Religion and Ecology in Kazakhstan

A lot of people have been asking me “What religion is Kazakhstan?” This is no easy question to answer. Yes, most of the country identifies as Muslim, but there are also ancient Jewish communities that have been isolated from the rest of the diaspora for a millennia and Eastern Orthodox Christianity is widely observed. Further, the official state posture is not merely one of tolerance, although there is certainly plenty of that, but the aggressive promotion of interfaith dialogue and cooperation. For example, in the newly built capital city of Almaty, one of the most impressive new constructions is massive pyramidal cathedral, over sixty meters in height, that houses chapels for all forty-six of the countries major religions.  Conceived by the president as a meeting place for the world’s religious leaders to promote tolerance and understanding, the 90,000 square meter Palace of Peace and Harmony is a 200-million-dollar testament to the palliative effect of getting human beings from different backgrounds under one roof. (And it houses a 1,500 seat opera house to boot!)

 “The pyramid is extraordinary both in concept and in structure, a modern multi-faith cathedral, described by Lord Foster as ‘A contemporary reconsideration of religious architecture … dedicated to the renunciation of violence and the promotion of faith and human equality.'”

An architectural journalist, visiting the construction in 2006 described the process  as a “shrieking fiery pandemonium (being transformed into) a mysterious kind of heaven … The interior, all swirling smoke and deafening clamor, shot through with torrents of sparks, was William Blake crossed with Piranesi … more Inca than Egyptian; like a temple … a place to wonder at.” The Palace of Peace and Harmony was built around the clock from prefabricated materials constructed in Turkey during the winter months, designed by British architects, funded and constructed by Kazakh workers in a city that has appeared out of no where in the desert, all in little over a year. In Christopher Robbins’ 2006 interview with Kazakhstan’s President Nazerbayev, the president describes some of the thinking behind the project: 

Akbar the Great had a dream of building one big temple for everyone. He was Muslim himself but was tolerant of all religions. His vision was that everyone would enter the great temple through one big gate, and once inside they would have their own temples in which to pray – Christian, jewish, Hindu, Muslim. So everyone entered and prayed to their own God, but they arrived and departed through the gate shoulder to shoulder. I’m building that temple now.

All the major religions insist there is but one God. Well, in my opinion that is so – but we all approach him in our own way. The Koran states that if you kill one person you have killed everyone in the world, and the prophet Mohammed has said it is the duty of Muslims to spread love among people. I want to disprove the Huntington theory which says that the clash of civilizations is inevitable because we are all different. Yes, you can prophesy disaster and apocalypse, or you can think that humans are smarter than that and will not push themselves to that confrontation.

We have forty-six different religions in Kazakhstan operating in peaceful co-existence. No one is restricted from building his own house of prayer. No one is afraid to pray to his own God. And there is not a hint of one group deliberately offending another. The Kazakhs of the twenty-first century should be tolerant, modern people. I tell young people here that they should be citizens of the world and that for them there should be only one nationality – humankind.

 Critics could call these words naively idealistic and triumphant, but to me they are quite inspiring. It is refreshing to see a head of state speak with such rhetoric and actually put money and policy behind such a vision. I look forward to attending a worship in Kazakhstan and seeing how it really comes about.

 

Another huge problem faced by the country of Kazakhstan is an inheritance of ecological disaster from the Soviet Union. During the Stalin years, the Soviet central planners embarked on an ambitious project to transform the steppe into a breadbasket for Russia. The area around the Aral sea in particular, a dry region always, was selected to grow cotton for the rest of the the Soviet Union and it’s satellite states. To accomplish this, water was drained from the Aral sea, formerly the largest freshwater lake in the world. At first the project was a success, cotton was produced at impressive rates and indeed supplied populations as far away as Cuba. However, it soon became apparent that there was an unintended victim – the Sea Level.

 As water was drained for intensive agriculture, the huge body of water known as the Aral began to drop in volume. Simultaneously, fertilizer and pesticide run-off made its way into the remaining reservoir and groundwater. As the water drained, increasing the salinity of the water, and the pollutants poured in, aquatic life began to die by the ton, destroying a thriving fishing economy and an ancient way of life. In a tour of the region in 2006, president Nazerbayev described the situation:

Look, the land around the Aral Sea is already so contaminated that the most rational solution would simply be to move all the people and abandon the area as a wasteland. Kazakhstan is so vast and Sparsely populated there is certainly no shortage of land elsewhere. But we do not have the resources to build enough houses for everybody. And even if we did, many people would simply refuse to go. The Kazakhs are very conscious of tradition. They want to die in the place where they were born.

However, many efforts are currently underway for environmental restoration. In his visit to the area for “The Land that Disappeared,” Christopher Robbins  describes seeing such projects:

“Halfway along the shore of the lake we dropped down to visit work in progress on an eleven- kilometer dam being built by the Chinses with money from the Kazakh government and the World Bank. In previous years the local population and regional government had experimented with sand dykes which had been washed away in storms. The dykes however, had proved that both the level and the quality of the water could be improved significantly by damming.

 

‘This dam is the eight wonder of the world,’ an excited engineer told me. ‘No one has done something like this before. It’s working! In a year the water can be raised four metros. It might not be possible to raise the lake to its previous level, but we should be able to get another five metres- enough to bring key harbors back to life and revive the fishing industry. Where else in the former Soviet Union has there been such success in cleaning up an ecological disaster?’

Indeed these efforts are inspiring. Kazakhstan has already had success building a capital where once there was nothing (Astana), and are tackling even larger problems, environmental degradation and religious tolerance. If they go at it with the same voracity and enthusiasm that they have displaced in their mere quarter century of independence, I have no doubt they will succeed.

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Understanding Mobile Health

Following in the footsteps of my colleague Emin, I’d like to take the opportunity to give a bit of explanation regarding the function and workings of a mobile health platform. First things first, when I say “mobile health” or “mhealth” I don’t mean the use of mobile clinics. These are remarkable initiatives, but people are often confused when I bring up cell phones. mHealth refers to the next generation of “telemedicine” or “remote medicine,” and harnesses new technologies in the cellular industry to preform healthcare. Basically, it’s healthcare with cell phones.

There are three main advantages to using a mHealth platform, the opportunity for home visits, telemedicine/telereferals, and training or continuous training for improvements.

Using mHealth in home visits allow for many advantages. Cell phones equipped with mHealth technology allow a community health worker to take pictures to send to a specialist, refer to texts or auxillarly resources, and transmit patient information in a secured fashion. Home visitations themselves are great, it is often quite difficult for a person in need of constant medical care such as a pregnant mother or someone suffering from lifestyle related chronic diseases to travel to a clinic for routine treatment. It is more resource effective to utilize community health workers or local nurses to make home visitation than expensive specialists. Home visitations allow hospitals and other large institutions to monitor patients continuously and refer to specialists remotely for diagnostics when needed while still providing quality point-of-care treatment. Finally, home visitations coupled with mHealth allows local health worker resources to be leveraged, promoting a greater degree of trust and continuity of care between provider and patient.

Telemedicine or telereferals in rural clinic or during field visits, health worker or nurse can use telemedicine kit to send patient symptoms info to remote doctors to eliminate unnecessary referrals and transport of patients. Doctors can review prior patient history with ease. Coupled with community health workers or local nurses, this practice enables point-of-care diagnostics capability and shortens time to treatment through remote consultation with physicians compared to physical referral into hospital systems.

The use of mHealth for training is another often overlooked advantage to mHealth. Say a community has been identified as at risk for diabetes and all of it’s associated illnesses. The following graphic illustrates how mHealth assists in the training of local, place-based community health workers. As you can see, a key advantage to mHealth is not only in training, but continuous training, ensuring a consistently high quality of care.

For me the natural next question is what about HIPAA requirements? For those of you outside of the know, the Health Insurance Portability and Accountability Act is a 1996 law that regulates the use of electronic patient data. The aim is privacy, and information is subjected to a rigorous criterion of desensitization in order to comply. This means that any medical information on a patient, which is private, has to be unattached to any identifier for that patient, such as social security number or name and birthday. Wouldn’t mHealth and the free and open use of patient data open up a variety of HIPAA noncompliance issues?

In fact not. I’ve spoken with Ting Shih of Clickmedix about this exact issue, and their comprehensive system has worked within the HIPAA regulations in the US and similar regulations abroad. Her company’s system takes data captured at point-of-care by primary care doctors or community health workers- data that is attached to a patient’s personal information- runs it through their system in order to desensitize it, and then sends it to the necessary hospitals or to worldwide network of specialists already collaborating on telehealth issues. Then, once the appropriate diagnosis is made, the data is then sent back to clickmedix, which re-attaches the diagnosis to the particular patient, and returns it to the community health workers. The entire process occurs within five minutes.
In another post, I’ll outline why Kazakhstan is so open for innovation in this sector. For now I’ll leave you with this outline as to how mHealth actually works