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.