As the Aral Sea retreats, dust and disease flourish; Catastrophe: In Uzbekistan, scientists try to determine whether the decimation up of a sea has touched off a tuberculosis epidemic.

THE BALTIMORE SUN

MUYNAK, Uzbekistan -- A trim work boat festooned with cheerful bunting stands next to the town hall, and a brightly painted mural depicts a thriving seaport, with strapping fishermen, a busy cannery and bright, blue water.

It's a ghostly sight. There's no water here. One of the world's great environmental catastrophes descended on Muynak 30 years ago, when the Aral Sea began drying up. Today, Muynak is a dusty wasteland. The sea is about 70 miles away from its original shoreline.

The fresh air that once brought tourists flocking to the beaches and sanitariums is now laden with germs. A plague of tuberculosis, which thrives among the poverty-stricken, has descended on Muynak and nearby towns in remote, Western Uzbekistan, sickening more people every day.

Carefree vacationers have been replaced by a handful of doctors and scientists who are trying to stem the epidemic and answer a vexing question: Has the destruction of the environment by leaders of the former Soviet Union somehow nurtured a disease that was once widely considered under control?

The available facts are terrifying. Doctors estimate the new cases of tuberculosis in Muynak amounted to 200 per 100,000 people last year, which means it's as dangerous to live in this part of Central Asia as to be locked up in a Russian prison, notorious for poor diet, miserable conditions and soaring tuberculosis rates.

"The people of Muynak are suffering silently," says Dr. Tunde Madaras, a tuberculosis specialist at the U.N. World Health Organization in Copenhagen, Denmark. "This small corner of the world has been forgotten."

Human arrogance, greed

And all this pain, she says, is the result of human arrogance and greed.

Muynak (pronounced Moon-ahk) is in a region of Uzbekistan named Karakalpakstan, populated by about 400,000 Karakalpak (it means Black Hat People) along with about 400,000 Uzbeks and 300,000 Kazakhs. The town used to be full of fruit trees and greenery, until Soviet planners began to divert water from the Aral's tributaries to irrigate the fields that produced cotton, Uzbekistan's main crop, which was sent to Moscow as tribute.

The irrigation, begun in the late 1950s, gradually shrank the Aral Sea. As it shrank, the slightly brackish water turned saltier. All but two of the sea's 20 species of fish disappeared. Crops declined. People in the region became poorer and poorer, their diets worse and worse. About 40 percent suffer from malnutrition. A quarter of the children have stunted growth. Nearly all women of child-bearing age are anemic. Tuberculosis thrives.

"The main reason is the ecological disaster," Madaras says. "The Aral Sea is a man-made disaster. This was a beautiful green area turned into desert by man."

Though scientists the world over are concerned about the Aral, undoing man's folly is difficult. Re-diverting the Aral's tributaries would dry up Uzbekistan's cotton crop, killing off what's left of the main source of revenue.

Delicate politics

And the politics are delicate. The main tributary, the Amu Darya, begins in Tajikistan and flows along the border with Afghanistan -- two countries torn by civil war. Those countries, along with Kazakhstan and Turkmenistan, would have to agree on any plan. An international commission has been trying to find ways to restore the sea, but so far has accomplished nothing. All the while, the former seabed continues to poison luckless towns like Muynak.

Uzbekistan always used large amounts of pesticides -- an estimated 50 pounds per acre compared with the 7 pounds considered average elsewhere. Eventually, the chemicals ran off into the sea, polluting it. And when the water receded, the toxins stayed behind on the exposed seabed, blown with salt through the dusty air.

Scientists have never demonstrated a link between chemical pollution and the human immune system, says Dr. Joost van der Meer, research coordinator here for Doctors Without Borders. His mission is to find out if there is one.

When the Aral Sea left town, it was as if the richest employer had skipped out in the middle of the night, leaving only bad debts behind. The main source of income in the region disappeared, along with the fruit trees.

The poverty brought poor health even as the former system of medical care was falling apart, and tuberculosis has spread quickly across the former Soviet Union. Uzbekistan has a TB incidence rate of 54.8 per 100,000 -- which WHO considers an epidemic level -- and Muynak's is nearly four times that. Russia's is 82.3. (The U.S. rate is about 8 per 100,000, the Baltimore rate 14 per 100,000.)

"It's been a paradise for infectious diseases," says Damir R. Babanazarov, Karakalpakstan's minister of health. "We can say that to a certain extent changes in the environment have created the background for tuberculosis."

Poor medical care

The collapse of the health system brought on by the demise of the Soviet Union probably aggravated the situation because of the disruption of treatment and social upheaval, van der Meer says.

Treatment was often interrupted because of lack of drugs, leading to the emergence of deadly, drug-resistant TB strains. People stopped seeking treatment because they thought nothing would be done. Even worse, in the case of tuberculosis, they began buying drugs and treating themselves. Drugs are widely available without a prescription across the former Soviet Union. Sick people buy the antibiotics that treat tuberculosis and in a month or so feel dramatically better.

Then they stop taking the medicine. The bacteria, not yet destroyed, regroup and turn into a drug-resistant form that is hugely expensive to treat. If a normal case can be cured with $100 worth of drugs over a year, the resistant form requires $1,000 worth of treatment.

For the last year, Doctors Without Borders, an international health organization, has been running a pilot treatment program in Muynak and another town in Karakalpakstan. The treatment, recommended by WHO as the most effective and economical, is called Direct Observed Treatment Short Course, or DOTS.

Instead of using the expensive X-rays widely employed across Uzbekistan, patients are diagnosed by examining a smear of sputum through a microscope. The sick are hospitalized for seven to eight months, instead of a year, and during the following four months, the patients visit a clinic where nurses watch them take their medicine.

Health officials in Karakalpakstan and in the Uzbek capital of Tashkent are enthusiastic about the results and want to expand DOTS, but they live in a poor country with many demands, and they have not yet gotten the money to retrain doctors and nurses across the nation. Most of Uzbekistan still uses the old method. And no one knows how fast resistant tuberculosis is emerging.

What they do know is that nearly 13,000 cases were reported across Uzbekistan in 1997 and that each infected person can infect 10 to 12 others in a year.

Muynak's 40-bed TB hospital once stood at the edge of the sea. Now it's a small compound of a half-dozen low adobe buildings sitting forlornly on a gritty lot.

"Twelve people died of tuberculosis last year," says Dr. Berdibek Reimov, the hospital's director. They died, he says, of an entirely curable disease.

"And now more and more young people and more and more women are catching it," he says. In Karakalpakstan, 70 percent of tuberculosis patients are 15 to 39 years old. Perhaps 20 percent of those infected are drug resistant.

Today, in Muynak, Rustem Dyusenov, the deputy mayor, looks out a window and describes what he used to see.

"The sand was golden," he says. "Everyone said it was the most beautiful sand anywhere. The water was dark blue, and clear. We always had fish soup for dinner. Visitors were surprised by the freshness of the air, and they took as much as they could."

He looks out the window again, over the outhouses behind the town hall, to a dull, brown, desert-like landscape. "Terrible," he says. "Terrible."

The Muynak cannery was built in 1939, and by the 1960s it was producing 20 million cans of fish a year, says Daulbai Kgyrniyazov, the director. A year ago, production was down to 2 million cans.

He descends two flights of stairs from his office to the factory floor, where a thick mist is rising and workers slosh around on a wet floor. There are no more fish from the Aral Sea, so the most recent catch has been trucked in from lakes near Tashkent, 1,500 miles away.

Women are gutting and cutting the fish by hand, putting the chunks on a creaky conveyor belt pulled along by outsized and rusty gears and chains. Other women take a handful of fish and put it into a small can. They weigh it, by hand.

Kgyrniyazov shows off two new brightly colored labels he has redesigned in an effort to make his product more appealing, his factory profitable.

"Do you know anyone who would like to invest?" he asks eagerly.

Hope, they like to say here, dies last.

So the people of Muynak go on as if the Aral Sea were still there. If they gave up the cannery, they would have nothing at all. On their wedding day, young couples go to what was once the edge of the water, and are photographed next to the World War II monument there.

"As the sea retreated, we tried to follow it," says Dr. Amanbai Mambetkadirov, Muynak's chief doctor, standing in what was once the seabed, gesturing toward some small buildings put up in the wake of the absent Aral. Along what was once the shore stands an unused oil terminal. By the time it was finished, the sea had gone.

Cattle wander behind him. Camels graze in the sandy crater. Long-abandoned boats lurch this way and that as they rot in the sand.

"We used to swim here," he says. "Everyone had a boat. It was just like Finland."

Those who came here when times were good have left, Mambetkadirov says dismissively, but those who were born here have stayed. They'll die here.

"We cannot influence what happens," he says. "Only people with money can do that. We must stay and wait. Maybe the sea will rise again."

Pub Date: 2/14/99

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