Turkmen Doctor Stripped of Her Profession for Challenging Malpractice

Cards on the table: we thought long and hard at turkmen.news about publishing the contents of this letter to us for fear of harming the author. There are plenty of examples in Turkmenistan of a complainant to state bodies or human rights organizations abroad being punished rather than the target of the complaint. In order to minimize the risk of punishment we have decided not only to publish the story, but also to report the situation to the International Labor Organization, International Trade Union Confederation, and human rights organizations.

On July 26, 2017 Hursanay Ismatullaeva (pictured), a doctor at the Ene Mahri Perinatal Center in the town of Gokdepe, Ahal region, returned from a two-week trip to St Petersburg for medical treatment, taken as part of her vacation. She was amazed to discover that from July 12 she was no longer on the staff. An instruction to dismiss her had been signed by the center’s acting chief doctor, Annamurat Hanov, and dated July 24. The document gave the reason for her dismissal as unauthorized absence from July 12 to 24, and the basis as the chief doctor’s “personal initiative” (in Turkmen Meniň görkezmäm).

There is no concept of “personal initiative” in the Turkmen Labor Code. According to the law, dismissal for unauthorized absence is allowed only with the agreement of the primary trade union committee, but the committee had not held a meeting – the document and the signatures of those who allegedly attended were forged, and there is written confirmation of this.

Having studied all the circumstances of the illegal dismissal, the association of trade unions of Ahal region was initially on Dr Ismatullaeva’s side. It instructed Dr Hanov to reinstate her and pay her for the days of enforced absence. But later, when the case came to court, the trade union changed its position 180 degrees. The court hearing proceeded with numerous infringements and decided in favor of the chief doctor. Dismissed, Dr Ismatullaeva wrote to the prosecutor’s office, the ombudsperson, the National Security Ministry, but none of them found any violations of the Labor Code, while the Supreme Court did not consider her complaint.

Dismissal order signed based on a 'personal initiative'. Swipe to see more
One of the doctors who supposedly attended the trade union's meeting declared: The signature is not mine. Swipe to see more
The courthouse's driver serves as an interpreter, but even that is fake - there was one to translate.

The “awkward” doctor

Some background about Hursanay Ismatullaeva: she graduated from St Petersburg State Pediatric Medical University in the late 1990s, and in 1999 she returned home and started work as a sonographer in the Gokdepe maternity hospital. In 2010 a new perinatal center was built in place of the old maternity hospital, and Dr Ismatullaeva worked there until her illegal dismissal in summer 2017.

Turkmen.news managed to contact two of Dr Ismatullaeva’s former patients who described her as a highly qualified diagnostic specialist. One of the women said that five years ago doctors had insisted she should have an operation, but at her very first consultation with Hursanay Ismatullaeva the doctor reassured her that she did not have a serious problem that required surgical intervention. The woman took the sonographer’s findings to her own doctor who dismissed Ismatullaeva’s conclusion and again insisted on an operation. The cost of the operation was substantial.

The patient was not in great pain at that time, so she decided to put the operation on hold and sent her ultrasound scan to an acquaintance living in America.

At her request doctors at three American clinics looked at the scan and agreed with Dr Ismatullaeva’s findings: an operation was not necessary and the bowel problem could be dealt with through a course of drug treatment.

The second woman was also grateful to Dr Ismatullaeva for sparing her an operation that other doctors at the perinatal center insisted she needed.

Turkmen.news has raised the issue of obstetrics in Turkmenistan many times. Medical institutions have an interest in carrying out caesarian sections, even if all the indicators show that the pregnant woman should have a natural birth. There are several reasons for this: first, the fear of responsibility – if something goes wrong, the doctor will be held responsible and it will have a negative effect on the statistics; second, the low qualifications and lack of experience of average medical personnel; third, personal profiteering under the guise of meeting the self-financing plan. As a result, Turkmenistan’s maternity departments and perinatal centers are keen to put everyone under the surgeon’s knife.

Our articles on the subject prompted a wave of responses from readers who told us their experience in different parts of the country. It can be concluded from all these stories that obstetrics in Turkmenistan has long since become a business income stream. According to the testimonies of former patients, doctors, nurses, and even orderlies won’t lift a finger until banknotes are rustling in the pockets of their white coats, although Turkmenistan’s law “On protecting the health of citizens” says:

During pregnancy, childbirth and until the child reaches the age of three a woman has the right to free, specialist medical care in state medical institutions.

Nonetheless, when they enter an in-patient clinic, pregnant women have to sign a document confirming their supposedly voluntary agreement to pay for medical services. The doctors always have an interest in carrying out a caesarian section, not only because it is more expensive, but also because it puts money in the pocket of the whole operating team – the surgeon, anesthetist, and nurse.

Hursanay Ismatullaeva spoke out against unnecessary operations, which needless to say did not go down well with her bosses. She hardly ever received her monthly salary of 1,688 manats in full (around $70 US dollars according to the market rate). Some was always withheld and she would receive 1,100 or 950 manats. The administration would say this was for failure to meet the plan for paid services. The acting chief doctor Annamurat Hanov wrote in her reference after dismissal that she met the plan for paid services by 65-70%, although patients flocked to see her. Before her dismissal she had tried to contest the cut in her salary in court.

Ismatullaeva also failed to implement another requirement of the management – not to spend more than three minutes (!) with a patient and to make a clinical decision within that time. The management considered spending any more than three minutes per patient to be a waste and an obstacle to making as much money as possible.

Hursanay Ismatullaeva was an awkward person who was out of step with the rules of the acting chief doctor by not taking part in political, public events known as chare. There was a good reason for this – the doctor worked full time on a self-financing basis and her salary depended on her being at her workplace and receiving patients. Later, at the court hearing considering her complaint, the administrator in the capacity of respondent said: she goes against the president’s policy by not going to chare. Even the judges at the hearing were surprised at this answer: “What does a manager pay his staff for, if they are not at their workplaces? He requires the fulfillment of the plan but at the same time tears her away from her work.”

Reference letter. Swipe further to see more
Reference letter. Swipe to see unofficial Russian translation
Reference letter translated into Russian by turkmen.news

A cunning plan, cowardly trade union and partisan court

Let’s go back to the events of July 2017. Hursanay Ismatullaeva had to go to St Petersburg because of problems with her own health. She wrote an application to take two weeks of vacation and gave it personally to the chief doctor, which Annamurat Hanov himself confirmed at the hearing. In her presence the chief doctor wrote “I have no objection!” in the top corner of the application, as is customary, but he did not show her the subsequent instruction to allocate her holiday, simply assuring her that it had been written. Dr Ismatullaeva could not persuade the employer to return her application to her to show the court.

With hindsight Hursanay Ismatullaeva realizes she should have done whatever it took to get a copy of the instruction as insurance against dirty tricks. But when she returned to work, she got what she had not expected at all – dismissal for that two week absence.

Later, in court, Acting Chief Doctor Hanov was to say that he informed Ismatullaeva verbally that he would not sign her leave application until she brought permission from the court for her to leave the country in connection with her earlier complaint – about failure to pay her salary in full. Dr Ismatullaeva responded that she had to travel because of complications after an operation, she had made the application to take part of her vacation two weeks in advance, as is required by law, and her application to the court over her salary had nothing to do with her request to take some of her vacation. An employer is obliged either to sign a vacation application or to return it if it is refused, but Chief Doctor Hanov agreed to the vacation proposal and signed the application in Dr Ismatullaeva’s presence.

When she heard about her dismissal, Dr Ismatullaeva approached the Central Trade Union Committee of the association of trade unions, as she had been paying her union subs for 20 years. A meeting was held involving lawyer Sapar Babaev and inspector Ashirgeldi Charyev. They immediately established that the dismissal was a crude violation of the law. The employer had not submitted a petition for her dismissal to the primary trade union committee. Moreover, contrary to the provisions of the Labor Code no one had asked Dr Ismatullaeva to write an explanation for her absence from work. As a result, on August 9, 2017 an instruction was made to the Ene Mahri Center management to reinstate Dr Ismatullaeva and pay her salary for all the days of her enforced absence.

But this did not happen – Acting Chief Doctor Annamurat Hanov officially refused to carry out the instruction and informed the trade union about it in writing. Left in limbo without work or any prospects, Dr Ismatullaeva submitted a complaint to the Gokdepe district court which was heard on October 30, 2017. All the participants in the hearing – the complainant, the trade union representative, and the respondent – again confirmed their positions on the issue, but the court refused to uphold Dr Ismatullaeva’s complaint and took the side of Chief Doctor Hanov.

There were irregularities in the hearing itself too. For example, the record of proceedings shows that since the complainant is an ethnic Uzbek, she was provided with an interpreter, Dovran Pollyev, who also doubled up as the court’s driver. In fact there had been no interpreter at all, and Dr Ismatullaeva understood only half the proceedings.

Official translation into Russian of the court hearing protocol

Moreover, since she could not afford to hire a defense lawyer, Dr Ismatullaeva put her hopes in a state attorney, but none was provided. The court also refused handwriting analysis – the signatures of the members of the Ene Mahri Center trade union committee on the document agreeing to the dismissal were forged, as had been established by the Ahal region trade union. One of the doctors who allegedly signed the agreement – Dr Irina Lisyuk – wrote: “That’s not my signature.” The judge did not take it into account. Finally, the court ignored the fact that the document agreeing to her dismissal was signed on July 24, though in fact the Ene Mahri Center trade union committee meeting took place on July 26. Moreover, the minutes of the meeting say that Hursanay Ismatullaeva herself attended the meeting but this is also a lie. That day the doctor was at the Ministry of Internal Affairs criminal forensic center and she has a certificate to prove it, signed by the head of the center, Col. Orazmuradov.

Dr Ismatullaeva described all these irregularities in detail in several complaints to the ombudsperson Yazdursun Gurbannazarova (turkmen.news has copies). But the official palmed off the doctor, first on one department, then another, and the last time did not consider her complaint at all.

Surprisingly, over time the trade union leadership was not only passive, it backpedaled, disowning its instruction at another court sitting, initiated by Dr Ismatullaeva over the inaction of the Ahal region trade union. The same lawyer, Babaev, and inspector, Ashirov, who had found serious irregularities in the dismissal of Dr Ismatullaeva preferred to capitulate, forgetting that their mission is to defend workers who pay their membership subscriptions without fail for many years. 

Crime without a punishment

Three years have now passed. Dr Hursanay Ismatullaeva remains without work. Through the labor exchange she has been taken on at least five times by different medical institutions, including private ones, but the next day she has been dismissed with apologies. Patients from different parts of the country still seek her out, as they have heard of her professionalism and decency, and even colleagues try to be examined by her. They know that Dr Ismatullaeva will not make a false diagnosis, which means she will not put their lives at risk.

The death of the Ene Mahri Center’s deputy chief doctor for medical affairs, Bahar Beknepesova, remains fresh in the mind. Witnesses, former employees of the medical center who left at different times, told turkmen.news about the case. The deputy chief doctor, 50, had an allergic reaction to a drip containing Gordox. The doctor who prescribed the procedure must not have given a preliminary test dose of the medicine, which comes with a warning of the high risk of allergic/anaphylactic reaction.

When the allergy became apparent, the head of the delivery room, Aky Orazova, who was conducting the procedure, panicked, and instead of calcium chloride, which has an anti-allergenic effect, gave her colleague potassium chloride, which has the opposite effect on the organism, lowering arterial pressure, causing arrhythmia, and blocking and stopping the heart.

This is what happened to Dr Bahar Beknepesova.

After many electric shocks they managed to get the patient’s heart going again, but the center’s management were ruled by their ambitions and preferred to hide the doctor’s true condition. Instead of transferring her to a specialist clinic, they left her to die, which happened five days later. The cause of death was recorded as a heart attack in her medical records. A consultant who had been called in to see the patient while she was still alive was also persuaded to sign this diagnosis, although Dr Beknepesova did not have any symptoms of a heart attack. If she had been taken to a specialist department, the doctor’s life would have been saved.

This story says a lot about the management of the Ene Mahri Center. It’s not surprising that they sought at any cost to get rid of the “awkward” Dr Ismatullaeva who knew too much and could not keep quiet.

There are plenty of examples in the history of modern Turkmenistan of the persecution of people who are an inconvenience to the authorities: a tacit ban is imposed on them finding work, dirty tricks are carried out against them, libelous fabrications are spread about them, and they are put behind bars. These people include so-called “troublemakers” who refuse to accept injustice and try to appeal to the courts, prosecutor’s office, ministries and departments, and the ombudsperson. The ombudsperson’s office initially said that the employer would be obliged to carry out the instruction of the trade union, but it later emerged there had supposedly been no infringement of the law.

In the vast majority of cases such applications lead to nothing but problems. And if anyone tries to find protection abroad, they are automatically dubbed a “traitor to the motherland”, and more serious steps can be taken against them underpinned by the Criminal Code.

Hursanay Ismatullaeva is practically defenseless. She is an ethnic Uzbek, which is also an unspoken reason to humiliate and persecute her. There is no one to defend the woman inside the country, no one to help her stand up for her rights, and get reinstatement at work, as even the Supreme Court has not considered her complaint. It means that in Turkmenistan it is possible to sack a doctor for refusing to take part in public events to mark New Year, Children’s Day, and Medical Workers’ Day, as is set out in the primary trade union committee’s written agreement to her dismissal for absence, drawn up retrospectively.

Seeking justice

Turkmen.news considers this publication to be an official appeal to the Prosecutor General’s Office of Turkmenistan to conduct a thorough, objective, comprehensive review of the dismissal of Hursanay Rahmetovna Ismatullaeva. We request a legal assessment of the actions of those who brought about her dismissal from the Ene Mahri Center and who are now pulling invisible strings to ensure that a professional specialist should not be employed by any other medical institutions.

Hursanay Ismatullaeva has written an appeal to President Gurbanguly Berdimuhamedov, but as she is not sure it will reach the intended recipient, she has asked us to publish it in the form of an open letter.

Dear President Berdimuhamedov,

I reach out to you not only as the head of state and guarantor of the Constitution, but also as a colleague. I am compelled to “wash this dirty linen in public”, as for three years I have been unable to get justice and defend my innocence through my own efforts.

I believe that you will get to the bottom of the situation outlined above. It cannot be allowed under your leadership in modern-day Turkmenistan that an employee whom someone dislikes, a professional specialist, can be dismissed from work, moreover with the wording “on the personal initiative” of the chief doctor.

I have dedicated my whole life to an honorable cause. I have done my work conscientiously, remaining faithful to my Hippocratic oath. My service record includes hundreds, if not thousands, of expressions of gratitude and wishes of good health for providing an accurate diagnosis and saving seriously ill patients. No one has ever had any criticism of the professionalism of my work throughout my working life.

Unfortunately, my appeals to the country’s law-enforcement and human rights institutions, to the chairman of the trade union of Ahal region, to Mejlis deputy Bayramgul Muradova, Ombudsperson Yazdursun Gurbannazarova, Ahal regional governor Serdar Berdimuhamedov, and also to the Turkmenistan Supreme Court, Prosecutor General’s Office, Ministry of Internal Affairs and Ministry of National Security have not changed the situation, and the actions of my previous manager Annamurat Hanov have gone unpunished. This is the situation that has compelled me to appeal to you, Mr. President, in the form of an open letter via the Internet. I hope that you will show understanding of my situation and restore justice.

With my very best wishes for your good health,

Dr Hursanay Ismatullaeva