VZCZCXRO1484
OO RUEHAG RUEHAST RUEHDA RUEHDBU RUEHDF RUEHFL RUEHIK RUEHKW RUEHLA
RUEHLN RUEHLZ RUEHNP RUEHPOD RUEHROV RUEHSK RUEHSR RUEHVK RUEHYG
DE RUEHTA #0270/01 0441009
ZNR UUUUU ZZH
O 131009Z FEB 09
FM AMEMBASSY ASTANA
TO RUEHC/SECSTATE WASHDC IMMEDIATE 4618
INFO RUCNCIS/CIS COLLECTIVE 1193
RUEHZL/EUROPEAN POLITICAL COLLECTIVE
RUEHNE/AMEMBASSY NEW DELHI 0527
RUEHIL/AMEMBASSY ISLAMABAD 2145
RUEHBUL/AMEMBASSY KABUL 0429
RUEHKT/AMEMBASSY KATHMANDU 0002
RUEHLM/AMEMBASSY COLOMBO 0037
RUEHKA/AMEMBASSY DHAKA 0045
RUEHBJ/AMEMBASSY BEIJING 0588
RUEHKO/AMEMBASSY TOKYO 1294
RUEHUL/AMEMBASSY SEOUL 0298
RUCNDT/USMISSION USUN NEW YORK 2157
RUEHNO/USMISSION USNATO 2485
RUCPDOC/DEPT OF COMMERCE WASHDC
RUEAIIA/CIA WASHDC
RHEFAAA/DIA WASHDC
RHEHNSC/NSC WASHDC 0767
RUEKJCS/SECDEF WASHDC 0683
RUEKJCS/JOINT STAFF WASHDC
RHMFIUU/CDR USCENTCOM MACDILL AFB FL
RUEHAST/USOFFICE ALMATY 1205
RUEHPH/CDC ATLANTA

UNCLAS SECTION 01 OF 03 ASTANA 000270 
 
SIPDIS 
 
STATE FOR SCA/CEN, EUR/ACE, F 
STATE PLEASE PASS TO USAID 
 
E.O. 12958: N/A 
TAGS: PGOV PREL EAID SOCI KZ
SUBJECT:  KAZAKHSTAN:  USAID PROFESSIONAL EXCHANGE PROGRAM PRODUCES 
REAL HEALTH DIVIDENDS 
 
ASTANA 00000270  001.2 OF 003 
 
 
¶1.  SUMMARY:  The 2006 HIV outbreak among children in southern 
Kazakhstan is a painful reminder to Kazakhstani families of the 
vulnerabilities in their health-care system.  However, as a result 
of the outbreak, a USAID exchange program conducted in September 
2007 contributed to the recent establishment of both a 
medical-equipment sterilization center and a blood-safety center in 
the Southern Kazakhstan region.  Both centers, and associated 
appropriate equipment and evidence-based protocols, will help to 
reduce the threat of such a tragedy re-occurring, and begin to 
rehabilitate the image of Kazakhstan's health-care system.  END 
SUMMARY. 
 
NOSOCOMIAL OUTBREAK OF HIV PROVOKES OUTRAGE 
 
¶2.  In February 2006, a sudden outbreak of HIV infections among 
small children and infants shocked and frightened the citizens of 
the Southern Kazakhstan region.  The Government of Kazakhstan 
initially blamed the outbreak on mother-to-child transmission, 
publicly stating that the children were all born of prostitutes. 
When testing of the mothers disproved this theory and the number of 
cases continued to rise, the focus turned to the hospitals in which 
the children were receiving treatment.  Further investigation soon 
revealed that some of the infections were caused by tainted blood 
during needless blood transfusions prescribed by doctors. 
 
¶3.  At the request of the Ministry of Health, the U.S. Centers for 
Disease Control and Prevention (CDC) participated in this 
epidemiological investigation and supported the findings that the 
infections could have been caused by the unsafe use of blood and 
blood products, and the lack of infection-control procedures during 
the delivery of medical care.  As the cause of the HIV outbreak 
became public, the initial shock and fear turned to anger, as well 
as a search for retribution and justice. 
 
¶4.  While the use of tainted blood was identified as a potential 
cause, the spread of the infection within the hospitals was further 
exacerbated by the re-use of medical equipment that was not properly 
sterilized.  The HIV outbreak resulted in the infection of more than 
140 children.  Many of the infected children have since died, while 
others are ostracized by their communities and, in some cases, by 
their own homes.  Twenty-one doctors and medical-care workers were 
tried and convicted for medical malpractice and negligence, with 
many sentenced to time in prison. 
 
¶5.  While the Government of Kazakhstan was initially quick to 
deflect blame for the HIV outbreak in response to the public outcry, 
it soon recognized the need to take action quickly.  Financial and 
human resources were mobilized to develop a response that included 
care for those infected during the outbreak, as well as steps to 
ensure the safety of the blood supply and the hygiene of medical 
facilities.  The Government of Kazakhstan also asked the 
international community for assistance in infectious disease 
control.  The U.S. Government listened and responded. 
 
THE BEST ASSISTANCE -- OUR EXPERIENCE 
 
¶6.  In support of the Government of Kazakhstan's efforts to respond 
to this HIV outbreak in particular, and infectious diseases control 
in general, USAID, in partnership with CDC, initiated and developed 
an extensive study tour of U.S. health institutions for a group of 
key medical and health professionals.  The study tour went forward 
in August 2007 through USAID's Community Connections program on 
"Infection Control and Blood Safety."  Ten participants were 
selected among health and medical specialists from Southern 
Kazakhstan, and from the Ministry of Health. 
 
ASTANA 00000270  002.2 OF 003 
 
 
 
¶7.  During their three weeks in the United States, program 
participants observed blood transfusion processes in medical 
settings and discussed various systems for promoting 
infection-control management with infection-control and blood-safety 
experts.  The Kazakhstani specialists visited the American Red 
Cross, New York City Blood Bank, the New York office of the CDC, the 
Public Health Service of the U.S. Department of Health and Human 
Services, the Massachusetts Department of Public Health HIV/AIDS 
Bureau, and local non-governmental organizations.  They observed and 
experienced how these and other organizations deal with HIV/AIDS, 
tuberculosis, and blood transfusions.  Program participants were 
also introduced to governmental and non-governmental organizations' 
policies and regulations that support and improve infection control 
systems. 
 
KAZAKHSTAN SPECIALISTS DRAW ON THEIR U.S. EXPERIENCE 
 
¶8.  Several of the Community Connections participants are now 
playing leading roles in Kazakhstan's response to the HIV outbreak 
in Southern Kazakhstan, and infectious disease control more 
generally.  Using the knowledge and insights gained from the study 
tour, Dr. Marat Daumenov and Dr. Galymzhan Abish worked towards 
establishing new medical centers in Southern Kazakhstan, one focused 
on blood safety and another on the sterilization of medical 
equipment.  By the end of 2008, both the new sterilization center 
and blood-safety center were opened, with Dr. Daumenov and Dr. Abish 
appointed to be their respective directors.  Dr. Daumenov stated 
that, "we borrowed much from American practices and applied our new 
knowledge in these centers." 
 
¶9.  The two centers together employ approximately 200 medical staff 
and cover all fourteen districts of the Southern Kazakhstan region. 
More than 30 medical facilities will utilize the centers for blood 
safety and sterilization of medical equipment.  Dr. Daumenov further 
stated, "Now blood donors can receive appropriate medical services 
without endangering their lives.  And we are regaining the trust and 
esteem of citizens."  The ceremonial opening of the centers was held 
in January, with Kazakhstani President Nazarbayev's participation. 
 
¶10.  Other USAID Community Connection program participants also play 
key roles in improving the capabilities of Kazakhstan to prevent the 
spread of infectious diseases.  Dr. Kavira Mukasheva developed a 
curriculum based on her experience in the USAID Community 
Connections program, and held workshops training medical workers in 
the region.  She was also instrumental in the enactment of new 
legislation and Ministry of Health decrees that were designed to 
improve and institutionalize infection control.  Another 
participant, Ainura Malibayeva, was appointed the Deputy Director of 
the blood safety center.  Malibayeva cited the Community Connections 
program and the knowledge she acquired during the study tour as a 
key factor that led to her new appointment. 
 
¶11.  The USAID Community Connections program continues to provide 
exchange experiences for a variety of professionals, including 
entrepreneurs, business and religious leaders, local government 
officials, non-governmental organization leaders, and health 
professionals.  Programs are facilitated by U.S. host organizations, 
cover a range of topics, and use a variety of methodologies to 
expose participants to the institutions and challenges of a 
democratic, free-market society.  Programs also inspire participants 
to implement change in their home countries, build public-private 
partnerships, and create linkages with the American host 
communities.  A follow-on exchange program on blood safety will be 
organized this year as a result of the clear success of the previous 
 
ASTANA 00000270  003.2 OF 003 
 
 
program.  The 2009 program will focus on two cities in northern 
Kazakhstan. 
 
¶12.  COMMENT:  The USAID Community Connections program is another 
example of the benefits of professional and educational exchanges. 
Such programs have long-term and exponential effects on the 
communities and institutions that participate.  Both the 
blood-safety and the medical equipment sterilization centers will 
provide long-lasting and significant contributions to the health of 
the populations they serve, and begin to rehabilitate the damaged 
reputation of the Kazakhstani health-care system.  Moreover, the 
U.S. Government and its people and institutions were accepted as 
reliable partners and technical advisors during a time of critical 
need for the country.  END COMMENT. 
 
HOAGLAND