Every day in the breathing room of one of the largest hospitals in Kyrgyzstan, Aidai Temiraly Kyzy, a 24-year-old nurse, plays music and takes her patients to Kara Jorgo, the national dance of the Central Asian country.
This involves a series of body movements and leaves everyone smiling, but Kyzy doesn’t do it for fun. The session is part of a treatment program offered to people with severe chronic obstructive pulmonary disease (COPD), a common, preventable and treatable lung disease.
“Almost all patients, before doing so, complain of difficulty breathing, coughing and say they lack physical fitness,” he says. “But even on the second or third day, the improvement is noticeable. Physically, they can do more.
Kara Jorgo on stage. COPD patients dance a version in a hospital in Kyrgyzstan.
“I’ve seen patients with very low moods transform and, in the end, smile and are very grateful,” Kyzy says.
COPD develops from middle age; Symptoms include shortness of breath, chronic cough, often with phlegm, and fatigue. It is usually caused by smoking, but also by air pollution. There is no cure, and if left untreated, it can lead to premature death. If detected early, it can be treated and managed.
It is one of the top three causes of death worldwide and 90% of deaths occur in low- and middle-income countries. Globally, there are 3 million deaths a year from COPD, but that number is expected to rise to 5.4 million by 2060, according to the latest report from the Global Initiative for Chronic Obstructive Pulmonary Disease .
The National Center for Cardiology and Internal Medicine in Bishkek, Kyrgyzstan
“In Kyrgyzstan, COPD is a very serious problem,” said Professor Talant Sooronbaev, director of the National Center for Cardiology and Internal Medicine in Bishkek, the capital. Although official figures put the prevalence at between 30,000 and 40,000 cases, he cites research suggesting that up to 200,000 people, out of a population of about 6.5 million, have the disease.
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A common condition
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The human number of noncommunicable diseases (NCDs) is huge and increasing. These diseases end the lives of approximately 41 million of the 56 million people who die each year, and three-quarters of them are in the developing world.
MNTs are just that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental, and behavioral factors. The main types are cancers, chronic respiratory diseases, diabetes and cardiovascular diseases: heart attacks and strokes. Approximately 80% can be prevented, and all are on the rise, spreading inexorably around the world as the aging population and lifestyles driven by economic growth and urbanization make it unhealthy to be a global phenomenon.
NCDs, once considered the disease of the rich, now have control over the poor. Illness, disability, and death are perfectly designed to create and expand inequality, and being poor makes you less likely to be accurately diagnosed or treated.
The investment to deal with these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is surprisingly high.
In low-income countries, NCDs (usually slow and debilitating diseases) are seeing them invest or donate a fraction of the money they need. Care continues to focus on traditional disease threats, but cancer mortality rates have long outpaced the number of deaths from malaria, tuberculosis and HIV / AIDS combined.
A Common Condition is a new Guardian series that reports on NCDs in the developing world; its prevalence, solutions, causes and consequences, telling stories of people living with these diseases.
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Prof Talant Sooronbaev
“We have patients who do not understand because they have a cough or breathing problems. They do not visit the health services and remain undiagnosed, ”he says.
The number of patients is expected to increase. Sooronbaev says the country has more than 500,000 smokers and there is widespread indoor pollution caused by people in mountainous and remote regions who heat their homes with firewood, manure or coal during long, harsh winters.
Sooronbaev decided to act. COPD treatment in many countries involves prescribing oxygen, inhalers, and antibiotics, which patients must purchase. In Kyrgyzstan this can cost more than a monthly salary. Sooronbaev and his team began experimenting with lung rehabilitation, an exercise program designed in 2016 for people with lung conditions, as part of an EU-funded research project called Fresh Air.
I didn’t think it would work. I thought only inhalers or injections could help. But Tokhorbek Makeshov, a patient, had a massive impact
Over the years, the program has evolved and incorporated patient feedback. It is now being adopted by the Kyrgyz Ministry of Health and is already underway at three hospitals and two GP consultations. It lasts for six weeks, with a couple of sessions two hours a week. In addition to the conferences, dietary information and patient support groups, there is an exercise regimen that incorporates elements of volleyball, which is very popular in Kyrgyzstan, walking, cycling and dancing. The idea is that patients can continue with what is then taught at home.
Dr. Azamat Akylbekov, a Bishkek pulmonologist, has seen the transforming effect. “I remember a woman who was 63,” he says. “She cried because she had a severe shortness of breath, she was coughing all the time, she was addicted to oxygen and she was taking a lot of strong antibiotics and inhalers. She was really depressed.”
She was invited to participate in the program and the results surprised her. “Then it was like a flower: she smiled and her body language was more active. That stays in my head.”
Lung specialist Ayzhan Taalaybekova gives a lecture as part of the patient program
Tokhorbek Makeshov, 48, works at a pet market and lives in a village in the Naryn region, 190 miles (300 km) from Bishkek. He noticed that his health was deteriorating in 2015, but he thought it was just a smoker’s cough. In 2016, he was coughing up phlegm and became increasingly out of breath. His GP referred him to Bishkek Hospital where he stayed for 10 days and was diagnosed with COPD.
The hospital later invited him to participate in the lung rehabilitation program, which at the time was still part of a research project. He says, “I didn’t think it would work; I thought only inhalers or injections could help. But it was something new: I had nothing to lose.
“It had a massive impact. Rehabilitation didn’t cure me; I’m still coughing and I have outbreaks [of COPD] but I am more active. I can walk more and do more around the house. I was amazed to see that such simple exercises could improve my respiratory health. My whole vision changed. “
Nurse Aidai Temiraly Kyzy dances Kara Jorgo with patients
Sooronbaev wants lung rehabilitation to be available nationwide starting this year. Patients who have undergone the program are being trained to teach others, and Sooronbaev and colleagues should speak at medical conferences to inform other health professionals about their progress with the program.
“When we give medicines and drugs to patients with COPD, this is not a real medical service,” he says. “Lung rehabilitation is an important part of treatment. That is why we have plans to expand and why we will share our experience with neighboring countries: Tajikistan, Uzbekistan, Kazakhstan and Turkmenistan. “
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