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. Last Updated: 07/27/2016

No Quick Help From City Ambulances

It is 6 A.M. in downtown Moscow. Alexei, an ambulance paramedic, lights a cigarette, jokes with his friends, plays with a stray dog in the yard and walks to the ambulance to deal with the first emergency of the day.


The call came 45 minutes ago from a weeping mother who said her 25-year-old schizophrenic son was in a coma after taking an overdose of tablets.


Alexei is nonchalant. "The boy took the tablets yesterday. It makes no difference if we're half an hour late."


It is nearly 7 A.M. by the time Alexei boards the rickety Latvian-made ambulance, ironically known in Russian as skoraya pomoshch, or "quick help."


The smell of morning vodka is fresh on the driver's breath. The siren is not working and the driver is in no hurry. Within minutes, the ambulance is stuck in rush-hour traffic.


Russian government officials may be congratulating themselves on better economic indicators and a relaxation of political tension, but health care is getting worse.


For decades, cradle-to-grave care was the right of every Soviet citizen. There is still no shortage of qualified doctors. But keeping up standards is getting difficult as state subsidies dry up and costs soar.


The homeless who die on the streets -- bomzhi -- sometimes lie for hours before being picked up by paramedics.


One day, a dead woman lay unattended for a day in central Moscow a few hundred meters from the government headquarters.


A police officer answering an emergency call said: "Call the ambulance. There's not much we can do if she's dead."


Ambulances were on strike that day and the body lay until late afternoon, with passers-by taking little notice.


"Frankly, the dead are not our priority any more," says Alexei. "We don't have enough doctors, we don't have enough ambulances. Those we have are Soviet-made mini-vans converted into ambulances. They're not equipped properly."


The schizophrenic is Alexei's second client of the day. The previous one was a middle-aged woman who fell from a fourth-floor balcony.


Alexei's crew took the woman to the hospital. They then rolled up the blood-covered plastic sheet she was wrapped in and threw it to the back of the ambulance, possibly for further use.


The ambulance has the sickly smell of death. Blood is drying on the floor. "We've carried four dead in the past four hours," Alexei says, adding that they have no time to disinfect the vehicles.


The young schizophrenic lies twitching on the floor of a tiny flat. Alexei produces a syringe with an apparently unsterilized needle and injects the boy with morphine.


"He will survive," Alexei tells the distressed mother. He and the driver wrap up the skinny youth and take him away. No one tells the mother where her son is being taken.


The dead are the biggest problem, however. Doctors of the French medical charity Medecins Sans Frontieres say they occasionally find bodies of homeless people dumped outside their Moscow offices.


Vadim says ambulance crews deposit the bodies of homeless people at Moscow's morgues.


A senior doctor said one morgue in central Moscow takes in an average of 10 to 15 homeless people a week who have died on the streets.


At the morgue, several bodies were left on the floor and a terrible stench rose from others strewn along corridors.