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An 'Illegal' Outbreak of Plague

August 08, 2004|Wendy Orent | Wendy Orent is the author of "Plague: The Mysterious Past and Terrifying Future of the World's Most Dangerous Disease."

ATLANTA — The new nation of Turkmenistan, one of several Central Asian republics that rose from the Soviet Union's ashes, is ruled by a 64-year-old dictator named Saparmurad A. Niyazov, a strutting, miniature Saddam Hussein who calls himself Turkmenbashi (father of the Turkmens). A man of monstrous ego and modest intellect, he has outlawed beards on men and forbidden women to wear gold teeth, a sign of status.

The capital of Turkmenistan, Ashgabat, boasts an enormous golden revolving statue of the Turkmenbashi, oriented toward the sun so that its rays always shine on the statue's face. Niyazov is also building in the desert -- at a cost of $6.5 billion and using water diverted from a parched countryside -- what he calls "The Great Turkmen Lake." The world keeps quiet about Niyazov's eccentricities, aware that his vast wealth comes from control of one of the world's largest supplies of natural gas. All of this would be amusing, more or less, if we didn't think too hard about the effects of such policies. But over the last few months, the Turkmenbashi has taken the health of his nation's 5 million people into his own hands, with potentially devastating consequences.

In March, he dismissed 15,000 licensed healthcare workers "to save money" and replaced them with conscripts. In June, the Turkmenbashi fired Turkmen doctors and other health workers with foreign degrees, saying their training was "incompatible with the Turkmen education system." Most disturbing, he has declared all infectious diseases -- cholera, AIDS and other scourges -- illegal and has forbidden any mention of them.

Turkmenistan's Anti-Epidemic Emergency Commission has stated that "the epidemiological situation on the territory of Turkmenistan is safe. There are no cases of dangerous diseases." If only that were true.

According to both Gundogar, a Turkmen opposition group, and the Turkmenistan Helsinki Initiative, a deadly plague epidemic has broken out in the Turkmenbashi's territory. Yersinia pestis, the germ that causes plague, is widespread among rodents throughout Central Asia, and the strains they carry are among the oldest, most virulent and most dangerous in the world. In the barren deserts of Turkmenistan, the leading plague reservoir is a burrowing rat-sized animal with legs like a miniature kangaroo, Rhombomys opimus, the great gerbil. Recent years in Central Asia have been good for gerbils, producing bumper crops of the grains they eat. More grain means more gerbils, and more gerbils means more plague.

These outbreaks happen periodically, and with good public health systems in place they can be managed. The Soviets in their day responded quickly, though they kept news of the outbreaks from the outside world. In 1950, according to a recent account by Russian plague expert Lev Melnikov, a large plague outbreak in Turkmenistan killed several hundred people. That outbreak originated with a nomad hunter who bedded down overnight in gerbil territory and was bitten by infected fleas. He returned to his family's encampment; the disease spread rapidly to his lungs, and soon everyone in the settlement was infected. Some relatives fled to other nomad tents before they died, spreading the disease further. Only a heavy-footed response from the Soviet government, with medical teams, military quarantines and enormous pyres to burn the infected corpses of the nomads together with their tents brought the epidemic under control.

But the Soviets and their hundreds of trained plague experts no longer run the show, and the Turkmens are at the mercy of the Turkmenbashi's policies. At least 10 people are known to have died of plague this summer, and some reports place the figure considerably higher. The Turkmen government has responded, predictably, by declaring the word "plague" illegal. It has also instituted border controls "to prevent disease from entering Turkmenistan from neighboring states."

Still, reports continue to trickle out: of deaths in Merv in the southeast, in the capital city of Ashgabat, in the city of Turkmenbashi (formerly known as Krasnovodsk) on the shores of the Caspian Sea. Though some reports state that this outbreak of plague is bubonic, and thus spread only by infected fleas or by direct contact with a sick animal, others claim that the disease has become pneumonic, or lung-borne, the most feared and lethal form of the disease.

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