HEALTH CARE IN RUSSIA

Health expenditures: 6.5 percent of GDP (2013); country comparison to the world: 106 Physicians density: 4.31 physicians/1,000 population (2006); Hospital bed density: 9.7 beds/1,000 population (2006). [Source: CIA World Factbook =]

Health expenditures per capita in the 1990s: Russia spent $250 per capita on health care compared to $4,000 per capita in the United States. The Russian government at that time spent less than 2.6 of its budget in health care, compared to 7 to 9 percent in Europe as a whole.

Many Russians avoid health care. Doctors are too expensive and clinics are overcrowded and the waits can be unimaginably long. After the break up of the Soviet Union, entire segments of the health care system collapsed. The idea of paying for health care is extremely unpopular. As of 2005, pensioners paid about $15 a month for medicines.

Health care is free in principle, but in practice adequate treatment increasingly depends on wealth, and private health care is increasingly sought. Doctors generally are poorly trained and inadequately paid; most hospitals are in poor condition—many lack running water and sewerage—and waiting lists are long. There is a persistent shortage of nurses, specialized personnel, and medical supplies and equipment. Distribution of facilities and medical personnel is highly skewed in favor of urban areas, especially politically influential cities. Russia’s high ratio of hospital beds to population—12.1 to 1,000 in 1998—is because outpatient care is not emphasized as much as in the West. In 2004 there were 4.9 doctors per 1,000 inhabitants. [Source: Library of Congress, October 2006 **]

Health Care in the Soviet Era

In the Soviet Union era, everyone had access to health care. Despite shortages of drugs and other supplies, the infant mortality rate in some Eastern European countries was lower than the Unites States. The health care was far from being perfect but at least it was free and bribes for doctors usually came in the form of chocolates or flowers. The Soviet Union had more women doctors than men doctors. At one time over 80 percent of all doctors were women.

The glasnost period of the late 1980s first revealed the decay of the Soviet system of socialized medicine, which nominally guaranteed full health protection to all citizens without charge. That system had been installed under Joseph V. Stalin (in office 1927-53) with an emphasis on preserving a healthy work force as a matter of national economic policy. In the 1980s, Russia had a huge network of neighborhood and work-site clinics and first-aid facilities to provide readily accessible primary care, together with large hospitals and polyclinics to diagnose and treat more complex illnesses and to perform surgery. In 1986 the Soviet Union had 23,500 hospitals with more than 3.6 million beds. Such facilities included about 28,000 women's consultation centers and pediatric clinics, together with emergency ambulance services and sanatoriums.[Source: Library of Congress, July 1996 *]

In the 1980s, the Soviet Union was first in the world in the ratio of hospital beds to population. Behind this system was a huge, multilevel bureaucracy directed from Moscow in consultation with organs of the CPSU. All aspects of health service had nationwide annual programs with complex statistical accounting and goals. Physicians devoted an estimated 50 percent of their time to filling out forms, and every year a large part of the national health care budget went to construction of new facilities. *

The structure of the Soviet system, which specified the length of treatment for every disease, often caused people suffering from relatively minor ailments such as influenza to be hospitalized. The result was a serious overcrowding problem in hospitals despite the large number of beds available. Patients preferred hospital treatment because hospitals were better equipped than clinics and because crowded living conditions made recuperation at home difficult. Many large enterprises operated clinics that provided workers health care without requiring them to leave the work site. Such clinics aimed at reducing the incidence of sick leave, which averaged 3 percent of the workforce per day in the 1980s. *

Despite the nominally equitable nature of Soviet socialized medicine, the actual system was highly stratified according to location, with far inferior care and facilities available in rural areas, and especially according to political status. The Ministry of Health maintained a completely separate, vastly superior system of clinics, hospitals, and sanatoriums for top party and government officials and other elite groups such as writers, actors, musicians, and artists.

Medical Innovations in the Soviet Era

Before heart surgery is performed on Russian children at the Institute of Circulation and Pathology in Novosibirsk their heart is stopped by placing their body into a bag of ice-cubs which lowers the body temperature to 72°F. This is done to avoid oxygen dehydration. In the United States children undergoing this kind of surgery are placed on a heart and lung machine.☹

Russians pioneered laser eye surgery. Moscow opthomologist Svyatoslov Fyodorov made a fortune treating near-sightedness with an assembly line operation in which an incision was made in the cornea and a corrective lens was inserted. Eight patients were treated at once on tables arranged like the spokes of wheel. Five surgeons each perform a step of the operation and when they are finished the tables are rotated, advancing the patients onto the next station.

Fyodorov monitors the procedure with closed circuit televisions. He said he invented the turntable approach when Soviet government agreed to pay him on a per-person basis. He claims to have 99 percent success rate in the 1990s when American doctors said they could only help 67 percent of their patients say good-bye to their glasses. [Source: Michael E. Long, National Geographic, November 1992]

Explaining why medical acre was often so poor despite such advancements, one Russian woman told the Atlantic Monthly, "Soviet doctors are some of the best in the world. Really, the problem isn't that they're unskilled; it's that most are paid so little they don’t care if their patients live or die. But of you pay then they care."

Mental Health Care in the Soviet Era

The most outdated and abuse-ridden aspect of Soviet health care was psychiatric treatment. That system never advanced from the methodology of the 1950s, which included Pavlovian conditioned-response treatment, heavy reliance on drug therapy, and little practice of individual or group counseling. Therefore, most citizens preferred to suffer rather than submit themselves to treatment. [Source: Library of Congress *]

In addition, Soviet psychiatry was at the service of the government to declare dissenters "insane," commit them to psychiatric hospital-prisons, and administer powerful psychotropic drugs. In the mid-1980s, estimates of the number of political prisoners in such institutions ranged from 1,000 to several thousand, and in 1983 the Soviet Union withdrew from the World Psychiatric Association to avoid censure for its abuses of the profession. In 1988 the special psychiatric hospitals to which political dissidents had been committed were transferred from the jurisdiction of the Ministry of Internal Affairs to that of the Ministry of Health. *

Alcoholics, mentally retarded people, elderly and political dissidents were often kept together in the same state-run asylums. Patients released from mental hospital hospitals, even perfectly sane political dissidents, were stripped of the right to get married, drive a car, buy a house, or travel abroad because they has been being declared insane by a state psychiatric hospital.

Mental patients who could have been treated in the West were simply sedated in the Eastern bloc. In some mental hospitals, care consisted of requiring patients to have their heads shaved to prevent lice and giving them knock-out sedatives. Financing for these hospitals was drastically reduced after 1989. In some cases, mental health institutions operated as they did in the Soviet era.

Mental Hospitals for Soviet-Era Dissidents

Many dissidents were sent to mental hospitals and institutionalized with the diagnosis “vyalotekushchaya” ("sluggish schizophrenia"), a term used describe the mental disorder of a person that seemed perfectly normal. The "disease" was treated with massive doses of powerful tranquilizers like Thoazine for "prophylactic" purposes.

In the Soviet era, the mental health profession was coopted for political purposes, namely to provide a reason to imprison political prisoners. Mental hospital were a place to incarcerate political prisoners and give them psychotropic drugs. They were given fake diagnoses and interrogated about their sanity with an outcome predetermined by the KGB.

Solzhenitsyn wrote, “The incarceration of free-thinking, healthy people in madhouses is spiritual murder.” Political prisoners, who were diagnosed with “slow-developing schizophrenia,” had symptoms that included “stubbornness and inflexibility of convictions” and “reformist delusions.” Among those sent to mental hospitals were dissidents who protested the Soviet invasion of Czechoslovakia.

Sane dissidents were forced to share quarters with ravaging lunatics. Tortures to get sane inmates to admit they were ill included beatings, humiliations and injections with painful chemical that often caused the inmates to pass out. A favorite tactic was wrapping a patient in a 20 meter roll of wet bandages that cut off a person breathing and circulation as it dried. Documents show that people kept n punitive psychiatry hospitals died from overdoses of a blood-pressure drug.

One Hungarian who spent 55 years in captivity was placed in a gulag at the end of 1944 that was transformed to a mental hospital, where he remained until 2000. Patients released from mental hospital hospitals, even perfectly sane political dissidents in the Soviet era, were stripped of the right to get married, drive a car, buy a house, or travel abroad because they were declared insane by a state psychiatric hospital.

Health Care After the Break Up of Soviet Union

Russia's health care system deteriorated substantially in the 1990s. Equipment and medicines are in increasingly short supply, aging facilities have not been replaced, and existing facilities often are inaccessible. Medical personnel generally are not trained as rigorously as their contemporaries in the West, and chronic failures to pay doctors and nurses have exacerbated shortages in those professions. The 1997 national budget allocated US$1.6 billion for health, an increase of US$158 million over 1996, but most of the new money was targeted for medical centers in large cities. The 1997 figure was 2.6 percent of the gross domestic product (GDP), compared with the World Health Organization's recommended minimum share of 5 percent. [Source: Glenn E. Curtis, Library of Congress, July 1996 *]

Failures in health care are one aspect of an increasingly grave health crisis afflicting the Russian population as a whole in the 1990s. Other elements of the crisis include widespread and acute environmental pollution of various types, which government programs and nongovernmental "green" organizations have not been able to ameliorate; the continued heavy use of tobacco and alcohol and a growing narcotics addiction problem; and poor hygiene and nutrition practices among large portions of the population. *

The outline of the Soviet system did not change appreciably in the first half of the 1990s, but quality declined in nearly every aspect except the facilities designated for the elite. Partly because of low budget allocations for health, in 1997 new reports indicated that Russia's health crisis was worsening. Although the life expectancy for males increased from 57.3 years to 59.6 years between 1994 and 1996, the drinking and smoking habits of Russians, together with continued air pollution in many areas, kept mortality rates from cardiac and circulatory diseases more than twice as high as those in the United States. The incidence of infectious and parasitic diseases continued to increase. Although a major diphtheria vaccination program in 1995-96 radically reduced the incidence of that disease, tuberculosis cases increased sharply, especially in Russia's prisons. In 1997 the minister of health predicted that sexual promiscuity and drug addiction would cause 800,000 new cases of HIV infection by the year 2000. *

Russian Health Care System

Russia has an entrenched, albeit underfunded, system of socialized medicine. Basic medical care is available to most of the population free of cost, but its quality is extremely low by Western standards, and in the mid-1990s the efficiency of the system continued the decline that had begun before the collapse of the Soviet system. In the first four post-Soviet years, that decline was typified by significant increases in infant and maternal mortality and contagious diseases and by decreases in fertility and life expectancy. National distribution of facilities and medical personnel highly skewed in favor of urban areas, especially politically sensitive cities. In the mid 1990s, there was about 131 hospital beds per 10,000 population and one doctor for every 275 citizens. [Source: Library of Congress, July 1996 *]

The Russian health system is incredibly wasteful and inefficient . While many hospitals suffer from shortages of essential supplies, others are overstaffed and short of patients. In Tomsk, for example, a city wit 500,000 people, there 88 hospitals, 12 or which specialize in tuberculosis cases. One 500-bed hospital, with a staff of a 134, had an average only about a dozen patients in the hospitals at one time.

Responding to Russia’s health crisis, in 2005 President Putin included health care in a list of five top national priorities and called for an increase of 85 percent in health-related allocations in the 2006 federal budget and additional increases in future budgets. Most of the 2006 money was to pay for increased wages for health professionals and facilities improvements. **

Under Russian President Boris Yeltsin, Russia's government attempted to equalize the distribution of health care by fragmenting the Soviet-era network of top-level medical facilities for exclusive use of the elite. In 1993, Yeltsin signed a decree entitled On Immediate Measures to Provide Health Care for the People of the Russian Federation. The proclaimed goal, which already had been established in the 1980s, was the creation by 2000 of a "unified system of health care" for the entire population. However, economic constraints stymied the goal. In 1995 less than 1 percent of Russia's budget was earmarked for public health, compared with 6 percent in Britain and more than 12 percent in the United States. *

Poor State of Russian Hospitals

Russian hospitals are in poor condition—many lack running water and sewerage—and waiting lists are long. Distribution of facilities and medical personnel is highly skewed in favor of urban areas, especially politically influential cities. Russia’s high ratio of hospital beds to population—12.1 to 1,000 in 1998—is because outpatient care is not emphasized as much as in the West. [Source: Library of Congress, October 2006 **]

Although Russia pioneered in some specialized fields of medicine such as laser eye surgery and heart surgery, the country's medical establishment is generally deficient in hospital equipment, technology, and pharmaceuticals. For example, preventable infant deaths result from an absence of fetal heart monitors, ultrasound units, and various other equipment for monitoring labor and delivery; needless deaths from heart disease occur because hospitals lack the equipment needed to perform bypass surgery and angioplasty. [Source: Library of Congress, July 1996 *]

Russia's hospitals and polyclinics are generally old (about 15 percent were built before 1940), and they lack basic amenities. Roughly 42 percent of the country's hospitals and 30 percent of its clinics lack hot water, and 12 percent and 7 percent, respectively, have no running water at all. About 18 percent of hospitals and 15 percent of clinics are not connected to a sewerage system, and only 12 percent in both categories have central heating. Even in the best hospitals, medical personnel do not regularly wash their hands, surgical instruments are not always properly sterilized, and rates of infection are abnormally high. *

Many Russian hospitals are run-down, grubby and dreary with unsanitary conditions. There are shortages of medicine and supplies. The waiting lists for ordinary surgical procedures can be weeks or months. Hospitals can't afford to treat their patients are often victims of power outages. Hospital patients are often required to bring their own medicine. Relatives clean the rooms and bring food for family members in the hospital.

There are stories of hospitals reusing needles and gauze and severe shortages of nurses and cribs for children. Children with treatable infection sometimes die because there are no antibiotics. Even the hospital where President Yeltsin had heart surgery had unheated rooms, stray dog wandering in the doors, a waiting room filled cigarette smoke, closed down buildings and flickering florescent lights. Some clinics and hospitals don't have hot water. In some cases there is no water period.

Hospital Treatments in Russia

At many Russian clinics patients are often obliged to undergo testing, which they select themselves, before seeing a doctor. The procedure typically goes like this: 1) register at a desk and choose the test—an EKG, V-rays, VD test, blood test—you want from a menu; 2) then get a number and go and wait outside the room where the test is conducted; 3) undergo the test; 4) then go the registration desk and sign up for a doctor; 5) then wait and see the doctor; 6) go through a similar procedure to get the medicine you need.

A typical city hospital in the 1990s had modern endoscopic equipment but lacked up-to-date ultrasound and echocardiogram machines. Only about 40 percent of the people who needed kidney dialysis received it and heart bypass surgery was rarely performed. Patients are often treated as a group in a large room and told to "strip" by a babushka. Private doctors set ultrasound clinics in Moscow subway stations. Doctors receive about 25 percent of the$16 fee charged.

On getting treatment for cancer, Karoun Demirjian wrote in the Washington Post, ““There’s a huge, huge problem,” said Irina Agayan, a nurse at the First Moscow Hospice, describing a days-long process of securing signatures, waiting in lines and shuttling between clinics to obtain medications. “There are ways to get around it, through paid services, but that’s not the system. Even if you pay, there’s still a problem, because you have to be registered to go through many agencies. And all this time, the person is in pain.” [Source: Karoun Demirjian, Washington Post, July 10, 2015 /~]

Dentistry in Russia is also a poor state. There are stories of people who have lost all their teeth after a visit to the dentist and could not get compensation of any kind. One the her pet projects of President Boris Yeltsin's wife Naina was setting up a dental clinic for children. "Our dental care is a disaster," she said. "There are no proper painkillers, the drills are antiquated."

Shortages and High Costs of Medicines in Russia

The shortage of medicines in Russia is chronic and catastrophic. In the 1990s, Soviet-era supplies of materials and drugs were depleted and not being adequately replenished. Domestic production plummeted because of the obsolescence of pharmaceutical factories and shortages of requisite raw materials and supplies. Many of the items produced were ineffective. Russia relied increasingly on imports from former Soviet-bloc nations in Central Europe, which initially accepted barter transactions and payment in rubles but later demand hard currency, a scarce item in Russia, for their products. The nonconvertibility of the ruble also has hindered Russia's ability to purchase medicines abroad. Even when pharmaceuticals were available in Russia, they often were priced beyond the reach of doctors and patients. [Source: Library of Congress, July 1996 *]

Reporting from Nakhabino, Russia, Karoun Demirjian wrote in the Washington Post, “For the five years that doctors have battled the cancerous tumor pressing on her son’s spine, Elena Knyazeva has faced an ever-harder struggle to help him weather the pain. Diagnosed with virulent neuroblastoma at 4 months, Artyom — now 5 — has had multiple surgeries and rounds of chemotherapy. As a Russian citizen whose family has state-mandated health insurance, he is, in theory, entitled to all the benefits of the Russian public health-care system. [Source: Karoun Demirjian, Washington Post,July 10, 2015 /~]

“But in practice, while doctors treat his cancer, his family carries the burden of treating his pain. And as the Russian economy has faltered, pain management for people with severe illnesses, like Artyom, has become all but unaffordable. The fall of the ruble has driven the price of drugs — many of which are imported — nearly out of reach for many people. That has complicated an already bleak outlook for palliative-care patients in Russia, who are often thwarted in their quest to lessen their pain because of entrenched cultural prejudices and doctors’ legitimate fears of legal repercussions for prescribing controlled narcotics./~\

“When faced with such barriers, desperate patients and families are forced to find a way around the system. “The government helps, but only a very little bit,” said Knyazeva, 38, explaining that her husband’s salary as a military officer didn’t cover skyrocketing medication costs. “We practically have no free medicine or free medical care. You have to pay for everything.” Knyazeva is one of the lucky ones. Two months ago, she contacted the Vera Hospice Charity Fund on the advice of a friend. Artyom made the cut for private aid, keeping Knyazeva from having to choose between going broke and continuing to care for her only child, whom she’d conceived after 12?years of trying. Not that it was ever a choice. /~\

“Others are not so lucky. Private charities such as Vera, which provide comprehensive physical and mental health services to families of children with severe and terminal diseases, are few. Demand is so great that they have to turn away dozens each month, and there is no public option: Russia has no dedicated pediatric hospices. “A palliative-care patient needs medical equipment and drugs. Parents usually pay their own money to get that, and it’s about $1,000 a month,” said Lida Moniava, who runs children’s programming at Vera. That is about 1 1/2 times the salary of the average Russian urbanite. “Nobody helps. Parents try to raise money themselves. They create Web sites for their children. But the drugs are much more expensive. They cost 1 1/2 , twice as much as they did before.” /~\

Doctors in Russia

Doctors generally are poorly trained and inadequately paid. There is a persistent shortage of nurses, specialized personnel, and medical supplies and equipment. In 2004 there were 4.9 doctors per 1,000 inhabitants. Medical personnel generally are not trained as rigorously as their contemporaries in the West, and chronic failures to pay doctors and nurses have exacerbated shortages in those professions. Most of the 2006 money was to pay for increased wages for health professionals and facilities improvements. [Source: Library of Congress, October 2006 **]

In 1986 the Soviet Union had about 1.2 million doctors and about 3.2 million paramedical and nursing personnel. Medical training emphasized practical work over basic research and pure science; only nine medical institutes were attached to universities. In the late 1980s, the average doctor's salary was roughly comparable to that of the average industrial worker. In 1996 the average Moscow specialist made about US$75 per month, and senior doctors made about US$150 per month. Paramedics and nurses needed only two years of training and no scientific background; however, in rural areas, which suffered a shortage of doctors, such individuals often were the only medical personnel available. [Source: Library of Congress, July 1996 *]

Russia has many women doctors. At one time over 80 percent of all doctors were women. Doctors and nurses have a reputation for being incompetent and callous. They often sit around in the lobbies smoking cigarettes. Angered by the high rate of absenteeism, teachers at one medical school starting imposing fines of $4 for very hour of class they missed.

Doctors in Russia in the 1990s

In 1992 Russia had 662,700 doctors, a drop of about 32,000 since 1990, and 131 hospital beds per 10,000 population, a drop of 97,000 beds (about 5 percent) since 1990. Among the doctors, 78,600 were surgeons, 77,600 pediatricians, 39,600 gynecologists, 20,300 psychiatrists, and 18,500 neurologists. [Source: Library of Congress, July 1996 *]

In the early 1990s, the public health delivery system in Russia was in crisis. Although the number of doctors and paramedics has remained sufficiently high to ensure the provision of adequate treatment, most such personnel are poorly trained, lack modern equipment, and are badly paid. In 1995 Russia had one doctor for every 275 citizens (compared with one for every 450 in the United States), but about half of medical school graduates cannot diagnose simple ailments or read an electrocardiogram when they enter practice. In 1993 about forty institutions offered medical training, but the quality of training varied considerably. Many medical schools suffer from shortages of instructors, textbooks, current medical journals, contacts with Western experts, and equipment. *

Low salaries have made corruption common among medical personnel, who often extract bribes for both materials and services. Thus, although health care is free in principle, the chances of receiving adequate treatment may depend on the patient's wealth. The combination of bribes and authorized charges puts many types of medical treatment beyond the reach of all but the wealthy. Elderly people are hit especially hard by this situation. Meanwhile, a sharp decline in state funding has affected all aspects of medical care, from prevention to emergency treatment. Between 1990 and 1994, state funding declined from 3.4 percent of the national budget to 1.8 percent.

Low Doctor Salaries and Corruption in Russia

In 1992, doctors earned $7 a month, less than bus drivers. In 1995, they made about $100 a month, less than the national average. Often they didn't get paid at all. After the ruble collapsed in 1998 they earned $75 a month. In 2001, Russian President Vladimir Putin promised to raise salaries for doctors 60 percent. By 2004, doctors in state hospitals in Moscow and St. Petersburg were officially earning about $200 a month. Many Russian doctors can't even imagine American doctors making $20,000 a month.

Many doctors contemplate quitting medicine altogether and taking up another profession to earn money to take care of their families. To make ends meet doctors sell medicine on the side and sometimes demand kickbacks from patients for operations and other services. If you end up in a Russian emergency clinic you are advised to pay a cash gratuity up front if you want the best care.

The payments are often carefully calibrated to correspond with the seriousness of the treatment performed. Parents routinely give obstetricians $300 to make sure the mother and baby receives the best possible medical care. For the doctor this amount is often equivalent to several months salary.

One professor told the Los Angeles Times he needed immediate kidney surgery. To get his operation scheduled he gave a hospital officials an expensive bottle of cognac. The doctor who performed the operation was given $200, an expensive bottle of cognac and a car stereo. During his two week recovery he paid $80 a day for medicine that was supposed to be free.

People who have been in Russia for a while say that when you visit a hospital they best time to offer a bribe is when they ask for you insurance certificate (which are difficult for Russians to obtain and not everyone has one). It is generally sufficient to fork over around $100. “You’ll see right away the reaction. If they say, “We don’t known what we can do,’ the they are looking for more money.”

Health Customs in Russia

The impersonality and inaccessibility of national health system facilities, with patients often standing in line at clinics for an entire day before receiving brief diagnoses and prescriptions for drugs they cannot afford, has encouraged many Russians to turn to unorthodox alternatives such as faith healing, herbal medicine, and mysticism. By the mid-1990s, private medical clinics were serving a growing number of Russians unable to afford their care.

Many Russians don’t go to the hospital because they can’t afford it. Some prefer folk medicines to prescription drugs and have more faith in village folk cures than modern medicine and machines. Kidneys and other organs were are sold fairly openly in the early 2000s.

In the Soviet era, the state discouraged alternative medicine by arresting practitioners. By 1995, however, the number of such individuals was estimated at 300,000, and as many as 80 percent of Russians needing medical assistance have turned to them, according to a Yeltsin adviser on social policy. [Source: Library of Congress, July 1996 *]

Ideas about pain are different in Russia than they are in the U.S. “There is an attitude that if you’re in pain, you’ve got to be in pain,” Russian health care worker Lida Moniava told the Washington Post. Moniava said. “Even dentists don’t always give anesthesia.” Women have traditionally been encouraged not to take painkillers during childbirth so the child would not be harmed. In some cases, especially in Russia’s regions, aversion to palliative treatment is so strong that many doctors still advise parents to abandon their children at the first sign of serious trouble. [Source: Karoun Demirjian, Washington Post, July 10, 2015 /~]

Folk Medicines in Russia

Traditional folk healers constitute the largest group of nontraditional practitioners. They offer personalized attention and affordable cures such as birch bark and cranberries to cure a variety of complaints. Russians with access to a plot of land often grow their own herbs, and books describing home cures have become popular. Long-practiced cures such as wrapping oneself in a vinegar-soaked blanket and drinking one's own urine have become more widespread in the 1990s. [Source: Library of Congress, July 1996 *]

Russians sometimes treat a bloody nose by shoving beeswax up the affected nostril. Coal tablets are a common remedy for diarrhea. In Kamchatka tree fungus tea is said to be good for the kidneys. A typical treatment for a stomach problems might include blood pressure medicine, powdered birch buds, injections of boiled dog roses and polpola grass, and heaping potions of figs, pomegranates, dried apricots, plums and ruds, and a herbal tranquilizer. The idea is to both flush out and strengthen the body. [Source: Jeffrey Taylor, Atlantic Monthly]

Gennadi Nikonov, a Russian in the town of Rodniki, opened the International Center for Medicinal Leeches, a farm that produces medicinal leeches at a cost about 30 cents a piece. The leeches are fed cow's blood and sold to doctors in the United States for between $6 and $9 and to Chinese restaurants as a menu item. Nikonov recommended the leeches for relief from migraines and phlebitis. He has sold leeches to companies in France and the Ukraine, which made face creams from leeches. His own company is using leeches to make toothpastes and encourages buyers to dangle them from their ear to relive hypertension.

Kefir, a yoghurt-like drink that originated in the Caucasus mountains, is made from cow, goat or sheep milk fermented with whitish or yellowish Kefir grains, which when left in the milk overnight turns it into a fizzing, frothing beer-like brew. Kefir is sometimes prescribed by doctors as a treatment for tuberculosis and other diseases. Koumiss, fermented mare's milk, is also sometimes used as a treatment for tuberculosis and other diseases.

Proposed Health Care Reforms Under Putin

Brittany Holom wrote in the Washington Post: “Since the dissolution of the Soviet Union, analysts have argued that the Russian health-care system is in dire straits. It has struggled against a long history tied with alcoholism and issues of underfunding and structural imbalances linked with the legacies of the Soviet Semashko system. Nevertheless, although the goal of improvement has been constant across time and regimes in post-Soviet Russia, there has been little clear, strong direction for achieving this. [Source: Brittany Holom, Washington Post, January 1, 2015 ==]

“Then, in his 2012 “May Decrees” pledges, Putin promised a full restructuring of the system to meet updated health goals. The government immediately began planning for a shift of health-care financing to “single-channel” funding, which will begin in 2015. In April 2014, deputies approved an update of the state program “The Development of Healthcare,” which laid out strategies for advancing the Russian health care system. These strategies largely followed the recommendations and goals set out by the World Health Organization (WHO). ==

“Despite the reports on the struggles of the Russian health-care system, research has shown that health care – and the welfare state in general – is one area on which post-communist populations have maintained an unwavering and strong consensus since the fall of the Soviet Union. The belief in the government’s responsibility for providing quality health care continues to dominate expectations. ==

Protests Against Health Care Reform in Moscow

Brittany Holom wrote in the Washington Post: On November 20, 2014, “medical personnel, activist groups, and political parties gathered in Moscow, the noise slowly growing louder as group after group joined the marching line, using loudspeakers to project their chants into the biting winter air. The demonstrators’ signs called for a moratorium on proposed reforms to the city’s health-care system, with some demanding to know why there was money for war, but not for medicine.

“News agencies estimated that 5,000-6,000 people braved the day’s freezing temperatures to demand accessible, affordable medicine (dostupnaya meditsina). These protests against planned health-care reforms in Moscow marked the second event of its kind within the month; the first “doctors’ meeting” had taken place on Nov. 2. Another took place on Dec. 14, in combination with groups against education reforms. [Source: Brittany Holom, Washington Post, January 1, 2015; Holom is a Ph.D. candidate in the Department of Politics at Princeton University ==]

“The recent protests are rooted in Moscow health reform plans that first emerged in mid-October, when Russian Medical Server, an online medical news site, leaked the details of the intended changes to the city’s health care. To optimize the system’s structure, it was reported, the government planned to close 28 hospitals and clinics in the city and lay off thousands of medical personnel. According to the groups of doctors and nurses gathered at the rallies, the planning process took place behind closed doors for months, with little to no consultation with those working day-to-day in the city’s health-care system. Moscow officials later reported that the government’s Research Institute of the Organization of Healthcare and Medical Management had authored the reforms.” ==

Russians Turn to Illegal Drugs and Suicide for Pain Relief

Reporting from Nakhabino, Russia,Karoun Demirjian wrote in the Washington Post, “According to Russian reports, less than 1 percent of illegally trafficked drugs are peddled through prescriptions, yet more than half of drug-trafficking cases are brought against health-care workers. This spring, lawmakers pushed for rules prohibiting promotion of narcotics as “propaganda,” further spooking doctors who might otherwise help palliative-care patients. “The sphere of painkilling is very much regulated by the Federal Drug Control Service. They have a lot of money and so-called quotas of how many people they have to imprison in a year,” said Nyuta Federmesser, who founded Vera. “It is much easier to find the guilty among nurses and doctors and patients rather than be somewhere out in Tajikistan or Afghanistan looking for people who bring illegal drugs into the country.”[Source: Karoun Demirjian, Washington Post, July 10, 2015 /~]

“What results is problems that are avoidable. Renata Valeyeva, 8, had a brain tumor. Doctors found it when she was 5, drained it and left in a stent. But when she began complaining of headaches again in January, nobody wanted to treat her. For two days straight her family called for an ambulance, Renata’s great-aunt and chief caretaker, Natalia Sultanova, said, showing the medical workers who responded health forms documenting her condition. But they refused to take her to the hospital, offering only a light analgesic. On the third day, Renata fell into a coma. Now, she struggles to hold her head up, has difficulty eating and drinking, and cannot speak. “Can you imagine? Two days in a row we called the ambulance, and they just did not want to take a child with such symptoms,” Sultanova said./~\

“Because of Renata’s condition, her family receives about $250 a month from the government, which Sultanova said barely covers two weeks’ worth of Renata’s canned nutritional supplements, much less the cost of medications, equipment and incidentals. There are some signs that things may improve. As of July 1, a new law allows Russians to fill prescriptions for 15 days instead of five and eases certain other bureaucratic restrictions on medications. But a wide gap remains.

“Russia ranks 38th out of 42 European countries in the consumption of internationally regulated medical narcotics, according to a 2010 study by the International Narcotics Control Board. Russian use of such drugs amounts to just a fraction of a percentage point of consumption in the United States, even when adjusted for the two countries’ different population sizes. /~\

“While public hospices for adult cancer patients exist, there are not nearly enough, forcing many families into financial straits when they find they can’t rely on increasingly complex routes to public aid. As a result, a number of adults with life-threatening conditions are reportedly choosing a more drastic way out: suicide. Following a high-profile case last year in which a naval officer took his life because of lack of access to pain medications and, in his note, blamed the government, officials punished his doctors and doubled down on enforcing a law against reporting the causes of suicides.” /~\

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Text Sources: New York Times, Washington Post, Los Angeles Times, Times of London, Lonely Planet Guides, Library of Congress, U.S. government, Compton’s Encyclopedia, The Guardian, National Geographic, Smithsonian magazine, The New Yorker, Time, Newsweek, Reuters, AP, AFP, Wall Street Journal, The Atlantic Monthly, The Economist, Foreign Policy, Wikipedia, BBC, CNN, and various books, websites and other publications.

Last updated May 2016