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WHO Goodwill Ambassador's Newsletter For The Elimination Of Leprosy

AMBASSADOR’S JOURNAL: Travels in Central Asia

Accompanied by Dr. Romana Drabik, the Goodwill Ambassador visits Uzbekistan and Tajikistan to learn more about leprosy in these two countries.

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In front of Muynak's dermatology outpatient clinic

UZBEKISTAN (July 3-6)

In June last year I met several leprologists from Central Asia at a conference in Russia. The event had been organized by Dr. Victor Duyko, director of the Institute of Leprosy Training and Research in Astrakhan, and by Dr. Romana Drabik, a German doctor who has made it her personal mission to assist anti-leprosy activities in countries of the former Soviet Union.

Keen to learn more, I arranged a follow-up visit to two of the countries represented at the conference: Uzbekistan, where the autonomous republic of Karakalpakstan has contributed the bulk of that country's leprosy cases over the years; and Tajikistan, where I had been told that patients from neighboring Afghanistan cross the border for treatment. Accompanying me on my travels was the indefatigable Dr. Drabik.

After a brief stay in the Uzbek capital, Tashkent, where I called on WHO country representative Dr. Asmus Hammerich and Minister of Health Alimov Anvar Valiyevich, I flew to Nukus, the capital of Karakalpakstan. Situated in the northwest of Uzbekistan, Karakalpakstan literally means "the country of black hats."

According to Uzbekistan's chief leprologist, Dr. Eshboyev Egamberdi Khusanovich, who traveled with me to Nukus, Uzbekistan has recorded 28 new cases of leprosy since 1991, the year it became an independent nation. Of these, 17 were from Karakalpakstan. Moreover, nearly 300 of the 328 people registered in Uzbekistan as having had leprosy are also from Karakalpakstan.

Over a welcome dinner hosted by Dr. Khamraev Atajan Karimovich, the Vice Chairman of the Council of Ministers of Karakalpakstan, I was fascinated to hear from Dr. Eshboyev that four or five Japanese soldiers taken prisoner during World War II and held in Uzbekistan had been diagnosed with leprosy. Their records remain in the health ministry archives, including such details as their shoe size. All eventually returned to Japan.

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Rusting boats that used to ply the Aral Sea

On July 5, I traveled 220 kilometers north of Nukus to Muynak. This used to be a town of 70,000 people on the southern shore of the Aral Sea, once one of the largest lakes in the world. But two rivers that fed the lake, the Amu Darya and the Syr Darya, were diverted in Soviet times to irrigate land for food crops and cotton. The result is one of the great ecological disasters of modern times. In three decades, the Aral Sea has shrunk to a fraction of its former area. Left behind is a desert landscape that throws up a dust of salt and chemical residues that is said to be the cause of a growing number of health problems among people living in the area.

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The head of the clinic with a cabinet of over 400 patient records from Muynak (far left); a huge boiler to warm residential accommodation at Krantau Leprosarium

I had come to see the site of the former leprosarium and visit a clinic where the town's 49 people affected by leprosy are treated for ulcers and other conditions. Like the Aral Sea, there is little trace of the leprosarium today, but the eight ladies I met at the clinic painted a picture of life in Muynak in the old days.

They reminisced about swimming in the sea as children, working in the town's cannery, which produced 20 million cans of seafood a year, and how lively Muynak was at night with all the vacationers it attracted. "It was so noisy you couldn't sleep sometimes," one lady told me. The leprosarium may be gone, but the clinic stores the yellowing medical records of over 400 leprosy patients dating back 80 years to when the leprosarium opened in 1933.

The only leprosarium remaining in Uzbekistan today is in Krantau, 40 kilometers south of Nukus. It moved to its current location in 1952. It was at its busiest in the 1950s, home to some 700 patients. Today are there are just 35 residents and over twice that many staff. The residents live in one-story cottages, divided between two households. Prominent in each cottage is a floor-to-ceiling boiler, indicative of the fact that temperatures in Krantau fall to minus 10C in winter.