Knowledge on two wheels – Volunteers on the Aral Steppes fight Tuberculosis
20 Oct 2015
Karakalpakstan, Uzbekistan – In my school books the Aral Sea was still the world's fourth largest lake, providing stocks of fish to the then Soviet Union. Now what remains of the salt lake is only a memory, since ninety per cent of the lake that belongs partly to Kazakhstan and partly to Uzbekistan, has since evaporated into the air.
The area of Karakalpakstan that bears the greatest brunt of drought lies downstream on the Amudarya River. One-third of the population lives below the poverty line, making it the poorest area in Uzbekistan. On the barren Aral steppes, many communities are struggling to survive because the lake’s evaporation has slowly withered away the two most important industries - agriculture and fisheries. For one and a half years I followed one of the world’s largest ecological catastrophes up close, and learned to respect the value of clean water.
The consequences of the water’s disappearance have been unpredictable and dangerous. Hundreds of thousands of hectares of dried and fruitless lake bed have become the source of raging sandstorms. Climatic conditions change radically during the year, with summer temperatures soaring to 50 degrees Celsius, and the winter freezing dropping down to -30 degrees Celsius. Pesticides used on cotton fields are blown in the wind, and carried into airways. Respiratory diseases in the area have increased significantly, particularly that of tuberculosis’ worst, drug-resistant incarnation.
A joint project of five UN organizations has been established to address the disaster, and I worked with the initiative as the Volunteer Coordinator. Together with the local office of the Ministry of Health, the World Health Organization (WHO) and the United Nations Development Programme (UNDP), we trained local volunteers to be good health ambassadors. We taught them about tuberculosis infections, their symptoms, and the medication that can help. The volunteers encouraged patients to undergo long antibiotic treatments, which can last for more than a year and cause painful side effects. Often the treatment can interrupt the patient’s employment, impacting a whole family’s economy.
Tuberculosis trainings have been conducted in remote areas of Karakalpakstan for the general public, as well as in the educational institutions of the City of Nukus for professional students. Often I start the training by telling the story of my granddad, who died of tuberculosis 70 years ago in Finland. Finland was at that time emerging from its own disaster, the war, and there was no medication available to treat the disease. My grandmother told me a lot of stories about her late husband, and about the painful disease that caused great sadness and fear among people.
In the Aral area, the fear of certain death continues to be associated with tuberculosis, which hampers efforts to treat the condition. When I share that in Finland over the years we have been able to tackle tuberculosis, it gives people hope and motivation to act. Modern medicine means that the disease is usually treatable, if treatment is sought in time and if the cycle of medication is completed.
We campaigned in the driest and most remote areas of the Aral region, as messengers of positive spirit, hope and knowledge. Information flow can be slowed down by long distances, as small rural villages lie often hundreds of kilometers apart, and roads are often in poor condition. During the past year, almost two thousand people joined the campaign and signed up to be volunteers. Most of them were women, and this brought very positive results as women are key players when deciding family matters. The campaign has now reached more than 30,000 households, and almost a quarter of a million people.
Volunteer work is priceless, but the campaign wanted to thank and further encourage the most active volunteers and nurses operating in remote areas by giving them 110 bicycles. Pink bikes were given to the volunteers who in spite of the long distances faced in rural areas, have still managed to go from house to house to talk about the possibility of protecting against tuberculosis, while healing those who already face the disease. Preventing a disease is always better than curing it, and so volunteers have made a great effort to tell the healthy population about the bacterium, how it is spread, and how tuberculosis can be prevented.
A bicycle is small compensation for the work that volunteers have done to prevent tuberculosis, but its symbolic value is all the greater. The volunteers are recognized for their humanitarian work in front of their own communities, and thereby encourage others to do similar work.
The other side of the project has supported the livelihoods of the vulnerable parts of the population, by creating new, alternative livelihoods to replace withered ones. The project also safeguarded essential needs, such as water and heating supplies in the most vulnerable areas, that have been most impacted by the disaster. The project has helped establish small sewing shops and bakeries, among other businesses, while importing bee colonies for honey production and restoring water and heating systems in schools. The ‘Sustaining Livelihoods Affected by the Aral Sea Disaster’ Aral Sea Project has been ongoing since 2012, and has received further funding that will last until the end of 2015.
The volunteers that made up the ‘Community Health Volunteers of Karakalpakstan’ were awarded on September 25th at the UN Headquarters in New York, receiving the "Peoples' Voices Award" for their efforts and persistence towards attaining the UN Millennium Development Goals.
This text was originally written in Finnish for audiences in Finland
Author Heli Nykänen worked for two years as the Volunteer Coordinator in the project that prevents the spread of tuberculosis in Uzbekistan’s Karakalpakstan region. The UN joint project ‘Sustaining Livelihoods Affected by the Aral Sea Disaster’ is operated by five UN agencies, including UNDP, UNESCO, WHO, UNFPA and UNV. Since October 2015, Heli has served as the UNV Programme Coordinator in the UN Country Office in Tashkent, and visits the Aral region from time to time.