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At the entrance to Kulyab, 80 km from the Afghan border, the threatening glance of Lenin, represented on a gigantic mosaic, welcomes you. The fall of the USSR in 1991 followed by five years of civil war, thousands of deaths, 500.000 refugees and 300.000 men emigrating to Russia, have made Tajikistan the poorest country of the ex-USSR (GDP per capita 150US$).

It is 3 PM, the weather is still fine in this city, which was the centre of the civil war. Here, during the summer, the temperature reaches 50°C. Rare are the men who have not left for Russia in search of a job; those few stroll in the streets doing nothing. Women and children gather around some water pumps bordering the pavements. Houses have no running water and during the winter, when the precious liquid does not pass through the frozen pipes, it’s necessary to walk several hours to the nearest river.

In this country, populated by 7 million inhabitants, isolated from its neighbours (Turkish speaking) by linguistic and ethnic diversity (Tajiks are the only Central Asian people of Persian origin) the nouveaux riches are rare and the money does not circulate at all. Since the fall of the USSR everything has to be paid for, from the meals and drugs in the hospitals, the certificates of birth (10% of the children are not registered), to the trip to send a child to Russia, the last hope for many families to make a living. It is easy to hear elderly people and young students freshly graduated regretting the Soviet past which guaranteed employment, basic services and stability.

Once again women and children are paying the full price. One child in twelve does not reach the age of five. This is due to the lack of drugs, the water pollution, and malnutrition. 60%of Tajiks do not boil the water which reaches villages and towns transporting pesticides and other harmful substances from the countryside. Social services do not exist, families have not relearned the basics of child welfare. Here, people die of anaemia and vitamin A deficiencies because children are not breastfed. Tuberculosis, diphtheria and other diseases “once” prevented by means of vaccinations now too expensive contribute to the high mortality rate.

The Tajik paradox becomes obvious when one penetrates the maternity area of the hospital of Kulyab. Malika Fazova, head of department welcomes me with a smile. She is 50 years old and has all the competence and will required for her job. Her team is composed of 22 doctors, 52 male nurses and 40 midwives, all motivated and professionally prepared; but they are overstaffed. Malika confirms that the system is too centralised. Once, the State paid many of these expenses, but no longer, and they must struggle to continue their work. Drugs are missing (the patient’s families must buy them), the roofs are battered, as well as the ground, the hospital has no running water nor heating (patients must bring their own wood for heat in the winter), not to mention the electricity, available but two hours per day. Sheets are hand washed (the old washing machine has been broken for a long time) and hung to dry on metal wires covered with rust. The beds used for childbirth are themselves decayed and rusted.

Thus, it is not surprising to learn that 70% of the women choose to give birth in their own home, often without any medical assistance (to supplement their meagre wages, the doctors ask payment for services that should be free). Yesterday, in the maternity ward of the hospital, three children were born under good conditions, but in the infection area a pregnant woman suffers from typhoid fever and the doctors must face three cases of gestose with the only resource at their disposal – their professional competence. In the pathology area a mother in her 33rd week has broken her water. The doctors try to prolong her pregnancy, but it will be necessary to bring monitoring equipment from another institute, the only such apparatus in the country which still functions

A young doctor insists in saying that in spite of the difficult conditions they do their best and the results follow. Would this be an assertion due to pride or to the fear of a probable and imminent cut in the medical staff? But reality is tough: of 114 births in the last month, 6 of them appear to face tragic consequences. The major problem is an inability to breastfeed. Mothers are not able to nourish and take care of their babies on their own. Looking at the tiny limbs of Sainora is enough to get convinced. Sainora is a 7 months old baby who seems to have only a few days left to live. Two large ears for a tiny little mouse face. Wide open eyes, much too quiet for her age. Sainora weighted 4.5 kg at her birth, today she weights only 2.35 kg. Her 22 year old mother hasn’t been able to nurse her and Sainora is severely malnourished. In the therapeutic feeding centre run by Action Against Hunger, the similar cases of Madina and Annisse show that the problem is widespread.

While leaving the hospital the car moves towards a peripheral district of Kulyab which seems to have been bombed the day before. The houses precariously border the bed of a dry river eroded by innumerable torrential rains and floods. The pavement is a heap of overlapped and disordered stones. In the hollow of the riverbed, children play among the debris, girls wash the dishes and clothes in dirty ponds. Women collect the water from the holes in the old water pipelines built by the Soviets. Two families with similar stories open their doors to me. In the first one, Sainora, a young mother of a 4 month child, divorced, abandoned by her husband after the birth of their child, lives in her family home with her parents and 5 unemployed brothers. Rajamo, her daughter, is lying on a bed strewn with thousands of flowers. She’s been suffering from diarrhoea for one month and continues to lose weight. The drugs prescribed by the doctor are expensive and useless. To save Rajamo it would be enough to simply breastfeed her. On the other side of the street lives Mijgona, quite as young, she has two children. Her husband left for Russia, but the money he sends to her is not enough, and both her children suffer from malnutrition. 80% of the Tajik population is unemployed.

At the doors of Kulyab another story testifies to the incredible Tajik paradox. Bordering the only railroad in the country, a huge building dating from the Soviet time shelters a psychiatric hospital. The patients are approximately 150, men and women. The atmosphere feels languid, the patients spend their days outside, in the large court, working in the fields, cherishing the animals. Only the most dangerous cases are isolated inside a dark room where they spend days and nights, sitting on the ground, one next to the other, their glance lost to the darkness. The head of the department ensures me that they receive medication but when I ask for the pathology of certain patients, he is unable to answer me. No diagnosis are made here, the government does not pay for that. They review for me the life of one patient. She is the “easiest” case to diagnosis; when she was a child she was raped and beaten repetitively by her father and rejected by her mother. This was the only institute where she could go.

On the way back home one more stage of this trip towards “absurdity” makes me stop. On a small country road, behind greyish metal gates, an empty sanatorium, abandoned like many other public structures after the fall of the USSR. The money from Moscow stopped flowing and the building has slowly degraded. Three families have settled inside those old and dirty walls, having no other choice. Rajamo, 41 years old, always smiling, though the sad look in her eyes betrays her real state of mind. Rajamo has three children, she’s been living here for 10 years. Every day she walks to the nearest village to collect the water from a private water-pump. Her house is deprived of everything. Her older child is handicapped and manages to walk thanks to two wooden sticks made by her father. Rajamo and her husband work in the cotton fields, the principal activity of the inhabitants of the Kulyab district. The cotton monoculture was imposed by the Russians and remains today the primary economic resource of Tajikistan. But the price of cotton continues to fall and, in spite of a hard work and the participation of the children in the harvest, Rajamo’s family survives by chance.

Leaving this place it is impossible not to think about Alexander the Great who met his wife, the beautiful Roxanne, daughter of a King, here in Kulyab. The descendants of Roxanne look at my car departing, their eternal smiles on the lips and in their eyes the weight of this unbearable present.

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