Education And Debate

Tajikistan: no pay, no care

BMJ 1997; 315 doi: (Published 29 November 1997) Cite this as: BMJ 1997;315:1460
  1. Hans Veeken (, public health consultant
  1. a Médecins Sans Fronti`res, PO Box 10014, 1001 EA Amsterdam, Netherlands


    “If I tell you all the problems, you will get scared and run away.” The chief psychiatrist of the government can still joke, although the situation in Tajikistan gives no reason to do so. “But, if you insist: we lack specialists. They just ran away when we became independent in 1992 after the breakdown of the Soviet empire. Some of them studied in Russia; most were Russian anyway. Well, given the salaries in our country, a mere 2800 Tajik roubles a month [$3] for a psychiatrist, you cannot blame them. In psychiatry you cannot earn extra money—you will find little corruption; who can make a psychotic pay? Then, there is no transport in the country; we have no drugs. There is a lack of training and we have no contact with other countries. Since the civil war started, everything has gone downhill. Dr Gulmayov, the grand old man of Tajik psychiatry, was killed last year. Who can replace him?” The chief psychiatrist is aware of the problems, eager to get training, and realistic in his expectations. “Give us time,” he tells me.

    Electrosleep therapy

    It is best not to hurry in Tajikistan. Our planned trip the next day is cancelled because of security problems. At night we hear tanks rolling in the streets. The government is after Mahmout, a temporary dissident, an army colonel of 34 years, who attacked Dushanbe the day before my arrival. We reschedule and visit a day care centre for people with mental disorders.

    The place is old, and the doctor guides us carefully along the corridor, as if through a minefield: there are gaping holes hidden under the carpets. But it is spotlessly clean and friendly. A few patients are lying in bed. “I just gave them haloperidol,” he says and walks on. I notice that the …

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