Special Report

Volume 23, Number 2: February 2022
What the Almaty mobile palliative care team saw on the road in front of them when trying to do home visits on January 5. Photo used with permission.

Five Days of Mayhem in Kazakhstan

By Gulnara Kunirova
President, Kazakhstan Palliative Care Association

Mobile team members on a home visit. Photo used with permission.

On January 5, the first day back at work after the New Year holiday, the Almaty mobile team drove off to provide in-home palliative care to cancer patients, as usual. The doctor and nurse on board knew that the city was restless. Reports on social media suggested that protests, triggered by a rise in fuel prices, had spread to Almaty, which is Kazakhstan’s biggest city, and elsewhere, including Atyrau, Aktobe, Uralsk, Taraz, Shymkent, Kyzylorda, Karaganda, and even the capital, Nur-Sultan. Since the government had entered into a dialogue with demonstrators and a number of their demands had been met, few expected the protests to escalate.

No visits could be made that day

The city was bustling with people going about their everyday business. Our mobile team unexpectedly came up against a group of demonstrators walking in one of the main streets, blocking traffic. The car had to turn around to find a different route, but traffic jams throughout the city meant that not a single visit could be made that day.

While driving back toward the city center, the car became surrounded by an even bigger group of protesters who looked agitated and carried stones, sticks, and rebar. Young men stopped the car and, without asking permission, opened the doors and thoroughly searched the car, looking for guns or other arms. Fortunately, they released the mobile team unharmed, and strongly advised them to leave the area quickly.

For the next five days, ongoing protests stopped the team from visiting patients.

Information was scarce, the Internet was blocked

Officials said that terrorists had taken over the peaceful protests. The Internet was blocked and media provided very limited information on what was going on in Almaty or other regions. For several days, the city was at the mercy of looters and other criminals. Residents learned about riots by hearing gunfire, from phone calls with friends and acquaintances, and scarce reports on local television. City dwellers at the epicenter could see acts of violence from their own windows.

The authorities declared a state of emergency and a nationwide curfew.

How to provide services during a crisis?

Forcibly isolated, the team members continued to provide assistance via telephone consultations, including psychological support to patients and their families. This support was extremely important for people who not only needed professional help, but were also frightened by what was happening in their city.

Ready for action: the Almaty palliative care mobile team. Photo used with permission.

Another challenge was the fact that both cell phones and landlines worked intermittently; it was difficult to find out what colleagues from other regions were experiencing. We learned that hospices and inpatient palliative care units continued to provide patient care. Where taking to city streets was associated with a risk to life, hospitalization of new patients was not possible. In quieter regions, hospices and hospitals operated as usual, albeit taking precautions.

Effects and aftereffects

Lack of access to the electronic hospital referral network forced staff members of local outpatient polyclinics to switch to registering and referring patients on paper. Several medical facilities, including some district polyclinics, were temporarily closed. The supply chain of essential medicines for treatment of pain and other symptoms was disrupted.

For five troubling days, while the government liberated buildings and areas seized by attackers block by block, any movement around the city was dangerous. Numerous videos filmed by ordinary townspeople and journalists showed ambulances overturned and burnt. In Almaty, at least five emergency medical workers were injured as a result of illegal actions by protesters and two ambulances were destroyed.

Mobile palliative care teams were only able to resume their work on Monday, January 10. We thank all palliative care workers in Kazakhstan who used every opportunity during this major crisis to provide patients and their families with help and moral support.

To learn more about Kazakhstan Palliative Care Association, visit the IAHPC Global Directory of Palliative Care Institutions and Organizations.

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