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. Last Updated: 07/27/2016

Post-Soviet Health Care System a Shambles




TSKHINVALI, Georgia -- Most of the patients have been sent home because the vast medical complex has no heat. The nurses are huddled around a burning log in a makeshift fireplace. But up on the fourth floor of Republican Hospital, remarkably, medicine is still being practiced. Two surgeons are performing a hernia operation with uncommon skill -- and uncommon speed.


As a doctor anesthetizes the patient with an ether-soaked handkerchief and a nurse keeps him breathing with a hand-operated ventilator, the scrub nurse scoops up a pile of bloodied surgical instruments and carries them to a basin of pink water that has been standing uncovered for hours.


Working barehanded, she dunks the instruments in the water, swishes them about and returns them to the operating table with no further effort at sterilization. A moment later, one of those instruments is inside the patient.


The operation is finished in less than 10 minutes. When the surgeons are complimented on their speed, one replies: "It's not a matter of choice. We must go fast. The generator only supplies 15 minutes of electricity for the lights."


This provincial hospital is far removed from Russia's great cities, and Georgia has fared far worse than most former Soviet republics since the union split apart in 1991. But while the problems here may be especially acute, they are by not atypical. Throughout this vast ex-superpower, the health care system once touted by the Soviet leadership as an exemplar of "the human, caring face of socialism" is a shambles.


Life expectancy rates have plunged precipitously, driven downward by a deadly combination of spreading disease, alcohol and drug abuse, poor nutrition, chronic underfunding of medical facilities and isolation from Western scientific advances.


In 1993 alone, the life expectancy at birth for Russian males dropped from 61 to 58, according to the World Health Organization. Russia's death rate in 1995 was 1.6 times greater than its birth rate, triggering a decline in its population unprecedented in postwar times.


"We broke old mechanisms which managed society and health care, and we didn't create new ones; we didn't know how to," Dr. Lev Mogilevsky, co-director of an infectious disease treatment facility in the Ukrainian city of Odessa, said. "Now health care is on the brink of complete ruin."


The impact of this crisis is also falling heavily on those most vulnerable: the region's children. They suffer from high rates of birth defects, disease and mortality, bear the brunt of their parents' drug and alcohol abuse and are often denied medicines because of a belief that they are "weakened" and cannot handle certain antibiotics or vaccines.


As a consequence, they are far less likely to reach adulthood than their Western European counterparts, according to UNICEF.


Children in Russia, the largest of the former Soviet republics, are 2 1/2 times more likely to die before age 5 than U.S. children, global health experts say.


Some doctors find this unbearable. At the Leningrad Republican Infectious Disease Hospital, for instance, Dr. Paul Sergeyev tenderly strokes the blond head of 9-month-old Natalia, who was abandoned by her HIV-positive, opium-addicted mother.


"We can't know for sure whether a child is infected [with HIV] until 3 years old," he says with a frustrated shake of his head as he gently places Natalia back in her crib. "We have no money for [genetic] testing. We have no money for anything."


An eight-month examination by Newsday that ranged over 20 cities in five formerly communist countries, has found that this once-proud health care system has become a casualty of transition. It's not clear how quickly this occurred, because past health care claims by the Communist government were unreliable at best, fabricated at worst.


Here's what the examination found:


...Infectious diseases long thought to be under control or largely eradicated in the developed world have swept through former Soviet republics in a series of epidemics. These diseases -- which include tuberculosis, hepatitis, cholera, typhoid and influenza -- have been spread by chronically poor medical hygiene and sanitation, as well as the misuse of antibiotics. The tuberculosis rate, for instance, is 10 times the rate in the United States, and growing.


...The former health care delivery system -- inefficient, expensive and authoritarian, but widely accessible -- has all but collapsed in the wake of a massive funding crisis, and little has been done to replace it. The Russian government, for example, currently earmarks less than 2 percent of its annual budget for health services, compared with nearly 20 percent in the United States, resulting in chronic shortages of supplies, deteriorating facilities and late payment of wages to personnel.


...Long-term environmental problems are taking a growing toll on the public's health. In St. Petersburg, for instance, officials acknowledge they can no longer supply safe water to the city, a problem that resulted this summer in more than 500 cases of dysentery.


The Environment Ministry has concluded that at least half the nation's drinking water supply is unsafe.


...Hundreds of thousands of new patients are now entering the health system due to an unprecedented surge in drug abuse, which has fueled an explosion of HIV and hepatitis and compromised part of the region's blood supplies. There are few public education programs on the dangers of sharing needles, for instance, within a huge region in which two-thirds of AIDS patients are drug users.