There are no soft assignments for oil industry hands in the Caspian region of the Former Soviet Union.
The rigors of work in the former Soviet republic of Kazakhstan were covered at the HECTRA Conference by the medical directors of Tengizchevroil, Drs. Sharples and Carvalho.
And, Dr. Will Ponsonby, medical director, medical operations, central Asia for SOS International, drew on his extensive experience in the region to describe the situation in another potentially oil-rich former Soviet Republic, Azerbaijan.
Local health care facilities
Since independence, Azerbaijan has been fighting a war in the Ngorno Karabakh with neighboring Armenia. This, along with the poor state of the economy, means that there has been very little money to spend on health care.
Hospitals are in a poor state of repair, with little equipment. The equipment there is often not functioning because of lack of spare parts and money for repairs.
The hospitals have no money for pharmaceuticals. To be admitted to a hospital, then, a patient's family must provide food, nursing care, and usually the drugs and disposables.
The nation's doctors are working under very difficult conditions, and the hospitals fall far short of international standards. Therefore, health care and also the way that we use the local health facilities needs to be carefully managed. This has been done in a number of ways.
Alternative facilities
An international standard medical clinic was provided in Baku to minimize use of national health care facilities.
The clinic was staffed by expatriate physicians who were familiar with international medical protocols and had worked extensively in accident, emergency, and remote areas medicine. The clinic was equipped to provide both primary care and emergency services.
The clinic included an emergency room equipped with cardiac monitors, defibrillator, pulse oximeter, ventilator, oxygen, X-ray, and laboratory. Here, patients could be resuscitated and stabilized prior to emergency evacuation.
An observation room was provided to care for patients until they were evacuated, or until they were well enough to return to their homes.
The condition of the operating rooms in the national hospitals is very poor, and it is recommended that all elective surgery be carried out in a center meeting international standards. Some immediately life-threatening conditions, however, need to be operated on in situ. In this case, we must use the best available national surgeons and facilities.
Medical screening
All employees who are displaced and working away from their home countries should have a predeployment physical to ensure that they are fit. In many ways, the risks in the Former Soviet Union are greater than on a platform in the North Sea. We therefore recommend following the guidelines set out by the health subcommittee of the E&P Forum Health Assessment of Fitness to work in the E&P Industry.
Some of the companies carry out very rigorous medical examinations prior to a posting. They are therefore able to detect and manage some of the potential health problems of their expatriate employees.
There are other companies who are less rigorous. Some of these companies experience higher rates of morbidity among their expatriate employees. A review of medical evacuations from Baku, Azerbaijan, over a period of 1 year shows that over half of these were for pre-existing medical conditions, some of which should have precluded the individual from service in Azerbaijan.
These medical evacuations were carried out for severe back pain, cardiac problems, and psychological problems, including alcohol withdrawal. Better medical screening could have identified some of these problems so they could have been managed in a more proactive manner. This might have reduced the number of evacuations.
Medical evacuation
For expatriate patients who are seriously ill or injured there is no alternative; they must be evacuated to a medical center equivalent to those in their home country.
To manage this emergency response, plans have been drawn up in conjunction with client companies. These are reviewed regularly. During an evacuation, the clinic works closely with the patient's company and the nominated medical assistance company to ensure that the evacuation is well organized and proceeds smoothly.
The medical-assistance companies provide the logistical support for organizing tickets or air ambulance flights, and booking the hospital and guaranteeing payment.
Depending on the severity of the patient's problem, they could be evacuated on a scheduled flight or in an air ambulance. On scheduled flights, the patient may be escorted by a doctor or nurse. If necessary, a stretcher can be fitted. This should be ordered from the airline well in advance of the flight.
Pharmaceuticals
Some of the pharmaceuticals that are available locally are of dubious quality and origin. Many of the drugs are from the FSU and often preparations that western physicians and patients are unfamiliar with. Also, there are counterfeit pharmaceuticals.
Increasingly, however, internationally branded pharmaceuticals are being registered by the Ministry of Health of Azerbaijan and are becoming available locally.
Infectious diseases
For expatriates there is often a high degree of concern about infectious diseases in countries such as Azerbaijan. These diseases will be discussed individually, but generally with sensible management measures, such as vaccination and basic hygiene, they do not pose a significant health hazard to expatriates.
Diphtheria.-In the mid-1990s, there were several diphtheria epidemics in Baku resulting in hundreds of deaths. More recently, mass vaccination campaigns have reduced the incidence of diphtheria. However, we recommend that everyone check their vaccinations and if necessary have a booster.
Tuberculosis.-This is very widespread in Azerbaijan, and several aid organizations are running programs to combat it. Babies should be vaccinated at birth, and individuals can be screened with a Mantoux test and X-ray. For expatriates, the best protection is their generally good state of health, nutrition, and living conditions.
Typhoid and Hepatitis A.-These are also a risk, so we advise people to be careful about what they eat and drink and to be vaccinated. Foodhandlers should be screened before employment and on a regular basis.
Hepatitis B.-This disease is prevalent and is spread by contact with infected body fluids. Vaccinations are advised for everyone.
Sexually transmitted diseases.-These diseases, including gonorrhea, are relatively common. There are a number of HIV positive individuals in Azerbaijan, but the exact incidence of the disease is unknown.
Other diseases.-Plague and anthrax are endemic in rural areas of Azerbaijan. If there are outbreaks of these diseases, then it usually causes consternation among the expatriate population. These diseases can be managed by explanation of the disease and advice on simple hygiene measures.
Both of these diseases can be treated with antibiotics. To put the risk in perspective, it is also worth bearing in mind that they are both endemic in the southwestern US.
There has been an increasing malarial risk in Azerbaijan in the last 10 years. This is a result of the breakdown in public health measures following the breakup of the Soviet Union and the large numbers of internally displaced people who fled the conflict in Ngorno Karabakh.
The malaria is mainly plasmodium vivax, and it was mainly found in the south of the of the country until the last few years.
The situation was made worse in 1998 by heavy rains and flooding in central Azerbaijan which encouraged the geographical spread of the disease. In the city of Baku, the risk was not thought to be high enough to recommend the routine use of chemical prophylaxis, but general advice about avoiding insect bites was issued.
In the field in the affected areas, chloroquine was made available as a prophylaxis between April and October; insect repellants were issued; advice given about dress; and insect screens for the windows were recommended. We also advised that open areas of water around the camps be drained.
Rabies is also present. Work sites should be kept clear of food, and dogs should not be encouraged to come onto the site by feeding them. Parents were advised to vaccinate their children and to keep them away from dogs.
Gastroenteritis is the most common infection, and everyone suffers with this at some time. Symptoms can be mild-from stomach cramps to severe diarrhea and vomiting, resulting in severe dehydration.
The preparation of food often leaves much to be desired. The standards of butchery are very poor. Animals are killed by the side of the road and hung on trees for sale. There is no refrigeration, and hygiene is nonexistent.
Although one would be unlikely to purchase meat from roadside vendors, they are often the source of the meat which is served in local restaurants.
It is important to make sure that all meat is well cooked. Fruit and vegetables should be soaked in a sterilizing solution such as Milton. The tap water is often heavily contaminated with E. Coli, and we would advise that all water be filtered, and only bottled water used for drinking.
The AEA-recommended vaccination schedule for expatriates living and working in Azerbaijan is: Hepatitis A and B, Typhoid, Rabies for those at risk, a Polio booster, Diphtheria booster, and tetanus.
