In this interview, the FRESH AIR team in the Kyrgyz Republic gives an overview of FRESH AIR activities in the country and how they have helped to improve lung health in their local communities.
Could you describe the settings in which you implement the interventions in the Kyrgyz Republic?
Kyrgyzstan is a mountainous country, 94% of its territory is occupied by mountains and more than half of the settlements (1.75 million people) are located at altitudes greater than 2,000 m.
The FRESH AIR study was carried out in 30 villages, both in Naryn, a high-altitude region (2,200–3,200 m above sea level), and in Chui, a low-altitude region (730 m above sea level). Many of these settlements, especially in the high-altitude region, were difficult to access.
What is specific to the areas you are dealing with?
Most people in the lowland Chui Region live in rural areas and work in agriculture, although some industries, such as mining, concrete, slate and glass manufacturing, operate in the area.
In the Naryn region, people live at high altitude where weather conditions can be extreme. Biomass is burnt inside households for heating and cooking purposes, leading to indoor air pollution.
Tobacco smoking rates are high, with 48% of men smoking, according to official data from 2013; the smoking rate might be even higher. In rural areas, it is not unusual for men to smoke inside their house, exposing their families to second-hand smoke.
What you have been implementing for FRESH AIR so far?
The team has trained healthcare professionals, developed a protocol on asthma in children under 5 years of age based on the World Health Organization’s PEN (Package of essential noncommunicable disease interventions), and produced an information booklet for parents of children with asthma.
In the past months the FRESH AIR team has worked with village leaders and members of rural health committees to introduce clean stoves in villages and give information on smoking cessation through very brief advice (VBA).
What are the biggest challenges you face in your work for FRESH AIR?
FRESH AIR is, first of all, an opportunity to implement evidence-based interventions, to improve prevention, early diagnosis and management of lung diseases in primary care – and to exchange ideas about how to do it, especially in remote rural areas. We did not have any major problems. The only small problem was in accessing the high-altitude region of Ak-Say, (3,200-3,800 m above sea level), due to very cold weather and its impact on the roads.
Overall, FRESH AIR gave us the opportunity to strengthen ties with the local population and healthcare community in the two regions. We also managed to extend the community of stakeholders on lung health, which now includes politicians, health leaders, representatives of the Ministry of Health and local government representatives.
How did you involve patients in FRESH AIR activities?
The involvement of patients in FRESH AIR has been important. It is essential to have good contacts with them and that they are interested and willing to participate. The FRESH AIR team held talks and clearly explained the project, its aims and activities, so that the patients could sign the consent sheet confidently.
When new stoves were introduced, patient leaders helped to facilitate the change in the communities. In the future, the role of patients will be even more important, for the potential in self-management and self-reporting of lung conditions. We already have seven asthma clubs set up.
To what extent have you engaged with national policy makers about FRESH AIR?
We launched the project in April 2016. It was a very important meeting with good discussion and support from political leaders, deputies, high-level representatives from the Ministry of Health, the national coordinator of Horizon 2020, local administrative leaders, leading scientists and leaders of key hospital centres, including medical centres of the Naryn and Chui regions.
Thanks to their support, and with the assistance of the Minister of Health, we started to implement FRESH AIR results into our national healthcare programme.