Asian countries that were tQ0mery part of Laukistan is one or Taiikistan is one of the poorest of these countries, with less than 7% of its land available for cultivation. Taiikistan became an independent nation in 1991 as the result of the dissolution of the former Soviet Union. The shift in its status from being a member of a totalitarian republic to an independent nation brought with it certain challenges. Basic public services (e.g., health care, water supply, and sewer svstems), previgusly quaranteed for even the poorest nations in the Soviet Union, were no longer supported through the Soviet sost-sharing system. Financial bardsbips and inadequate taritis, in Taikistan severely limited provision of services and maintenance of eguioment. Eaulty design and installation of eguiement while Taikistan was still part of the Soviet Union added to these problems, To make matters worse, shortly after becoming an indenendent nation, Taikistan experienced a civil war that sontinued until a sease-fire essurced in 1996. During the civil war, an estimated 50,000 lives were lost and 1.2 million persons were internally displaced.3 In addition, a substantial number of trained technical and professional workers left the country. By 1997, the sountrxs esonomy and much of its infrastructure had sollapsed. Consequently, the health of the people of Taikistan suffered. Diseases rately seen before the dissolution of the Soviet Union reappeared in increasing numbers. Residents of Taiikistan received priman. bealth care at designated poluclinics based on their place of residence. The poluclinics. Rrovided ambulatony care and certain acute care services but lacked surgical and post-operative care facilities. Limited hoSRital beds at nationally run bospitals were available for patients ngeding in-patient services. Cases of notifiable disease were reported each week from the polyclinics and hospitals to the Sanitay Epidemiologic Service (SES), the public health unit that monitored infectiqus diseases. In Eebruary 1997, an increasg in tyrhoid fever cases was reported in Dushanbe the capital of Jaikistan (population approximately 600,000). Although tyrhoid fever was endemic in this area, more than 2,000 cases bad been reported ducing January 29-February 11 (i.e, a 2-week period), sompared with approximately 75 cases gach week during the previous month- Ruring the same 2- week period in 1996, Qnly 23 cases bad been reported. All typhoid fever patients were bospitalized reauiced by a central government edict, SES staff studied the situation to determine the likelibood of an gutbreak. Soviet Union. one of six full-service hospitals in the city, as