Kyrgyzstan: Are Manas Antibiotics Doing Harm?

At Bishkek’s Orto-Sai bazaar, 100-milligram tablets of doxycycline, an antibiotic used to treat infections, dispensed at Fort Bragg are available to buy from an open bottle. (Photo: EurasiaNet)

What do expired American-manufactured antibiotics and brand-new combat boots have in common? Hint: They’re widely available at the bustling markets of Kyrgyzstan’s capital, Bishkek.

It’s nothing new to see American military goods being re-sold outside a US base, certainly not in Kyrgyzstan. With estimated monthly food losses topping $10,000, the Manas Transit Center has, at times, kept Kyrgyz gourmands well stocked with T-bone steaks and lobster tails. But some of the other goods that appear to be coming from Manas have potentially serious health implications for residents in the impoverished Central Asian nation. Among the shampoos, socks and other sundry items are used and expired prescription medications designed to treat all sorts of ailments – under a doctor’s supervision.

At Bishkek’s Orto-Sai Bazaar, a pensioner stands over a box of American brand-name lotions for sale at 10 som (20 cents) a tube. Bottles of pills, including Wellbutrin, a prescription antidepressant, go for the same price. A middle-aged customer, asked if she knew what the tube of anti-fungal cream she was buying is for, replied that she doesn’t care because “the American cream gets your shoes shinier that anything you can buy in the stores.”

While using expired jock-itch cream to shine your shoes might be harmless, it highlights a public health concern. Of all her products, the pensioner quietly admits antibiotics sell best. Antibiotic misuse in Central Asia has encouraged the development of multi-drug resistant tuberculosis (MDR TB) strains that mean near-certain death for anyone who contracts them. Indeed, growing concern among international experts over the broader implications of these troubling trends has led the World Health Organization to place Kyrgyzstan in their “top-10 list” of countries with drug-resistant TB.

The pensioner says her biggest seller is doxycycline, a broad-spectrum antibiotic that is commonly used by the US military as a malarial prophylactic. The drug is also prescribed to treat E. coli, acne, chlamydia and anthrax, among other bacterial infections. People buy from her, she says, because they know the American products are of better quality than the Russian, Chinese or Turkish pharmaceuticals most readily available in Kyrgyzstan.

Beyond public health concerns, there are privacy issues, too. Many of these drugs are resold in their original prescription bottles, containing the names of the soldiers to whom they were prescribed and the facility at which they received care: Fort Lewis, Washington; Fort Bragg, North Carolina, Fort Benning, Georgia, and so on.

Asked about the abundance of products appearing to be from the Manas Transit Center, a spokesperson said the base “carefully guards against any form of theft,” adding that, “all employees must exit through a screening process that includes bag x-rays, body searches and vehicle inspections.”

Manas employees take “strict precautions to ensure appropriate control and disposal of our medications,” the spokesperson added, noting that unwanted or unused medications are incinerated.

A vender at Bishkek’s Osh Bazaar who specializes in American military kit, including new Oakley ballistic goggles and combat boots, suggested that theft from Manas is rampant and facilitated by local employees: “It’s simple. To get [these products] you just have to call your friend up, tell him what you need, and in a few days he’ll get it to you,” he said.

All the trash leaving the transit center, the spokesperson said, is handled by a local contractor, Ravil Yakupov. Yakupov – styled by Forbes Magazine last September as the local American Chamber of Commerce’s “poster boy”  – spoke to the magazine of his fondness for “the best quality trash in all of Kyrgyzstan,” produced by Manas in enormous quantities, some 30 to 40 tons per day.

In addition to the lucrative contract for removing waste – worth approximately $107,000 for a 10-month period ending this coming July, according to a Manas spokesperson – Yakupov also makes money “refashioning” the garbage into goods for resale, according to Forbes. Yakupov’s recycling has not been without contention; his donation of Manas’ used mattresses to local orphanages has won him some critics in local media.

Repeated attempts to reach Yakupov over the course of a week failed: His secretary first took messages and promised he would return the calls. Then she said she had never heard of him.

The Manas Transit Center spokesperson emphasized that “once the [local] contractor collects the trash, the material belongs to the contractor.”

Whether or not Yakupov is making money on the side, people buying Manas’ rubbish at Bishkek’s bazaars say they are happy just to have access to “American medicine.” Squatting on the ground and digging through the boxes of antibiotics at Orto-Sai, an elderly man squinted at a few canisters before settling on a medium-sized bottle of doxycycline. When asked if he knew what he was buying, he shook the bottle, paid for it and laughed: “No, but it helps my back.”

Kyrgyzstan: Are Manas Antibiotics Doing Harm?

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