Preliminary Conclusion

Based on the available to-date preliminary data, the situation shaped after the accident which resulted in spills of about two tonnes sodium cyanide into the Barskoon river was analyzed.

From the medical point of view the fact, that the people started applying to doctors only two days after intoxication, attracts our attention. This may be explained by the fact, that first clinical symptoms of intoxication were not so considerable and further non-availability of heavy cyanide poisoning could be potentially stated. It should also be pointed out, that in this region people see doctors only when they feel there's something serious or when they cannot understand what is happening with them.

The following might bring to a considerable increase of the number of registered casualties:

1. Doctors' being unaware of the clinical picture of intoxication;
2. Medical personnel's initial charging of the patients' state as the cause of natural playing safe;
3. There was insufficient differential diagnostics of:
   1. acute attack of chronic diseases;
   2. acute pathology of internal organs and systems;
   3. infectious diseases.
4. Children with preliminary diagnosis of "cyanide poisoning" arrived at the medical clinics together with their parents, who had no clinical symptoms of poisoning and for them case records were made up with the same diagnosis;
5. Children from the Barskoon and its vicinity brought to clinics for examination though they had no signs of poisoning were diagnosed as: "Cyanide intoxication. Examination". Further they were registered as the casualties;

Caused by the above-stated actions, the distortion of the real picture further might bring to unreasonable actions, contributing to development and spreading of infectious process.

The following may testify to availability of the infectious process:

1. Dynamics of people's applying to doctors (gradual increase of applications);
2. Appearance of the sick in neighbouring localities;
3. Appearance of sick medical personnel, working with the casualties from Barskoon.

With high extent of reliability we may say that the infectious process was caused by droplet viral infection of anthropogenic or zoogenic genesis (infection from animals), high likelihood of which can be stated on the basis of the animal death data along the whole north side of the Issyk-Kul (from Barskoon to Karakol).

For clearing the real picture I undertook the following actions:

1. The methodic of patients' examination was approved:
2. By my request local Health Bodies were increased by experts in infectious diseases, neuropathologists and eye doctors;
3. Inquiry to the virology lab concerning the analyses of the whole biological material of the patients on availability of virus infection was sent;
4. The question of possible zoonosis (animal infection) spreading among people and animals was posed.
5. Consultations with chemists-technologists for exclusion of possible interaction of cyanides with hyperchloride and chlorine, fluorine-organic compounds is necessary.
6. Find out the time of the last fertilizing of fields and gardens with herbicides and what kind of herbicides they were.
7. Find out amounts and kinds of preparations which were used for detoxification of soils. Exclude the possibility of chemical reagents' penetrating.

RECOMMENDATIONS

* Special investigation for determining of the real area where dangerous concentrations of cyanide spread on the Barskoon territory is to be carried out.

1. Carry out investigation experiment with dyestuff;
2. Draw up the map of contamination on Barskoon territory;
3. Obtain data on the background morbidity in the region for the recent 5 years;

• I consider it necessary to determine the final date of casualties arriving (not later than May 28/1998).
• It is necessary to hold meeting with medical personnel at place and determine criteria of determining poisoning availability or non-availability.
• For further examination send children selected by local Health Bodies to the Republican hospital in Bishkek, pregnant women to the Maternity Centre, adults - to the Propathology Chair of the Central Republican Hospital.
• Create expert, permanently acting Council for determination of the link of diseases with cyanide affect.
• Carry out prophylactic medical examination in Barskoon in 3 months and 1 year after poisoning for revealing of possible connection with cyanide affect.
• Carry out morbidity assessment in 1998 and 1999 years.