for what was needed. They didn’t lift their heads from the sick patients, but shouldn’t the treating doctors take care of the logistics? That is the job of the Ministry of Health.”
According to him, there was no clean area in the hastily converted gymnasium where medical staff could change into personal protective equipment (PPE) – tents for this purpose were only provided at the request of the staff themselves. “We were the first stationary clinic to open in Karakol, and the flow of patients was endless. We worked 12 hours with only one lunch break, everything was done in a hurry, maybe someone just couldn’t keep up,” said Tamara Bakasova, a doctor at this clinic.
“Later we opened a second day clinic and it became much easier for us.
The “Tolkun” Day Care Center in the city of Karakol was opened on the basis of a sports hall. According to Kydyrmyshev, the needs of hospitals and physicians are constantly changing and vary from hospital to hospital, but every improvement has to be fought for. “In the regional hospital, there is still no place for doctors to be quarantined, which means that after working in the red zone for 14 days, they go home to isolate themselves. How is this possible, considering that in the same region a doctor and four members of her family died? – Kydyrmyshev expresses his indignation.
On July 14, a petition appeared on change.org calling for the president to be impeached. One of the authors, journalist Raushan Aitkulova, also filed a statement with the Prosecutor General’s Office demanding that Sooronbay Jeenbekov, the government, and the former prime minister (who resigned in July amid a corruption scandal) be held criminally responsible for “inaction during the coronavirus pandemic, which resulted in the deaths of hundreds of Kyrgyz citizens.” The number of offers should remain: The attorney general’s office said the statement is still under review.
Nazikbek Kydyrmyshev also supports impeaching the president, but he did not have time to sign the petition because the website change.org was blocked in Kyrgyzstan the day after it was posted.