As health minister of Turkmenistan, he presided over a medical system regarded as one of the world's worst including the closure of all hospitals outside the capital. Now Gurbanguli Berdymukhamedov is suddenly head of the country.
Little is known of the man who became acting president after the death of Turkmenistan's longtime authoritarian leader, including his intentions of staying in office. The constitution says the acting president can't become full leader but the constitution also says he wasn't supposed to become acting president to begin with.
Under the late President Saparmurat Niyazov's domineering cult of personality, all other officials remained in the shadows, their public statements mostly limited to praising Niyazov and promising to follow his orders.
But Dosym Satpayev, a political analyst in Kazakhstan, says there is some reason to believe that Berdymukhamedov is something other than just a mouthpiece. He told The Associated Press that some former Turkmen officials describe Berdymukhamedov as "clever and professional in his field" and less heavy-handed than Niyazov.
"There are chances for some changes," he said.
Berdymukhamedov clearly has skills as a political survivor. The 49-year-old former dentist has been health minister since 1997 and deputy prime minister since 2001 a long tenure in view of Niyazov's penchant for firing senior officials, often accusing them of corruption.
His rise to the position of acting president appeared to be a master stroke of political maneuvering. Under the constitution, the speaker of parliament is supposed to take over temporarily upon the death of the president. But within hours after Niyazov's death, Berdymukhamedov was named acting president and the parliament speaker was dismissed because of a criminal investigation.
Whether Berdymukhamedov engineered the ascension or was the figurehead for other forces remains in question, reports AP.
In either case, some analysts see the move as a harbinger of continued one-party rule in Turkmenistan.
The national People's Council on Tuesday is to set a date for new elections and consider candidates for the vote. According to the constitution, the elections must be held within two months and the acting president cannot run. However, the People's Council also has the power to change the constitution.