VZCZCXRO7634
RR RUEHIK
DE RUEHAH #1551/01 3381140
ZNR UUUUU ZZH
R 041140Z DEC 09
FM AMEMBASSY ASHGABAT
TO RUEHC/SECSTATE WASHDC 3839
INFO RUCNCIS/CIS COLLECTIVE
RUCNMEM/EU MEMBER STATES COLLECTIVE
RUCNCLS/ALL SOUTH AND CENTRAL ASIA COLLECTIVE
RUEHAK/AMEMBASSY ANKARA 5947
RUEHBJ/AMEMBASSY BEIJING 3643
RUEHKO/AMEMBASSY TOKYO 3502
RUEHAST/AMCONSUL ALMATY 5560
RUEHIT/AMCONSUL ISTANBUL 4189
RHMCSUU/CDR USCENTCOM MACDILL AFB FL
RHEHNSC/NSC WASHDC
RUEAIIA/CIA WASHDC
RHEFDIA/DIA WASHDC
RUEKJCS/JOINT STAFF WASHDC
RUEKJCS/SECDEF WASHDC

UNCLAS SECTION 01 OF 02 ASHGABAT 001551 
 
SENSITIVE 
 
SIPDIS 
 
STATE FOR SCA/CEN, EUR/ACE, F, OES/IHB 
AID/W FOR EE/EA 
 
E.O. 12958: N/A 
TAGS: PGOV PREL EAID EINV TBIO SOCI TX
SUBJECT:  TURKMENISTAN: DOCTORS WITHOUT BORDERS ANNOUNCES 
PLANS TO CLOSE OPERATIONS 
 
REF: A) ASHGABAT 1400; B) 07 ASHGABAT 1285 
 
ASHGABAT 00001551  001.3 OF 002 
 
 
¶1.  (U) Sensitive but unclassified.  Not for public 
Internet. 
 
¶2.  (SBU) SUMMARY: On November 23, USAID received a 
letter dated November 19 from Head of Mission- 
Turkmenistan for Medicins sans Frontieres (MSF) 
announcing its intentions to end its operational presence 
in Turkmenistan.  MSF had been negotiating the terms of a 
proposed program to address multi-drug resistant 
tuberculosis (MDR-TB) for the last 17 months, but could 
not reach agreement with the Ministry of Healthcare and 
Medical Industry.  As one of the only non-governmental 
organizations working in Turkmenistan with independent 
funding, its departure represents a loss for the 
country's small humanitarian assistance community.  END 
SUMMARY 
 
PIONEER IN INTERNATIONAL TB TREATMENT APPROACHES 
 
¶3.  (SBU) Beginning in 1999, MSF in cooperation with the 
Ministry of Healthcare and Medical Industry (MOHMI) 
introduced the World Health Organization-recommended 
Directly Observed Treatment, Short-Course (DOTS) strategy 
of TB treatment in Turkmenistan.  The pilot program in 
Dashoguz was the first in the country to introduce 
internationally recognized standards for TB care.  MSF 
turned the pilot over the MOHMI in 2003.  Other 
international organizations -- including the U.S. 
Government through USAID -- provided continued support in 
additional pilot sites, which led to the MOHMI's national 
roll-out of DOTS in 2007.  (Refs A and B) 
 
¶4.  (SBU) Beginning in 2004, MSF supported the district 
hospital in Magdanly (Lebap province).  Activities 
concentrated on improvement of maternal and child health 
services in one hospital, with an accent on child 
delivery and care after birth.  This program closed 
September 2009.  (COMMENT: The MOHMI reportedly had 
concerns with MSF's approach in Magdanly because the 
implemented approaches contradicted national standards, 
which put the doctors in a difficult position. END 
COMMENT) 
 
NO PROGRESS WITH MINISTRY OF HEALTH ON MDR-TB 
 
¶5.  (SBU) The text of MSF's November 19 letter stated in 
part: 
 
QUOTE 
It had been MSF's intention to continue its cooperation 
with the Ministry of Health and to introduce treatment 
for multi-drug resistant Tuberculosis (MDR-TB).  MSF has 
been negotiating the terms of such a programme for the 
last 17 months but unfortunately no agreement could be 
reached.  MSF will continue to discuss further 
cooperation with the Government of Turkmenistan until 
15th December and if there was no positive result MSF 
regional representatives will resume discussions in the 
coming year.  Unfortunately as a consequence of the lack 
of progress in negotiations MSF will have to dismiss our 
local staff members as we cannot offer further employment 
unless a breakthrough in our discussions with the MOHMI 
can be achieved until November 30th.  This unfortunately 
appears to be unlikely. 
END QUOTE 
 
¶6.  (SBU) In a November 25 meeting with MSF's 
Humanitarian Affairs Advisor Mark Walsh, post learned 
that MSF was formally advised 2 weeks ago that the MOHMI 
was only willing to cooperate on technical support and 
 
ASHGABAT 00001551  002.3 OF 002 
 
 
training on laboratory supply, rather than on broader 
MDR-TB challenges.  He stressed that MSF still wants to 
be involved in treatment programs.  (COMMENT: Direct, 
hands-on involvement in treatment is not something the 
ministry is prepared to cede to international 
organizations at this time.  Instead, it prefers to work 
with international organizations to prepare its 
specialists to carry out work based on international 
standards themselves.  END COMMENT) In spite of the lack 
of ongoing operations, MSF plans to keeps its 
registration and will continue to seek opportunities to 
engage. 
 
¶7.  (SBU) COMMENT: The decision by MSF to close its 
operations in Turkmenistan is not surprising.  Both local 
staff and visiting delegations actively engaged with 
MOHMI over the past year ?- to no avail -- and routinely 
met with USAID and other international organizations 
during these visits to discuss possible areas of 
engagement.  USAID staff learned previously from local 
MSF staff that MSF had proposed to MOHMI to create an 
MDR-TB reference laboratory for diagnostics at the 
district level.  The MOHMI opposed this idea because it 
contradicted existing TB service structures, under which 
a district level laboratory should not exceed the 
capabilities of the national facility.  Furthermore, the 
number of patients needing MDR-TB diagnostics in any 
pilot district would be considerably less than at the 
national level.  Therefore, the creation of a site of 
excellence for diagnostics for such a small size 
population was considered inappropriate by local 
government. 
 
¶8.  (SBU) COMMENT CONTINUED: In the end, a rigid 
insistence on direct involvement in treatment, combined 
with a failure to accurately assess local attitudes and 
expectations contributed to MSF's failure to reach 
agreement with MOHMI.  That said, as one of the only non- 
governmental organizations working in Turkmenistan with 
independent funding, MSF's departure represents a loss 
for the already small international development 
community.  END COMMENT. 
 
ECKSTROM