Doctors describe instructions to Conceal Information.
Against the backdrop of Turkmenistan’s denial of coronavirus in the country, the WHO decided to visit the country this week in order to assess the current situation.
Turkmenistan is one of the most closed and repressive nations in the world.
For this reason, there is reason to believe that, in spite of the WHO’s authority, leaders in Turkmenistan are allowing the organization access to only those clinics that are guaranteed to house patients whose illnesses are in no way connected to the coronavirus or pneumonia.
We were able to speak with doctors at clinics and hospitals in all regions of Turkmenistan. They describe how the government is forcing them to conceal their observations of the progress of the disease in the country, and the conditions they are compelled to work under. Because of the government’s record of cruel repression, we cannot name the doctors with whom we spoke, or the regions or districts in which they work.
Hiding the coronavirus/pneumonia from the WHO
According to conversations with doctors and medical personnel in Turkmenistan, doctors in the country are currently forbidden from listing “pneumonia” as a primary diagnosis. The doctors described the specific instructions they received to conceal any instances of coronavirus and respiratory infections in the country. Sources say that the first step will be to organize visits from the WHO to infected hospitals. All patients who are suspected of having acute respiratory infections or pneumonia will be moved to different clinics. Since any medical analysis requires patient consent, those wishing to be tested for the virus using the WHO’s tests will not be able to. Nonetheless, “for reassurance” the organization will be shown pre-tested patients, in whom the virus will not be detected.
Clinic workers believe that the WHO will be shown patients without the slightest symptoms of acute respiratory infection, who have already had a lung X-ray and a CT. As a result of natural disaster – a severe hurricane in the Lebap region – a quarantine camp there was demolished. The WHO will be shown Turkmenistan’s complete preparedness to fight the virus epidemic in the country.
Security Services intervention to distract attention from pneumonia
Doctors discussed how a pneumonia diagnosis must be secondary. Doctors at clinics in the capital said that they could neither confirm nor deny a coronavirus diagnosis – that there are no tests, and that laboratories capable of such analysis and research are not being provided.
As the doctors at clinics in Turkmenistan report, for patients admitted to hospitals with complaints of a dry cough and high temperature, especially those over 65, the primary diagnoses are predetermined: hypertension, angina or ischemic heart disease. For younger patients admitted with acute respiratory symptoms, the diagnosis is seasonal allergies, bronchitis, or asthma.
“Upon admission, doctors are given clear instructions not to write down anything about the patient’s temperature or cold or flu-like symptoms. When getting their medical history, we try to hospitalize patients on the basis of complaints of headache, heightened temperature, and chest pain or allergies. They are monitored by workers from the national safety committee to ascertain our suspicions about what these people are actually sick with. I wouldn’t stand for this and said ‘If you’re so smart, come yourselves and show me this diagnosis that you think is necessary, but you don’t need to stand in front of me and inspect me. Yes, he has pneumonia and he should receive medicine appropriate to his diagnosis.’ A Committee for National Security staffer started to scream and threatened me, saying: ‘Treat whatever you want however you want, but pneumonia should not show up in the medical record.’ Then I had a conversation with the chief medical officer, where he clearly said that this is the decree: do not write pneumonia” – says a doctor at a regional clinic with 15 years’ experience.
Apart from this it must be noted that Committee for National Security has agents in every clinic in Turkmenistan. They monitor doctors and medical personnel: for example, they can be present at patient examinations, participate in five-minute [consultations], interfere with patient treatment, dictating to the doctor which specific procedures they must conduct (including surgery), and which medications should be administered. The completion of patient medical histories, particularly now, also takes place under their supervision.
No treatment plans or case management, just intimidation
“Today, doctors have no clear plan for managing these patients. Instead, we are just bullied to coming up with a clear plan to manage patients. And for what? Why is there such inadequate management? It’s essential to devote special attention to preemptive anti-inflammatory treatment to prevent a severe case of the disease, and to anticoagulant treatment, which is necessary to prevent the development of dangerous complications from coronavirus, such as thrombosis and thromboembolism. We need a description of how to treat incoming patients in high-risk groups, such as patients with diabetes, arterial hypertension, and heart failure. Instead of expanding and adding to the instrumental and laboratory diagnostics of coronavirus, they just intimidate and threaten us.
There is also the unspoken order from the Ministry of Health that says that patients over 65 years old generally should not be hospitalized.” Says a doctor at a clinic in the capital, with 25 years of experience.
Emergency medics say: “We won’t come to patients older than 65, and of course we won’t hospitalize them. If necessary, a local doctor will come to them, and he’ll do whatever is needed.”
Personal protective equipment? Buy it yourself or shut up!
Because there are no protective suits [gowns] in the country, and the only protection for doctors consists of gloves, the risk of infection among medical personnel is very high. Masks, gloves, and extra sets of gowns must be purchased at the expense of medical workers themselves. Not all clinics have showers, therefore after work all medical personnel go home, without even being able to shower after having been in contact with patients. Doctors in regional hospitals complain that because there is no water they can’t even wash their hands, let alone take a shower. Upon bringing their complaints to the chief medical officer, they receive this answer: “If you don’t want to work, leave; no one’s keeping you here.”
After working with patients, doctors and junior staff go home and interact with friends and neighbors, and so the circle of potentially infected citizens is widening. Some doctors reported that they had mild symptoms of acute respiratory infection. In spite of this they continued to go to work and interact with patients. They treated themselves [administered medicine to themselves.]
Lack of tests, lack of reliable information
“I don’t know whether I had the coronavirus or whether it was a normal seasonal flu. There are no tests for COVID-19, analyses for the presence of antibodies aren’t provided in advance. Our laboratories aren’t prepared to conduct such analyses, and don’t have the [chemical reactants?] necessary to conduct a study.” Says a doctor at a clinic in the capital, with 20 years’ experience.
“Within the Ministry of Health, regional health services, and sanitary-epidemiological stations, meetings are held continuously where they are calling for a fight against infection. At every stage, all throughout Turkmenistan, people are dying. Taking into account the fact of internal migration, and of course that the majority of people live in rented apartments and as a rule they are not registered anywhere[?], the reported death toll is seriously distorted for the internal use of Ministry of Health workers. Of course, a portion of the people and children dead from acute respiratory syndrome or maybe coronavirus were simply not recorded as deceased at their place of residence. No one is sure how many people have died in reality.”
Notably, even if other types of infections are suspected, treatment requires a lot of resources.. Antiviral medications, antibiotics and such are very expensive. Quality medications, which are supplied from Russia, Hungary, the Czech Republic and Slovakia, are available to very few. Medications from India and locally produced medications are not high-quality, therefore they don’t provide the needed effectiveness in treating infections. Patients complain that in buying cheap medication, they’re still spending money, but without seeing any results. “Not long ago I bought antibiotics produced in India. There was no relief at all. I got sick and I’m still sick. I bought more analgesic tablets, produced by a company in Ajanta. I had the impression that all I’d done was eat honey.” Says Jeren (whose name has been changed to protect their identity.)
Because of the border closure, the prices of medication have gone up significantly, and health insurance in Turkmenistan does not provide free medical services.
Preventative examination of school children
Since the middle of April 2020 preventative medical examinations have been conducted in all schools in the capital of Ashgabat. School children were examined by an ophthalmologist, an audiologist, a neuropathologist, a cardiologist, a surgeon, an orthopedist, a tuberculosis specialist, and a gynecologist. In every school, medical specialists worked over the course of 10 days, with no weekends, from morning until night. A source reported that the examinations showed that out of 3000 students, 250 children were completely healthy. Detected among the other 2750 were visual impairments, cardiovascular diseases, and problems hearing. Signs of acute respiratory infection were also detected. Lung x-rays, ultrasounds, and even laboratory analyses, including tests for coronavirus, were not conducted. Officially the children who were examined in every school in the capital were considered healthy.
Lack of autopsy reports
Reports have come in about increased cases of death among elderly people. Theoretically they could have died of coronavirus, but autopsies – taking into account the lack of laboratory analysis, histological studies and the absence of forensic examinations – can establish no concrete facts about the possibility of deaths from the coronavirus.
As a rule, autopsies in the country are conducted only in cases of violent death. Histological studies of tissues samples are not conducted.
The central pathological and histological laboratory is located only in Ashgabat, there aren’t any in remote areas and regional centers. There are forensic medical laboratories in each region, but they consist of morgues, where the doctor works in conjunction with their main profession[?]. In these facilities there is no equipment of any kind that could conform to the international standard, and examinations are conducted visually.