Tomsk Basks in Health Care Revival

ReutersTuberculosis doctor Sergei Ilin visiting patient Lyubov Potaskayeva in her apartment in Agrogorodok last month.
MELNIKOVO, Tomsk Region Yevgeny Kalashnikov's hulking frame dominated the director's office on the second floor of a hospital in the Tomsk region.

Looking up from his desk littered with papers, he said, "Things have got so much better."

It felt as if the only thing to change in Kalashnikov's office over the last few years was the flip-top calendar.

A grubby window gave the room a view over water pipes running across scrubland. Potted plants lined the windowsill. There was no computer.

But the 104-bed Hospital No. 1 in Melnikovo a farming town of 20,000 lying on the edge of one of the world's biggest swamps an hour's drive from the capital of the Tomsk region is part of a health care revolution sweeping the country.

"The attitude of the state has changed, and the future looks good," Kalashnikov said.

Both the federal and regional governments enriched by energy and commodity exports over the last decade have poured money into the country's Communist-era health care system, which crumbled after the 1991 collapse of the Soviet Union.

President Dmitry Medvedev and Prime Minister Vladimir Putin have made improving the health of Russians central to their policies and pledged billions of dollars to boost health care.

Advertisements line the streets promoting family values and healthy living, and the state gives cash benefits to mothers.

Russia is fighting to stem a declining population a UN report said it could fall to 100 million from 142 million within 40 to 50 years partly because an expanding economy needs a healthy workforce in areas such as Siberia and the Far East.

From 1992 to 2006, Russia lost 400,000 to 650,000 people per year because of emigration, declining life expectancy and growing infant mortality. In the 1990s, life expectancy for men dropped to 55 years 20 years below Western Europe.

Last year, though, infant mortality fell and life expectancy rose.

Now a survey by independent pollster Levada Center shows Russians becoming more upbeat about the state of public health care since 2000, although starting from a low base.

"There has been a definite trend of people saying things have improved since 2000," said Natalya Bondarenko, an analyst at Levada Center. "Most people also said that Putin had improved things."

The Ob River flows over 3,500 kilometers into the Arctic Ocean from Russia's southern border, through some of Siberia's biggest cities and past some of its smallest villages.

It is about 500 meters wide where it passes the village of Pobeda in Tomsk, a ramshackle village of tumbling wooden houses where about 2,300 people live.

But Pobeda has its own clinic, a two-story building staffed by a doctor and two nurses who hand out basic medical care.

"We need to help, it's important," Gennady Murzin, the 54-year-old doctor, said with a grin.

The clinic has been open for about 18 months, he said, and cost 2.5 million rubles (about $107,000) to set up. Most of the patients need basic help and medicine to treat illnesses linked to poverty and alcoholism.

For Albert Adamyan, the Tomsk region's health chief, the clinic in Pobeda is typical of the health service reorganization he wants to see.

In 2004, there were six local clinics. Now, there are 50 scattered around the region, roughly the size of Poland with a population of 1 million, where mosquitoes the size of a thumbnail swarm in summer and snow coats the ground in winter.

"Our focus is on local clinics," he said in his office overlooking Tomsk city's main square. "It's a general trend across Russia to focus on primary health care."

He said there had been a 14 percent increase in Tomsk's health care budget every year for the past few years to about 7 billion rubles last year.

Like the rest of rural Russia, poverty, alcoholism and the legacy of Communist planning are the main threats to health.

A clump of seven prefabricated concrete buildings housing about 200 people stood gray against a dark sky near Melnikovo. Rain had scattered a group of ragged children playing with a ball and turned the tracks to mud.

A stench of urine lingered in the stairwell of the first apartment block in this isolated, half-constructed Soviet agriculture complex called Agrogorodok.

In the top floor apartment lives Lyubov Potaskayeva, 85. She is being treated for tuberculosis, a diagnosis likely to have been missed a few years ago without the improved level of health care.

"I'm a Soviet woman. My father fought in the Great War, and I gave blood!" she screeched in frustration at her surroundings. Then, more calmly, she said: "I was treated in hospital for four months and in good conditions. I now take seven pills a day."

Outside a crowd gathered. Visitors to Agrogorodok are rare.