Friday, March 9, 2018

Under Putin, the Russian Village isn’t Just Dying; It’s Being Systematically Killed Off

Paul Goble

            Staunton, March 9 – Vladimir Putin’s destruction of the health care system in rural Russia, his failure to invest in roads outside the largest cities, and the elimination of bus routes that carried those without cars to medical treatment is leading to the disappearance of over 1,000 cities a year.

            But this is not some natural death of rural Russia; it is the direct result of Putin’s optimization program and represents what can only be called the murder of Russian villages and thus of an entire way of life and national culture, moves that Soviet intellectuals protested against 50 years ago but are largely silent about now.

            According to Rosstat, the number of hospitals in Russia fell from 10,700 in 2000 when Putin came to power to 5400 in 2015; and if the current rate continues, with a loss of 353 mostly rural hospitals a year, in three to four years, Russia will have the same number of hospitals the Russian Empire had in 1913, according to the Center for Economic and Political Reforms.

            Its 26-page report on the way in which Putin’s “optimization” of health care is working to drive some Russians from the villages and to drive others to an early grave is devastating (ЗдравоЗахоронение.-Оптимизация-российской-системы-здравоохранения-в-действии.pdf).

            Putin in his message to the Federal Assembly promised to throw money at the problem sometime in the future; but he has made similar promises in the past without changing the destructive vectors of his own policies – and so there is no reason to believe he will change course and begin to save the Russian village.

            But the combination of the Kremlin leader’s promises however empty they most certainly are and the tendency of people to fail to link even the most dire statistics with very real human costs probably will be enough to keep this issue from attracting the attention it should to the fate of millions of Russians still living in the villages.

            That makes a new report by Radio Liberty’s Russian Service so valuable.  It describes the pre-1991 rise of medical care in a single district in Kirov Oblast and the post-2000 collapse of that care through the eyes of  Sergey Vetoshkin, a Moscow doctor who was born and grew up in that district (

                In tsarist times, he says, the number of hospital beds rose gradually to 50 by 1910, before declining to 30 in the wake of the Bolshevik revolution.  Then it recovered, and by 1956, there were 250 hospital beds in the central district hospital, 90 more in three branch hospitals and 36 medical points. The district had 38 doctors and 252 other medical personnel.

            While conditions in these hospitals were not always the best, they were better than residents had known before or know now.  In 1991, the doctor says, the regional hospital opened a new three-story wing with 70 beds.  But with this, Vetoshkin says, “one can stop talking about the development of the regional health care system.”

            There were problems in the 1990s and the early 2000s, but the situation became desire beginning in 2009 when Putin announced his optimization program, a euphemism for closure. Between 2009 and 2011, 47 medical facilities with approximately 7500 beds were shut down.  Some 125 secondary medical facilities in the villages were then shut down.

            As a result, the doctor continues, “residents from distant settlements where the nearest hospital was now dozens of kilometers away were deprived of accessible medical service.”  Only 45 percent of the roads in the district are paved and most are impassible part of the year; and more than 70 percent of the people are now forced to rely on nurses in rural medical points.

            Adding to the disaster, Vetoshkin says, Moscow closed the district medical training college which over the 70 years of its existence had prepared some 7500 specialists. All branch hospitals were closed, and “practically all feldsher-midwife points were liquidated.”  And the central regional hospital lost most of its departments, with those remaining suffering serious reductions.

            The number of hospital beds fell from 340 to 30, and outpatient services were severely curtailed.  Patients of all kinds from the most infectious to newborns were thrown into the same wards because the doctors had no other choice.  And doctors have been forced to limit hospital stays to “no more than 10 days” regardless of prognosis.

            Emblematic of how Putin’s reforms are working is the fact that the regional hospital had to close its own kitchen and purchase food from the neighboring district one 60 kilometers away. Those suffering strokes or heart attacks can count on only severely limited ambulance services to take them to that alternative district hospital. Few of these people survive the trip.

            Specialists are no longer available either locally or in neighboring areas which means that those who can’t travel long distances simply aren’t treated.  And most people can’t go: they don’t own cars, there aren’t any buses anymore, and a taxi ride costs 400 to 500 rubles (7 to 8 US dollars) each way, an enormous burden for the many unemployed. 

            Medical care in the district, Vetoshkin says, has been thrown back to what it was a century ago by Putin’s optimization program. And he thus fully agrees with the conclusion of the Center for Economic and Political Reforms that “the state has intentionally carried out a policy of depopulating rural areas by taking away from the villages their ‘last hope for the future.’”

            Under Putin’s rule, the population of rural Russia has fallen consistently, with many people fleeing and others dying prematurely, both of which are not some natural and inevitable force but rather of Kremlin policies that even Putin is now being forced to at least say are indefensible.

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