The Turkmen president's decision to close down all hospitals in the republic
and concentrate treatment in the capital Ashgabat has caused dismay at home
and abroad.

"Why should we waste good medical specialists on the villages when they
should be working in the capital?" asked President Saparmurat Niazov, who
styles himself Turkmenbashi or "Leader of the Turkmen", as he announced the
reforms on February 28.

"Why do we need hospitals and doctors all over the country? Let citizens
come to the capital and be treated there. Needy people can visit state
clinics for advice and the better-off can go to private hospitals. Nobody
will be without medical help!"

The move is the third in a series of blows for the medical sector. Two years
ago, some 12,000 medical personnel were laid off, and 15,000 more were made
redundant last year and replaced with conscript soldiers. It is estimated
that thousands more will lose their jobs through these new cuts.

The news has been greeted with anger in Turkmenistan, not least because it
came only a week after the president flew a group of senior German surgeons
to Ashgabat so that he could undergo an eye operation.

As the majority of the population live in abject poverty, analysts fear that
many will go without vital medical attention, no matter what Turkmenbashi
says.

Only polyclinics, offering a range of basic health services, will remain in
the regional centres, with non-emergency patients being sent to the capital
for treatment - but at their own expense.

And with many towns in this vast but sparsely populated country located
hundreds of kilometres away from the capital, just getting to hospital will
be no easy matter. The travel costs from remote rural regions will be too
high for many.

However, most observers fear the real cost will be counted in lives, not
money. As travel to the capital can take many hours, anyone seeking urgent
medical help could die without prompt treatment.

Taxi driver Merdan, whose elderly parents live in village of Gumdag some 390
kilometres from Ashgabat, told IWPR he was deeply concerned by the news.

"My father is a heart patient, and he goes to the district hospital twice a
year for a check-up and treatment," he said. "But after these new rules are
introduced, he will have to go to Ashgabat - and with his small pension it
will be very hard for him to do this even once a year."

Turkmenbashi insists the latest reforms will not put lives at risk and
points to the existence of an air ambulance service as an important failsafe
in emergency situations. However, medical analysts say that only one
helicopter has been available for the whole country since 2001.

"I live in the eastern village of Gaz-Achak, and to get to Asghabat today I
had a two-hour drive to Kerka, where I caught a plane that flies on that
route only twice a week," said entrepreneur Gulshira.

"So if I have a serious attack of appendicitis, or, God forbid, a heart
attack, I can only reach a surgeon in the capital in ten hours - and only on
certain days."

Ashgabat residents are worried that the new rules will lead to an influx of
desperately poor people from the regions.

Natalya Davydovna, who lives near one children's hospital in the capital,
said, "People often knock on our door asking for money or to be allowed to
stay the night. They are parents whose children are in hospital, and they do
not have the money to stay in the capital. The numbers are certain to
increase."

One hospital orderly told IWPR that this situation was commonplace. "Entire
families from out of town sleep under the windows of the hospital while
their children are being treated inside," he said. "In the cold or in the
heat, they lay out blankets and sleep on the ground, adults and children
alike."

"The hospital administration used to try to do something about this, but now
they no longer drive these people away."

The situation is often little better inside the hospitals.

Many who have attended Ashgabat's expensive medical centres are disappointed
with the quality of service and lack of specialists and modern equipment
available.

Frequently, the young specialists who work at the centres graduated from the
state medical institute after the republic gained its independence in 1991,
and many do not understand the Latin terms use in international medicine.

Qualified personnel of the old school have either been laid off, or have
resigned voluntarily.

Former paediatrician Svetlana Ivanovna told IWPR that she had left her
clinic in 2002 because she did not want to follow "the enlightened health
policies of president-for-life Turkmenbashi" and treat people with
improvised remedies and folk medicine, such as wood ash instead of
antiseptic to sterilise wounds.

"It's strange that the president made the decision to close the hospitals a
week after he had an eye operation conducted under general anaesthetic by
German doctors who were flown in specially," she noted.

"But the Turkmen people are silent about all these terrible new rules, and
only express their dissatisfaction in their own kitchens, as it is dangerous
and improper to criticise the president out loud."