The World Health Organization declared a global pandemic four months ago. But despite the lead-up time and experience of other countries, Kyrgyzstan has not proven ready for a rise in infection numbers. There are not enough beds in hospitals, there’s a clear lack of doctors and nurses, ambulances cannot cope with the colossal number of callouts, and there’s a backlog of people to be buried in cemeteries. What’s more, Kyrgyz citizens are having to deal with this on their own. While the government says it has the situation under control, the president is busy preparing for the upcoming parliamentary elections, and MPs have left for their “well deserved” holidays.
“I have the feeling I’m lying in a military hospital after a battle. I can hear a man’s heavy breathing from the ward on my left. Every minute, his moaning gets stronger and louder, he is suffering terribly,” this is how a patient in a Bishkek hospital describes the situation on the coronavirus ward.
“For the tenth time, the senior doctor calls somebody to ask for ventilators. But there aren’t any. The ICU refuses to accept any more patients, there’s no beds. Then, 20 minutes of silence, before a woman runs out into the corridor and shouts: ‘Help, this man has died!’ Everyone runs over, dropping things, calling the emergency staff. They massage his heart, ask for adrenalin. His pulse comes back, and they take him off, at last, to the ICU. Later we hear over the radio that they have five ventilators and seven patients, they’re trying to do something. Somebody’s shouting that they’re about to die.”
These are the words of a young woman who shared a post on Twitter. Her story quickly went viral, once again confirming that Kyrgyzstan’s healthcare system is on the verge of collapse.
At the hospital steps
The epidemiological situation in Kyrgyzstan deteriorated sharply in June. Since then, the number of people infected per day has risen to several hundred. When coronavirus was first identified in the country, 25 cases were being registered per day. Now that figure is over 300 new cases per day. But these are only the official figures, which only cover people who have been tested.
In reality, it’s practically impossible to take a test, whether you pay for it or not. Kyrgyzstan has still not introduced mass testing, and there are five laboratories that can provide tests.
It’s also unclear why official statistics do not include pneumonia cases, which, as many experts claim, is a result of coronavirus infection. Between March and 10 July, according to Kyrgyzstan’s Ministry of Health, 350 people have died from pneumonia in the country. That is more than double the number of people who have died in the same period from coronavirus.
The problems don’t end with hospitalisation. There’s a lack of beds, ventilators and oxygen concentrators in intensive care units, as well as medical personnel, whose ranks are thinning
The epicentre of the infection has emerged in the capital Bishkek, Osh and Chuy region in the north. Bishkek has had the worst of it so far. In a matter of days, the city’s hospitals ran out of beds even in the corridors. Serious patients still cannot get hospitalised. Two residents of Bishkek died from pneumonia while waiting at the doors of the national hospital. They did not receive treatment in time.
Day clinics in sports centres and other municipal buildings have tried to take some of the strain. You can receive drips, injections and a medical consultation there. But given the fact that the hospitals are full, people with serious cases have started coming to the day clinics. Seven people died in them in the first week after opening.
But the problems don’t end with hospitalisation. There’s a lack of beds, ventilators and oxygen concentrators in intensive care units, as well as medical personnel, whose ranks are thinning. According to the ministry of health, every sixth person infected with coronavirus is a medic. On the whole, medical staff make up 15% of the overall number of cases in the country.
The first three cases in Kyrgyzstan were announced on 18 March. The infection had been discovered in the south of the country, where a group of people had returned from a pilgrimage to Saudia Arabia. It was stated that one of them had broken quarantine and organised a party with 150 people. As a result, Osh, the biggest city in the south of the country, became a hotspot for the virus.
The authorities decided to follow Kazakhstan’s lead and announced an emergency situation in Bishkek, Osh and Jalal-Abad, and across the country. Citizens were not supposed to leave their homes unnecessarily or travel around or outside their towns. School children and students shifted to distance learning via local TV stations. Public transport and taxis were curtailed, as was most forms of business. People who broke the curfew, which lasted between 8pm and 7am, were arrested and fined. So far, 4,846 people have been detained for breaking the curfew, and 1,275 of them have been fined between 3,000-13,000 soms ($38-$167).
As they closed the cities, though, the Kyrgyz authorities did not provide an alternative for people to feed their families. No one, it seems, considered vulnerable people, who had to try and save themselves from starving after not receiving their wages. There was little point expecting help from the state, and so some people took the initiative, buying and delivering food to those in need, as well as PPE to medics and the police. This is how residents of Kyrgyzstan “survived” a whole month.
On 10 May, the government ended the emergency situation, introducing a quarantine to replace it. By that time, there were 1,002 confirmed cases in the country, and these cases were found mostly among people who had recently arrived in the country and those who had been in contact with them. In comparison with the rest of the world, the virus was spreading slowly in Kyrgyzstan, and the death rate was extremely low.
It seems this situation convinced the health ministry that the peak of the pandemic was over. Hoping for a positive result, the authorities started reducing the quarantine measures, and at the start of June Kyrgyz citizens had returned to their usual way of life. At that time, there were more than 2,000 confirmed cases.
But it was not possible to avoid a deterioration in the situation. As expected, the removal of quarantine measures led to a sharp rise in the infection and death rates by mid-June, and the virus was present in every region of the country. After this, WHO included Kyrgyzstan in the list of countries where the infection rates were rapidly rising.
Almost as soon as the virus entered the country, Kyrgyzstan’s Ministry of Finance opened a special account for the health ministry, and announced that it was collecting funds, calling on “every citizen who is not indifferent and sincerely wants to make a contribution”. According to the ministry, people have so far donated $1.8m, of which $1.65m has already been used.
These funds were assigned for paying compensation to medics who had mobilised as part of the pandemic response. Medical staff were supposed to receive additional payments to their bank accounts, and at the start this is what happened. But the first payments held the full names of the recipients, and this was deemed a potential breach of Kyrgyzstan’s law on personal data. Now it is currently not possible to identify the recipients of the funds, and whether the payments are reaching medical staff.
Kyrgyzstan also asked international donors - IMF, Asian Development Bank, World Bank and the European Union - for funds up to $627.3m. Half of these funds have already been transferred, but the complexity here is that $461.5m, or 74% of these funds are loans. This means that citizens will ultimately have to pay off these funds via taxes, just like the rest of the country’s external debt. The Kyrgyz government, it seems, has decided to spend the funds largely on filling the state budget, rather than supporting healthcare. Most of these funds have gone on paying wages, social welfare payments as well as transfers to the medical insurance fund.
Kyrgyzstan is also expecting to receive $30.4m from the German development bank KfW for supporting the country’s farmers; $50m from the Asia Bank for Infrastructure Investment on developing the private sector, and $15m for purchasing medicine from the Islamic Development Bank.
Many people are having to treat themselves, prescribing their own medicine without knowing their diagnosis in full. The health ministry has called on people not to self-medicate, but many have no other option - there’s nowhere to ask for help from. The Bishkek mayor’s office set up a phone line for receiving consultations, but it cannot deal with the amount of calls - just like the ambulance service, which is receiving up to 5,000 calls per day.
Aliya (name changed), a dispatcher at one of the ambulance stations in Bishkek, told me that previously they’d mostly dealt with cases of hypertension, but that now most of the calls come from people with coronavirus or pneumonia.
“The situation is very difficult. Today we’re still working through yesterday’s callouts, and there’s a lot of them, but the hospitals are overfull. There’s nowhere to take people. We bring people in to be hospitalised, but we’re told that there’s no beds. And then we have to take the poor people back,” Aliya says. “Then the ambulance teams have to wait for hospital beds to free up. Sometimes there’s beds after dinner, sometimes late at night. So we wait. As soon as a bed is free, we go back to the patients in trouble and take them to the hospital.”
Doctors in the emergency services are also in short supply, with many of them infected with the virus and had to take sick leave. Of the 447 medics who work in emergency services, 101 of them are currently on sick leave. Volunteers have taken their place.
Meanwhile, social media is full of calls for help - some people search for oxygen concentration machines, others ask for life-saving drugs, which can’t be found in pharmacies. Others share their grief. Kyrgyz citizens have never conveyed their sympathies so regularly.
Despite the lack of support from the state, society has come together. Businessmen have given over hotels for treating patients, artists have bought ventilators for hospitals and volunteers have cooperated to help doctors on the frontlines. One of these volunteers, Aigul, told me she decided to help despite the risk.
“I don’t have any medical training, but I couldn’t stand to one side and watch the tragedy happen. Me and some other volunteers got together online and came to the clinic,” she tells me. “We were shocked at what we saw - a lack of basic means of hygiene, patients choking. They were all scared because there was no one to help them. We’ve already started seeing problems and as far as possible started delivering hot drinks, food, medicine that we could get, cleaning up the day clinics and observation wards, in direct contact with patients. Although we’re burning out emotionally and physically, we believe that we can get positive results by working together.”
Others have started holding online consultations for people with COVID-19. Bektur, a young doctor, works in a field hospital during the day, and in the evening helps dozens of people treat themselves over the phone.
“Around 600 people wrote to me on the first day, I had to consult people until morning,” he says. “Now there’s fewer messages. But everyone who writes is understanding waits for an answer for 12 or even 24 hours. People are panicking, and they have lots of questions. This is why I decided to help and at least somehow reduce the load on our ambulance service.”
Elections vs. healthcare
Against a backdrop of unprepared hospitals, lack of medical equipment, infected doctors and unclear usage of donated funds, Kyrgyz citizens have developed concerns about the way the authorities have dealt with coronavirus. The pandemic has exposed problems that have been accumulating in the healthcare system for years.
Prior to parliament going on holiday, Kyrgyz MPs beat all their previous records and passed 63 laws during the last vote of the session. The most controversial was new disinformation legislation, which reproduces up to 96% of similar Russian legislation. Seventy nine MPs voted for the law, with 10 voting against. Online, people have expressed concerns that the new legislation could limit freedom of speech and amount to the introduction of censorship ahead of elections later this year.
Meanwhile, president Sooronbai Jeenbekov has announced that parliamentary elections will be held on 4 October. While the healthcare system is facing a distinct lack of funds and personnel, the central election commission announced that it would spend 21 million soms (approx. $280,000) on transporting banners and election materials.
Despite the fact that the situation continues to deteriorate, the authorities are yet to introduce further strictions due to the “difficult economic situation”. In April, however, the president stated that the most important thing was to preserve the lives and health of people - a message he repeated on 9 July. Requesting that public officials work harder to protect people’s health, president Jeenbekov nevertheless did not introduce a situation of emergency.
Meanwhile, journalists at the Kloop website have forecast that if the number of new cases continues to rise by 5% every day, then the country will have 23,000 cases in the next month - and more than 100,000 in two months. This level of infection could turn out to be a catastrophe for Kyrgyzstan.