Reaching Remote Kyrgyzstan – En Route to Mother and Child Survival
By Susanna Lehtimaki
Health and Nutrition Officer, UNICEF Kyrgyzstan
Kyzyl Jar is a small remote Kyrgyzstan village. It is located only 200 km from Osh, the second biggest city in the country, but due to treacherous road conditions, it can take over six hours by car from Osh to get there. During the winter, as much as three meters of snowfall can accumulate on the road, making the village inaccessible for several months.
The Bokonovs, a family with six children, have always lived in Kyzyl Jar. Winter time is difficult, since there are few employment opportunities and the family is dependent on social benefits that barely make ends meet. During the non-winter months, the father earns a little money by looking after their neighbours’ cattle. Workdays are long as he needs to cover dozens of kilometres per day of challenging alpine terrain to ensure the animals are fed. Still, the family is satisfied with life in the village: the eldest daughter is happily going to school and soon younger ones will follow in her footsteps.
Although the Bokonovs are not planning to leave their village, poverty and high unemployment in rural areas are driving many people, especially youth, to migrate to cities, both within Kyrgyzstan and abroad. Rural poverty has broad implications for Kyrgyzstan; aside from the negative impact it has on the well-being of families, it also contributes to general instability across the country. Frustration born from conditions of poverty contributed to the participation of many young people in the inter-ethnic violence in 2010 that affected an estimated 400,000 children in Southern Kyrgyzstan.
To improve social stability and living conditions of families in the region, UNICEF initiated a programme titled “Equity” in 2010. This initiative, supported by the British Government, aims to address the root causes of inequity and to reach children living in difficult life conditions. In Kyzyl Jar, UNICEF has supported the local hospital staff, part of a larger campaign reaching over 2,000 medical workers in the region. The health component aims to improve the quality of medical care provided to mothers and children through enhancing the clinical skills of doctors, midwives and nurses on perinatal care and neonatal resuscitation. High child mortality rates are being addressed by improving the case management skills of medical professionals dealing with cases of common childhood illnesses such as diarrhoea and pneumonia. For villages like Kyzyl Jar, the surrounding mountains and harsh winters limit the access to specialised emergency care, making the quality of accessible local services of the utmost importance.
In 2011, UNICEF also installed a generator for the local hospital to provide electricity throughout the year. Fridges were provided to ensure temperature regime for vaccine storage. Additionally, the instalment of new windows and doors has contributed to reducing hypothermia among newborns. According to hospital staff, temperature management has drastically improved and the wards now stay warm even when the temperature outside goes below minus 30 ºC.
Still, some urgent concerns around medical services remain. Foremost among them is emergency transportation: an ambulance stands in the yard of the hospital, but it is outdated and without any medical equipment. The road to the hospital is unpaved and littered with holes and stones hindering transportation significantly. The Bokonovs live nearby, so they have not had any problems with getting medical care on time. However, since the majority of the people in the region can’t afford a car or a horse, it is not uncommon that a pregnant woman is unable to secure timely transportation and is forced to give birth on the way to the hospital. To help address this issue, UNICEF has supported Village Health Committees (village based volunteer groups), who distribute essential information on health issues to their communities, and devise emergency transportation plans for each village in remote regions. These plans help to identify transportation, usually a local driver that can provide transport to local families for emergency care in the event that ambulance services are unavailable.
The Village Health Committees are also important facilitators in increasing the awareness of families on common health issues such as diarrhoea, pneumonia, complications during pregnancy, nutrition and anaemia which undermines health of every second child in the country. In 2009, UNICEF initiated Gulazyk, a national micronutrient powder programme in Kyrgyzstan. Gulazyk sprinkle sachets contain micronutrients that help to prevent anaemia and stunting in infants and children. These sachets are distributed to families with children under two years of age and Village Health Committees provide guidance to families on how to best use them. The youngest member of the Bokonovs regular eats porridge with Gulazyk. His mother is happy to see the positive results: her son is growing well and has been healthy since using Gulazyk. The additional micronutrients provided by the sachets are often critical for families like the Bokonovs, as the daily diet in rural areas consists mainly of rice, potatoes and bread – meat, fruits and vegetables are an expensive luxury.
Improving living conditions and ensuring that access to basic services, especially those contributing to mother and child survival – is a long-term strategy that UNICEF is committed to implementing in Kyrgyzstan, helping families like the Bokonovs live healthy and happy lives.