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The most important and valuable thing in human life is health. If you have health, you are a happy person, so I always pray to God to give me strong spirit, strong will, and, of course, health. I do not lag behind in anything, I help here, I help there, I sing and dance like this
Toktonazarova Tonya
Health Promotion Units (offices in public health institutions in Kyrgyzstan, which are funded by the Ministry of Healthcare and work closely with the Village Health Committees (VHC).

The purpose of the Health Promotion Units is to help village residents, mainly in disease prevention. Our direct task is to work with the Village Health Committees to conduct campaigns and seminars. The committees were established in 2002. Currently, there are 19 village health committees in Jumgal district. They consist of chairmen and several members who work on a voluntary basis.

There are Regional Health Promotion Units (OBLKUZ) and seminars are held for them in Bishkek. When Regional Health Promotion Units gathers us, we, Health Promotion Units from five districts of Naryn Oblast, meet together, communicate, and decide how to conduct seminars, at what time and where, and then we conduct them in the villages. The Regional Health Promotion Units gives us a plan that comes from the top, we choose from it what we need, make our annual and semi-annual plans and work on them.

We go to ayils according to a schedule. On the day of our arrival, village committees gather, like today, for example, at least 7-8 members, and we hold seminars on the given topics, distribute leaflets and books. Then they divide households and walk through the streets – each gets twenty households, and this year it is forty households for each. This means that she has to go around them and have conversations and distribute materials. Afterwards they give us reports – how many households were covered, how many participants were there. Once a month, we routinely hold seminars in ayils, in committees and government organizations – the House of Culture, social fund, post office, library and others. We also attract school organizers and social pedagogues.

We distribute brochures, good and very comprehensible leaflets in Kyrgyz language. If necessary, we can sit down and talk with the residents, they ask whatever they do not understand. It is interesting to work with ayil people, because they share experience, you learn from them. Their questions help.

I have been working in medicine for 45 years, and in the Health Promotion Unit since 2004.
Before that, I worked as a senior nurse in the therapy department and at the polyclinic. Then I was offered to come to the center, they explained that we will work with people in the villag-
es. I liked it and transferred here.

We like field visits, people greet us well, and sometimes we receive offers from residents
about what they want to know. It's interesting to work with people, you only see sick people
in the hospital, and it's better to work with people.
About 180 Health Promotion Units in Kyrgyzstan.

It is interesting to work with ayil people, because they share experience, you learn from them. Their questions help
Current health issues in villages
Village committees always carry out orientation work, round tables, discussions – how children should eat, what salt to use in food, measure blood pressure of the old people. Recently we gathered everyone – measured their height and weight.

They worked on anemia and on brucellosis for many years. At the moment, brucellosis has decreased and the results on anemia have been good, but it is impossible to reduce it completely, because women give birth in the village a lot. It is very difficult to reduce, so we are constantly working on it. This is the most sensitive question. Pregnant women are advised on how to behave, eat and rest. We distribute books, leaflets and suggest to eat fruits and vegetables. In ayils, you know, there is always the same «tamak» (food) and it leads to anemia.

Third year in a row we have been working with schools. We work with students of 9, 10, and 11th grades on HIV/AIDS. We hold separate classes for girls and boys. Also, in schools there was a good program «taza tishter» (clean teeth), sanitation and hygiene, from the 1st to 11th grades. We trained class teachers and organizers in the training sector.

We also conducted seminars on sanitation for adults, approached each household, told each family about hygiene, and even checked their toilets. Then we built proper toilets for some of them. In general, the district became better, everybody already has clean water, everybody tries to do something for their health.

We told them about the harm of smoking and nasvay and worked on the topic of alcoholism. Nowadays, they barely drink and it is the achievement of the VHC members, because we were on duty, we walked and explained. We were on duty even at funerals and it yielded results. We also talked about suicide.

When the village committees were established, residents asked for a bathhouse, the Swiss project helped. We have 16 bathhouses in the ayils around the district, hairdressing salons, sewing and carpentry factories were opened. We also helped families without husbands to plant potatoes and bought chickens for the families with a low income.

Mostly middle-aged women work in village committees, few men, they are not interested, two or three only. Young people are also not interested in this at the moment. In fact, I don't know what kind of atmosphere they live in. The committee consists of teachers, ayil okmotu workers, social workers, but mostly housewives.
What kind of difficulties do you have?
Sometimes there are few people gathering. If there are five to seven members, then we are allowed to hold the meeting. If there are three or four people, it is not enough. In winter it is difficult to go out, it is always snowing, the roads are not good. In January we do not meet much, because it is cold. In autumn, in October-November, it is also difficult, as the staff of village committees are in the fields. After the harvest we try to do our best. In summer we work constantly, except for our vacation time.

Ayil okmotu almost doesn't help, because the members change a lot – you go there, a person was just selected, you have to explain everything, then two or three months later this person is not there anymore – he was let go. And we have to wait for a new one and make an agreement again. It is difficult to work with them.

There are not enough doctors. Only 24 doctors in the district covering 40,000 people. It is very difficult for them, and there are enough average medical workers, nurses. We have two positions for doctors in the district, and there is only one surgeon left. He was born in our village Baisak, so, it seems, he does not leave only because of it. One doctor was offended, because he came here, but there were no conditions, our district did not help him, could not even give him an apartment. A small remote area, almost no conditions. It is very difficult for young people here, we cannot make them stay, we cannot provide them with an apartment, help them, create necessary conditions, that is why they probably do not come.
Elmira Kurmanaliyeva
I'm from Issyk-Kul. My husband and I met in the Orgochor village. After graduating from university, he came there for an internship, and I was sent from the Pedagogical Institute. That's how we met, and I became the daughter-in-law of the village, I was 23. Mom of five children.

There is a secondary school in the Tyugol-Sai village, 7 km away from here, I worked as a Russian language teacher there. Now I can't even talk, I forgot the language. Then I moved here and started to teach biology and chemistry. At the moment I am retired, but anyway, I continue to work as a geography teacher, because there is no one to replace me.

FOP (Feldsher Obstetric Post) and opening of the Village Health Committee public volunteer initiatives in villages of Kyrgyzstan that promote healthy lifestyle and work with the people on social issues).

When the Swiss project started to work, we set up a committee, and I became a member of it. We immediately began to investigate problems of the villagers – there was no kindergarten, no bathhouse, and there were problems with clean water. But if the majority needed a bathhouse in Jumgal district, the residents of Epkin needed a medical station. Medical care was provided in one private house. That's how we built the FOP. Then we prepared a project for ARIS to purchase equipment and we got everything we needed.

When there was no FOP, we went to the Chayek village just to get one pill. If you fell ill today, you had to wait until tomorrow. There were no cars, just a bus. Residents called it the «yellow bus». It went out in the morning and came in the evening – one route. Everyone was waiting. Then the FOP was built, and everything was fine. Even children with disabilities can be prescribed pills. For example, one of my children has epilepsy. Whatever the day, at any time of day they can give an injection. It became so easy, and before we suffered a lot.

Thanks to this, people began to believe us. Nowadays, none of the ayil okmotu meetings is held without us. Even if it is necessary to discuss problems concerning the livestock, they ask for help to gather people.
More than 1700 rural Health Committees in 84% of all villages in Kyrgyzstan.
If you fell ill today, you had to wait until tomorrow. There were no cars, just a bus. Residents called it the «yellow bus». It went out in the morning and came in the evening – one route. Everyone was waiting. Then the FOP was built, and everything was fine
The start of the Village Health Committee work
The biggest obstacle was created by our girls' husbands. «Where do you go? Why are you going? No one is paying you for your work!», – those were their complaints. They would drink, the villagers would come up to them and start mocking them: «Where does your wife spend time until the night? Just like that, without a diploma and education, she walks through the streets and distributes leaflets. Your wife has become an important person!». It was hard to hear such words, but over time, they began to understand our work, and everything was left behind.

At first there were 21 people in the committee, gradually some left, died, and today it consists of 13 members. It is almost entirely comprised of women, there are four new members. There are only two men. They drive a tractor. When there is a meeting, they often ask to leave, they say they need to work, earn money for the family. At first there were 6-7 men, some died, others moved to Bishkek, and since then we haven't accepted any new ones.
Working with residents
Our FOP is fully equipped. Residents receive timely vaccinations and injections. When we started working, we conducted a survey, and it turned out that there were villagers who had never been vaccinated. There were people, who came to the FOP, and they did not have a passport or their children had no birth certificates. We helped them to get the documents, so we have experience working with documents. We got used to it. If something happens, we are immediately contacted with a request and questions. We help and give advices.

In those years we started to work diligently. We raised the issue of sanitation and hygiene. We divided the village into micro-sites and divided them among ourselves. We took over the responsibilities for the streets where we lived, because we knew who lived there, who did what, how many children they had, their particular problems, and whether there was anything to eat. For example, we knew how many people lived in each house, what diseases were spreading and how to prevent them. We trained the villagers.

Then we started with water. Now almost 50% of the population have a toilet and clean water at home. There were no such cases before. This is one of our first efforts, somewhere in 2013, I do not remember exactly. We found out how people used water, as well as how they got milk –whether cows were milked with clean hands. We were asking if there was a washbasin, soap, where the drain went, if there was a pipe, and if it was clean at their homes. We trained the villagers. For the construction of a good toilet we presented a towel in front of everybody and officially congratulated them and presented them with gifts.

We fought alcoholism, went to their homes and found out how much they spent. There was a time when mothers couldn't afford to buy anything for their children. We asked them to take a notebook and write down their expenses. As a result, it turned out that women spent more money on alcohol than men, because mostly men worked and watched after the livestock, while women often went to visit friends, had a drink there – birthday celebration and so forth. They started to add it up and think where they could spend that kind of money, saying that they could buy a calf or a bicycle for a child for it. Some people calculated the sum and it turned out that they could buy a TV set for this amount.

Now we report to the district committee on non-communicable diseases, on the 15th day of each month. Here are the tables. We go to their homes and talk about healthy lifestyle, ask if anyone smokes at home or drinks, does anyone exercise and look after nutrition? If there is a person who smokes, he or she signs a table that he or she will quit within a month. Then children remind him of what they have promised and begin to insist on it. In December, the school celebrated New Year's Eve by inviting parents to the event and presenting them with gifts for their endurance. «Here, we asked them to quit smoking by February, and they gave up their bad habits in August. Today we want to congratulate you», – after such words we handed out one cake to each of them. Alcoholism has been defeated the same way.

This approach helps. When you praise the father in front of his children, it is very motivating. Seeing that someone's father has been praised, children begin to ask their father to do the same. Before we present a gift, we praise the person, we say what a good man he is and make him an example for everyone. So, we have managed to get a lot of people to quit smoking, and my husband is still smoking.

There is not a free minute. For example, now we are preparing a report on non-communicable diseases. Every month we have a schedule of work – sanitation and hygiene, we encourage people not to throw garbage and keep it clean. As for brucellosis, we demanded that every house should have a pit. We checked and said that it was necessary to bury dead animals in it. They can't be left outside because there are dogs and you can get infected from them.
Strength and motivation today
Everybody got used to it. We don't ask to be greeted appropriately anymore and they don't ask us why we came. When we come, we don't behave like Elmira or Masha the neighbor, but let them know that we are from the Health Committee. «What else are you going to teach?», – they ask, smiling. They are friendly.

«Why is that tramp coming? Doesn't she have anything to do at home? She goes to other people's homes!», – we have heard all kinds of words about ourselves. We even wanted to quit, but remembering what work we did, we calmed down. We used to go to Chayek to get medicine, but now we don't need to suffer, thanks to our efforts we have a FOP. People believe now, and it used to be that not only residents, but even ayil okmotu did not pay attention. Everything has changed, on the contrary, they ask to gather people and ask for advice.

Thank-you letters and awards are motivational. Thanks to the committee, our girls have become respected people in the village. For example, people chose me as a local council member. They wrote about us in the newspapers. They send a lot of letters of thanks. The most important thing is trust and gratitude of people. They come and say thank you for this and that. We educate them.
They say there aren't many residents
What do we need for our village? What are the needs of the residents? Some say that we need a gym and a playground, others ask us to build a kindergarten, and some people need a sewing machine in the sewing factory.

There was a nurse who worked, then left for Russia because of her small salary, but came back two weeks ago. For a month or even two we lived without a physician, went to the neighboring village for an I.V. and injections.

Today, we live in a world of advanced technology – we read and watch what is happening in other villages and try to do better. Wherever we go, whatever doors we knock on, we write project proposals, but we are denied, because they say that there aren't many residents here.
According to the villagers, about 500 people (70-80 households) live in the Epkin village of Jumgalsky district, Naryn region.
... mostly young people leave – there are no 25, 30, 35-year olds here. The average age is from 40 to 60. And what would one do here?
Suybeshe Turgunaliyeva
I work in the school as a deputy director of the educational affairs in the Epkin village and as
a local kenesh member of two convocations. I am from Chayek myself, but I married that guy
and have been living here for 30 years, have five children. My husband died seven years
ago. When my husband was here, of course, it was better.

Children have moved away and live in the city. I won't force them: "Live with an old woman.
Come here!". They are young too, let them live as they wish. However, I don't think 60 years
old is such an old age that one should take a cane and just sit. No. I do all the work – flowers,
trees, my house is clean, lambs, cows, sheep – I do everything myself.

Life is given once, we don't have two lives, so live, work, create, read. If you want to go somewhere, go. I think I did good that I saw a lot in my youth. Then I got married, and didn't go out anymore, where would you go with all of your children?
Life in the village
There are about 78-80 households in the village (Epkin, Dzhumgalsky district of Naryn oblast). There used to be a lot of residents, now children have grown up and left for Russia, for Bishkek, they send money to their parents. Some people come back, come to school as teachers, but mostly young people leave – there are no 25, 30, 35-year-olds here. The average age is from 40 to 60. And what would one do here? What would they do? Well, you can do your own household work, that's all.

The school is small – 106 students, 20 teachers. In summer, children run, play volleyball
and basketball. In winter we do not go out, and children do not go out, they just play chess,
checkers, toguz korgool. We need a gym at the very least. I have raised this question more
than once, when local kenesh members came to meet with the residents. Since then: "Okay,
okay", – they promise, and when the elections are over, they become kenesh members and
forget about us.

Even the meals are not organized at school. There should be a separate dining room, children should eat fully – buckwheat porridge, rice porridge, and we do not have the opportunity, because there is only one small room with buns, cupcakes, tea and milk, and that's all. There are just school and FOP (Feldsher Obstetric Post) in the village. Nevertheless, we live, and what can we do? And so, of course, the remarkable places around here are nature.
Kyrgyz and Kazakh folk tabletop, which literally means "nine peas of dung".
FOP (Feldsher Obstetric Post)
When I came to this village, there was nothing here – not this FOP, not this school. In 1990,
the school was built. In 2006, they came from the Swiss Embassy and built the FOP. Residents
helped, they brought ordinary bricks and built it. Since then, people have been coming here,
getting vaccinated. A nurse works here, she was given one office. What else can I say? The
most sore spot we have is that the FOP is not registered, there are no documents. That's why
we can't write a project proposal, update something or build something on – it's impossible
without the documents. It is like a child was born without a birth certificate, passport or anything. And what will be his fate? This is the fate of our FOP. Last year we whitewashed everything ourselves. I, as a kenesh member, bought this drain for 5 thousand, a sink, I just helped. Last year we built a toilet, and they do not give anything from ayil okmotu so far.

My graduates will come on May 24th, I was their supervising teacher, I want to make a deal
with them – you will not give me any gifts, I need nothing, neither a gold ring, nor a gold
chain. Please help us with the fence for the FOP. I don't know what they will say. This is my
offer. If it were in my power, I would do it myself. But, we also live as ordinary people, an
ordinary teacher, a salary of 13 thousand soms. I always help the chairwoman of the village
health committee. To the fullest extent that I can. We do not shine in any way, you see, everything it so grey, there are no conditions, but nevertheless, we continue to live, we do not lose
our spirit.
Village Health Committees
People are already accustomed to village committees. They are loved because they are
active and communicate closely with the people, and distribute pamphlets to their homes.
People read these pamphlets and pay attention to them. Seeds of carrots and beets were
distributed. Please plant them and then you will get the results – your children will have proper
nutrition. I learned, for example, that there is a lot of calcium in apples. I also didn't think that
an ordinary beetroot is good for a people. Ever since I found out, I've been adding them to
my home menu.

We try to develop further, but how will we develop if there are no documents? This stops us.
And so, she (Epkin village health committee chairwoman) and I have this personality – we
cannot stay at home. If things remain undone at home, I will finish them in the evening or after
lunch. But, most importantly, I come here – what should I do? What should I do to help? What
problems have arisen? And we solve them together.

Students of the 8th, 9th, 10th grades are involved, they are already adults – 15, 16 years old.
If there are no parents, let the children listen and participate instead. They also express their
opinions, help the committees, distribute pamphlets on the streets and door-to-door. Very
good helpers.
Female leader
I love my job, and as a child I dreamed of becoming a policewoman. Girls in shoulder straps
were just a dream, but not always, as it turns out, dreams come true. I became a teacher, Excellence in Public Education awardee. Entered the Michurinsk Pedagogical Institute in 1976- 1977. Then, due to family circumstances, I returned and graduated from the Kyrgyz Women's Pedagogical Institute and worked in schools.

Recently I was at the "Regional Development" Forum and before March 7th in Enesai, there
were women kenesh members. They said there that more women on duty were needed, in the
aiyl okmotu, so they could lead, and that more quotas in the Jogorku Kenesh (the Parliament)
and village Kenesh (local council) were needed. There is good development and good progress at places, where women work. Women are better as leaders than men, I think. She will solve the most problematic issues and our regions will be progressing.

A woman is more enduring, hard working. God probably created her good from all sides – gave her mind and stamina. We are giving birth, but can men give birth? They would die. We survive the pregnancy for nine months, then we do not sleep for nights and days, the child cries and the man sleeps. And we bring them up and still have time to work in public places. It is necessary to promote it.

I think a woman is a strong person. From Kyrgyz history, for example, Kurmanjan Datka. It
appears that if a person has a strong will and character, then we can overcome everything.

I just bow down before our women. Men should not be offended, thanks to us, they are always honored. Right, Diana? And what can we do? (laughs). The family plays a huge role in
the life of a woman leader. If her husband and children support her – mother, you need to
change, mother, have a rest, drink this, drink that – she will fly.

We are not as white in the village as you are. But there are girls in our school who have a
good manicure, wear mini-skirts. It's a pleasure to look at them. Let them enjoy life, dress up,
put on makeup. You know, Diana, I was young and beautiful as you, too, and on August 29th
I will turn 60.

This is the little biography of mine, my little secret, is what I told you. And it's just a tiny excerpt
from my life, and if you tell it, a person's biography is a story. You have a story, I have one...
And there is always this wind. And we are used to it. Well, how would we turn out white? If
always, from morning till evening, there is such a wind, my God. So, Diana, if there are any
more questions, I am ready to answer them.
For this conversation we are grateful to Elmira Kurmanaliyeva (Chairman of Epkin Village Health Committee), Gulyazim Isagulova (head of Jumgal district Health Promotion Unit), Tonya Toktonazarova (nurse of Jumgal district Health Promotion Unit), Suybeshe Turgunaliyeva (Deputy Director of the Educational Affairs of the A. Sadyrbaev Secondary School in Epkin village), as well as to all others, who helped to create this material.
Health
Access to quality and affordable health services is a basic human right. Health is a priority
of the Swiss cooperation in the Kyrgyz Republic. Over the years, joint efforts of develop-
ment partners, including SDC, and of the government of Kyrgyzstan contributed to significant
progress in reducing under-5 mortality from 65.8 deaths per 1,000 live births in 1990 to 21.1
in 2016, thus reaching MDG 4. Improvements in early detection and treatment of tuberculosis
have been dramatic over the past decade, and the prevalence of tuberculosis was halved
between 2000 and 2012. Thanks to Swiss-funded projects, the awareness of the population
concerning the main factors related to non-communicable diseases (such as diabetes and hy-
pertension) increased and health facilities perform better in terms of waste management and
reduction of hospital-acquired infections for instance. Swiss support to the reform of medical
education contributed to the improvement of the quality of newly trained family doctors and
nurses and to reduction in the shortage of family doctors in rural areas.
Yet, there are still significant challenges, notably in ensuring access to good quality services
countrywide. With a view to further improve quality of services, reduce inequities in health
outcomes and financial protection, and strengthen public health, the government of Kyrgyz-
stan adopted a new healthcare sector strategy until 2030. The Swiss cooperation will contin-
ue to support the Kyrgyzstani authorities in implementing the healthcare sector reforms, with
a focus on improving the primary healthcare system.

Projects implemented in the health sector in Kyrgyzstan:
  • Budget Support to the Health Sector in Kyrgyzstan;
  • Medical Education Reforms in Kyrgyzstan;
  • Health Facilities Autonomy in Kyrgyzstan;
  • Non-communicable diseases: a scourge in Kyrgyzstan.
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