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Mainstream, VOL LVIII No 31, New Delhi, July 18, 2020

Russia’s health system is dying on its feet | Marc Bennetts

Friday 17 July 2020

by Marc Bennetts, Bogdanovich

An ominous mould crept along the crumbling walls. Water dripped from the ceiling into plastic buckets that provided a rare splash of colour amid the gloom. Blood and urine-stained pillows lay in an untidy pile.

It could have been the setting for a post-apocalyptic film. Yet this dilapidated building in Bogdanovich, a small town in Russia’s Ural region, is a state hospital laundry facility.

"Once, there was no hot water here for an entire year," said Nadezhda Shchipaeva, 49, who has worked at the laundry since 2001. She said that frequent problems with antiquated washing machines mean staff often have to scrub sheets by hand. Sometimes, there is no washing powder.

The hospital laundry workers of Bogdanovich complain of having no hot water for a year. One, Nadezhda Shchipaeva, 49, said the work had ruined her health
Workers also revealed that they are under orders to clean the disposable sheets that patients die on. The sheets are then returned to the wards. The policy is enforced, they said, even if the patients died of tuberculosis or other infectious diseases.

A grime-caked sink, the only one in the building, is used for washing dirty sheets and pillows, as well as the staff’s cutlery and dishes. In winter, temperatures in the building can fall to as low as 9C. Staff are paid a monthly salary of just 11,000 roubles (£135).

"I’ve ruined my health by working in this place," said Ms Shchipaeva, who suffers from arthritis and osteoporosis, as well as breathing problems. Hospital officials, she said, treat her and her colleagues "like trash." She broke down in tears.

I was invited to Bogdanovich, which is home to 29,000 people, by Anastasia Vasilyeva, the leader of the Alliance of Doctors, an independent trade union, to witness the grim reality of Russian provincial healthcare. The union, founded in 2018, is supported by Alexei Navalny, Russia’s best-known opposition figure. It has branches in 31 towns and cities and around 1,000 members.

Dr Vasilyeva, an ophthalmologist aged 35, was visibly shaken. "What kind of country reuses the hospital sheets that people die on? This is a national disgrace," she said. She was not allowed to inspect wards or other hospital facilities.

Poverty and crippling workloads are a fact of life for state medical workers. Average monthly salaries for Russian doctors in the provinces, excluding remote regions in the far north, where wages are higher, are around 55,000 roubles (£652). However, this includes overtime. Ms Vasilyeva said her research indicated that doctors in the poorest regions receive around 25,000 roubles (£301) a month for a 40-hour week. In December, a 28-year old doctor died of heart failure in southern Siberia’s Altai region after working 48 hour shifts, with just 24 hours to recover in between.

According to a 2017 study, doctors earn a lower hourly wage than supervisors at McDonald’s. Nurses are paid even less. Anastasia Shkinder, a nurse at Bogdanovich’s central hospital, gets 14,000 roubles (£168) a month. "I’m barely surviving," said the 35-year old single mother of two. "Life is so very hard."

Such dire conditions have triggered growing discontent. There were around two dozen cases of industrial action by medical workers last year across Russia. On January 27, Ms Shchipaeva and 14 other hospital workers in Bogdanovich also went on strike for better conditions and increased pay.

Most trade unions are controlled indirectly by the Kremlin, however, and most of Russia’s medical staff are wary about speaking out. "People are afraid," Ms Shkinder said.

Perhaps it is with good reason. Vladimir Govrilov, a 58-year-old workman at the state hospital in Bogdanovich, alleged last year that Yelena Vdovina, the city’s chief doctor, and a member of her staff attacked him when he complained about working conditions.

Ms Vdovina, who has two portraits of President Putin in her airy office, denied the charges. She refused to comment when The Times asked her if she was ashamed of the hellish conditions in the hospital’s launderette. Pavel Martyanov, the head of the city’s administration, reluctantly accepted that there were "problems."

Wages for medical staff may be low, but the number of hospitals in Russia has halved since Mr Putin, 67, came to power in 2000, falling from 10,700 to just 5,300 today. Millions of people in rural areas, where roads are notoriously bad, have no access to urgent medical care. "We’ve heard stories of ambulances being dragged along by tractors," Ms Vasilyeva said.

Veronika Skvortsova, the health minister until this month, said in December that Russia’s healthcare system had set a global "benchmark" for excellence. The comment was mocked by critics who cited the Kremlin’s failure to tackle rocketing HIV infection rates and widespread failures in cancer screening and early prevention.

Annual mortality rates in Russia, at 13 deaths per 1,000 people, are on a par with those in the Central African Republic. Project, an investigative website, said recently that patients with serious illnesses were twice as likely to survive in Moscow than in the country’s poorer regions.

Russia spends $524 per head of population or 5.3 per cent of its GDP on healthcare, according to the World Bank. The country’s own Audit Chamber, however, puts the figure at just under 3 per cent. Britain’s spending on healthcare, in comparison, is at least eight times higher per head of population, at $4,356 (£3,327), or 9.8 per cent of GDP. Opposition figures allege that much of the money that Russia allocates to its national health service is siphoned off by corrupt officials.

The chronic lack of funding for Russia’s healthcare system - which is so keenly felt in rural areas - is not just a problem for patients and the medical staff who treat them. It is increasingly growing into a problem for President Putin. During his annual phone in last year, a number of Russians called to complain about the healthcare system and Mr Putin is struggling to boost his popularity at home.

The state hospital in Bogdanovich has received 150 million roubles (£1.8 million) from the regional budget, but it is unclear exactly how the money was spent. On Tuesday, the day after Ms Shchipaeva and her colleagues went on strike, prosecutors said that Ms Vdovina, the chief doctor, was guilty of financial irregularities. She faces a fine of around 20,000 roubles (£236).

It was a small, yet symbolic victory for the Alliance of Doctors. "We can change the country, if we all stand together," Ms Vasilyeva said. "It’s not going to happen today or tomorrow. But change will come, eventually. It has to."

Courtesy: The Times (UK), February 6, 2020 | URL:

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